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Pathology Flashcards

1
Q

Fibroadenoma

A

Common in young women <30
“breast mice” - discrete, non-tender, firm lumps
Benign

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2
Q

Abscess

A

Common in lactating women.
Red, hot, tender swelling
More common in smokers

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3
Q

Pagets disease of the breast

A

Ca of the nipple-areolar complex presenting as an eczematous lesion of the nipple
Most associated with invasive BC
Usually unilateral

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4
Q

Fat necrosis

A

Obese W with large breasts
May follow trauma
Firm and round but may become irregular/hard

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5
Q

Fibrocystic breast

A

Breast pain - sx may fluctuate with menstrual cycles
Middle aged
Rubbery, well circumscribed, mobile mass

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6
Q

Intraductal papilloma

A

Bloody nipple discharge

Younger

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7
Q

Mammary duct ectasia

A

Dilatation of breast ducts
Common in meno W
Smokers
Thick + green discharge

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8
Q

Consequences of acute inflammation

A

Resolution
Scarring/fibrosis
Progression to chronic

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9
Q

Vascular changes in acute inflammation

A

Vasodilation (arterioles)

Increased permeability (capillary bed/venules)

Leukocyte margination

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10
Q

Leukocyte emigration

A

Margination - (stasis) movement to the periphery of the BV

Rolling - weak binding to endo by selectins

Adhesion - firm adhesion to endo by integrins

Transmigration

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11
Q

Clinical aspects of acute inflammation

A

Calor Rubor Tumour Dolor

Heat, redness, swelling, pain

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12
Q

Anti-inflammatory therapy

A

Broad spectrum e.g. NSAIDs - inhibit COX1/2 involved with arachidonic acid metabolism

Targeted treatments e.g. Anti-TNF antibodies, Anti-ICAM1

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13
Q

Stages of phagocytosis

A

Recognition + attachment of particle to leukocyte

Engulfment

Killing + degradation

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14
Q

Causes of chronic inflammation

A

Progression from acute e.g. repeated episodes of cholecystitis

Primary chronic e.g.micro-organisms associated with intracellular infections ( hep C, TB) or foreign body reactions (silica, atherosclerosis), or autoimmune diseases or unknown aetiology e.g. chronic IBD, sarcoidosis

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15
Q

Ratio of fat to haemopoietic cells in the BM?

A

30:70

Fat tissue is an important diagnostic criterion as it is increased in marrow aplastic states + decreased in myeloproliferative disorders

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16
Q

Erythrocyte in a BM sample

A

Looks purple + round

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17
Q

Granulocyte in BM sample

A

Looks pink with purple shaped thing inside

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18
Q

What does a megakaryocyte become?

A

A platelet

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19
Q

Megakaryocyte on a BM sample

A

Quite large - pink with purple in the middle (like granulocyte but a lot bigger)

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20
Q

Diagnosis of CLL on a BM film

A

Tumour cells express CD20 and CD23

Marrow shows nodular + diffuse infiltration by small lymphocytes with scanty cytoplasm, clumped chromatin and low mitotic activity

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21
Q

Diagnosis of CML on a BM film

A

BM is hyper cellular as attested by decrease in fat cells

and shows majority of mature (hyper segmented) neutrophil granulocytes

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22
Q

Diagnosis of AML on BM film

A

Hyper cellular marrow with monotonous proliferation of undifferentiated cells

High rate of proliferation as attested by expression of Ki67 molecule within nuclei of tumour cells

Proliferating blasts express CD34

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23
Q

More than 90% of causes of transmural MI are due to..

