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MRCOG - Part 1 > Pathology > Flashcards

Pathology Flashcards

1
Q

What are the 4 microscopic characteristics of dysplasia?

A

1) Anisocytosis
2) Poikilocytosis
3) Hyperchromatism
4) Mitotic figures

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2
Q

What is anisocytosis?

A

Unequal cell size

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3
Q

What is poikilocytosis?

A

Abnormal cell shape

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4
Q

What is hyperchromatism?

A

Pigmentation

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5
Q

What is hypertrophy due to?

A

Typically a result of increased intracellular protein rather cytosol

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6
Q

What is the difference between hypertrophy and hyperplasia?

A 
Hypertrophy = increased cell