A

Acute thrombosis of a ruptured atherosclerotic plaque

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24
Q

What precipitates angina in patients with underlying coronary artery atherosclerosis

A

An increase in HR - increases demand for energy + decreases duration of diastole relative to systole therefore decreases time of myocardial perfusion

Reduced BP - less pressure to overcome resistance of stenotic arteries + there is associated increased in HR which increases the myocardial energy requirements and decrease time for perfusion of heart

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25
What does the RCA supply?
RV free wall, posterobasal wall of LV and posterior third of ventricular septum
26
What does the L circumflex supply?
Lateral wall of L ventricle
27
What does the LAD supply?
Anterior wall of LV, apex of heart + anterior 2/3 of interventricular septum
28
Occlusion of the LAD artery produces a .... infarct
Anterior
29
Occlusion of the L CFX artery produces a .... infarct
Lateral
30
Occlusion of the RCA produces a .... infarct
Posterior
31
Pulmonary HTN results in which sided HF?
Right
32
Which type of HF causes congestion of the liver with a nutmeg liver
Right
33
Which type of HF causes impairment of renal function due to hypoperfusion of the kidneys?
Left
34
Which type of HF causes impairment of renal function due to congestion of the kidneys?
Right
35
Is rheumatic heart disease related to RA?
Yes - occurs in 20-40% of severe prolonged RA. Most common finding is fibrinous pericarditis
36
Most common long term problem of rheumatic heart disease?
Mitral stenosis
37
Does rheumatic heart disease predispose to infective endocarditis?
Yes - deforming fibrotic valvular disease is a feature of chronic rheumatic heart disease. Valve abnormalities predispose to infective endocarditis
38
Most common cause of sudden explained death in young athletes
Hypertrophic cardiomyopathy
39
3 types of cardiomyopathy
Dilated cardiomyopathy Hypertrophic cardiomyopathy Restrictive cardiomyopathy There are overlaps of features between the groups
40
Most common primary tumour of the heart
Atrial myxoma
41
What is bronchopneumonia?
Inflammation of the lung beginning as inflammation of bronchi and bronchioles with extension into adjacent alveolar spaces
42
What is lobar pneumonia?
Acute inflammation of the lung in which a large part of a lobe or an entire lobe is involved (acute bronchi pneumonia is different because it is patchy)
43
4 classic stages of lobar pneumonia
Congestion in the first 24h Red hepatisation or consolidation Grey hepatisation Resolution
44
Complications of acute pneumonia
``` Death Lung abscess Empyema Spread of infection - meningitis, arthritis, IE Fibrosis of lung ```
45
Causes of lung abscesses
Acute pneumonia Septic emboli Puncture wounds of the chest
46
What are opportunistic infections that HIV pts may develop in the lung?
``` TB pneumocystis carinii Cytomegalovirus Herpes simplex virus Varicella-zoster Atypical mycobacteria Aspergillus ```
47
What conditions predispose to PE?
``` Immobility Pregnancy COCP CHF Thrombosing disorders ```
48
Consequences of PE?
Many have no effect as undergo fibrinolysis + disappear Large emboli may cause sudden death Repeated small emboli may lead to fibrous narrowing of small pulmonary arteries causing pulmonary HTN An embolism may cause pulmonary infarction but only if there is HF with a rise in pressure in the pulmonary circulation
49
Changes seen in bronchial lining of smokers?
Squamous metaplasia Increased no. of mucous glands Epithelial atypia leading to carcinoma in situ
50
What may be local effects of a bronchial carcinoma?
- Bleeding into a bronchus - Obstruction of a bronchus causing bronchopneumonia, lung abscess, bronchiectasis or collapse of lobe - Pleural effusion - Invasion of recurrent laryngeal nerve causing hoarseness - Invasion of ribs, oesophagus, phrenic nerve, SVC or pericardium - Invasion of symp chain causing Horner's syndrome
51
Common patterns of metastatic neoplasia in the lung?
Multiple small masses | Few large masses = cannon ball
52
What is ARDS?
Defined clinically as acute respiratory failure with decreased arterial oxygen content, decreased lung compliance so lungs are stiff and diffuse lung infiltrates on XR. Pathologically - diffuse alveolar damage with oedema, haemorrhage and hyaline membranes in alveolar ducts in early stages with fibrosis later
53
What is pneumoconiosis?
Non-neoplastic lung condition caused by inhalation or inorganic or organic particles
54
Most common cancer in the kidney?
Renal cell carcinoma - don't confirm with biopsy because of risk of dissemination of cancer along needle track - yellowish mash with degenerate, cystic areas Transitional neoplasia much less common Kidney is unusual site for metastatic carcinoma
55
Spread of renal cell carcinoma
May be local invasion of kidney, fat around kidney + renal pelvis that leads to haematuria. Main route of spread is into renal vein + then dissemination to lungs, bones + sometimes unusual sites e.g. skin Lymph node spread is not common
56
Investigations for MS
MRI - plaques of demyelination and exclude other diagnoses Oligoclonal bands in the CSF Visual evoked potentials (VEPs) on an EEG
57
Pathology of MS
Multiple, discrete areas in white matter where axons have lost myelin sheaths + early active stage - inflammatory changes Lesions scattered through the CNS and can appear anywhere but certain sites: optic nerves, SC and periventricular sites such as corpus callosum
58
Huntington disease pathology
Atrophy of corpus striatum (caudate nucleus + putamen) with some compensatory dilatation of the lateral ventricles
59
Huntingtons
Repeat of CAG in gene for protein huntingtin. 38+ repeats in individuals with HD. Anticipation occurs in children as number of repeats can increase at meiosis
60
How is HSV encephalitis in the immunocompetent managed?
If acyclovir is given in early stages - both mortality + morbidity are reduced
61
Which heart murmur presents with pulsatile hepatomegaly?
Tricuspid regurgitation - backflow of blood into liver during cardiac cycle
62
where does LDL build up in atherosclerosis?
Tunica intima
63
which arteries are more prone to atherosclerosis?
``` Abdo aorta Coronary ateries Popliteal arteries Thoracic aorta Internal carotids Circle of Willis ```
64
Most common cause of ischaemic heart disease?
90% is due to atherosclerosis
65
What is critical stenosis?
>75% reduction in diameter of the artery | Leads to compensatory vasodilation but not enough to meet increased demands
66
Consequences of atherosclerosis
Narrowing - plaque size protrudes into lumen, overlying thrombus, haemorrhage into plaque Dilation (aneurysm) - rupture, mural thrombi which can embolise ``` Thrombosis Plaque rupture Haemorrhage Wall weakening Calcification ```
67
Stable v unstable plaque
Stable = thick fibrous cap Unstable = no thick cap, risk of rupture/fissure, emboli +/- thrombosis
68
What aggravates ischaemic heart disease?
Hypertrophy - more muscle so need more oxygen Hypotension - less pressure to overcome resistance in arteries + compensatory rise in HR Hypoxaemia Increased HR
69
Difference between angina + MI ?
Cell death (necrosis)
70
Transmural MI
Full thickness of the wall Usually associated with acute thrombosis/occlusion of vessel. Occasionally related to vasospasm or emboli
71
Subendocardial MI
inner 1/3 to 1/2 myocardium | Usually critical stenosis but no acute plaque change
72
At how many hours do you see MI?
Histologically - 4hrs | Macroscopically - 12h
73
Preconditioning
Repetitive short lived ischaemia may be protective
74
Complications of MI?
``` Cardiogenic shock Arrhythmias Myocardial rupture - tamponade, Pericarditis Ventricular aneurysm ```
75
Compensatory mechanisms of heart in HF
Dilatation - increased preload Hypertrophy - increase in size of myocytes Neurohumoral mechanisms
76
L sided HF
Pulmonary oedema Organ ischemia - impaired renal function (high creatinine)
77
R sided HF
Peripheral oedema Congestion of organs Ascites/pleural effusion
78
What is pure R sided HF called?
Cor pulmonale (uncommon)
79
How does systemic HTN affect the L V?
LV hypertrophy No dilation of LV Increased heart weight Thick wall Impaired diastolic filling
80
Histological features of hypertrophy
Increased size of myocyte Increased nuclear size Interstitial fibrosis
81
Valvular heart disease - stenosis
failure of valve to open completely - impedes forward flow of blood
82
Valvular heart disease - incompetence
Regurgitation - failure of valve to close so allows reverse flow of blood
83
What is functional regurgitation?
valves become imcompetent due to dilation of ventricles (valve gets stretched so ends can't touch)
84
Most common functional valvular lesions
Mitral stenosis Mitral incompetence Aortic stenosis Aortic incompetence
85
Mitral stenosis
From rheumatic heart disease
86
Mitral incompetence
Floppy mitral valve
87
Aortic stenosis
Calcification of normal + congenitally bicuspid aortic valves
88
Aortic incompetence
Dilation of ascending aorta related to HTN + age + connective tissue disorders
89
Most common type of valvular heart disease?
Mitral regurgitation due to floppy mitral valve
90
What is rheumatic fever?
Occurs a few weeks after group A b-haemolytic streptococcal pharyngitis Thought to by hypersensitivity reaction induced by group A strep
91
Signs and symptoms of rheumatic fever
Fever Painful joints Involuntary muscle movements Non itchy rash - erhythema marginatum
92
Most important complication of rheumatic heart disease
Chronic rheumatic heart disease - characterised by: - Deforming fibrotic valvular disease (especially mitral stenosis) - Fish mouth/button hole stenosis - Chordea tendinae become fibrotic + stick togther
93
How many cases of mitral stenosis are caused by rheumatic heart disease?
99%
94
What does infective endocarditis cause on the heart?
Thrombotic debris | Organisms
95
Types of infective endocarditis
Acute - previously normal valve, acute onsent, 50% mortality, necrotising + ulcerative destruction Subacute - abnormal valve, insidious onset, most recover, less destructive
96
Which organisms cause acute endocarditis?
S aureus Pneumococcus S pyogenes
97
Which organisms cause subacute endocarditis?
Strep viridans | Enterococci
98
Which organism causes IE on prosthetic valves?
Staph epidermis
99
Which valves are most commonly affected in IE?
Aortic + mitral | Tricuspid in IVDU
100
Complications of IE?
``` Myocardial abscess Valve rupture/perforation Systemic emboli Septic emboli Immune complexes e.g. in kidney ```
101
What is nonbacterial thrombotic endocarditis?
Deposition of fibrin/plt thrombi on valve - quite small on a normal valve non-destructive
102
3 types of cardiomyopathy
Dilated (90%) Hypertrophic Restrictive (least common) Overlap of features in each group + spectrum of severity
103
Causes of dilated cardiomyopathy
``` Most idiopathic Alcohol Genetics Haemachromatosis Drugs Sarcoidosis ```
104
EF in dilated cardiomyopathy
25%
105
Hypertrophic cardiomyopathy
Myocardial hypertrophy - wall thick + assymetric with IV septum thicker than LV wall No ventricular dilation Interstitial fibrosis
106
When does the septum become wider than the wall?
Hypertrophic cardiomyopathy
107
Restrictive cardiomyopathy
Normal sized ventricles + chambers Both atrial dilated Firm myocardium Get decreased ventricular compliance so impaired filling
108
Most common cause of myocarditis
Viruses
109
What is myocarditis
Inflammatory process of the myocardium which results in injury to cardiac myocytes
110
Causes of pericarditis
Infections, immune mediated, MI, uraemia, trauma
111
Types of pericarditis
``` Serous - clear fluid Fibrinous - fibrin Purulent - pus Haemorrhagic - blood Caseous - TB ```
112
What does metastatic melanoma in heart look like?
Black dots through myocardium
113
Right to left shunt
``` Blood shunted from pulmonary to systemic circulation Cyanotic 5 't's: - Tetralogy of fallot - Transposition of great arteries - Perisistent Truncus arteriosus - Tricuspid atresia - Total anomalous pulmonary venous connection ```
114
L to R shunt
Get pulmonary HTN ASD VSD Patent ductus arteriosus AV septal defect

Year 3 (14 decks)

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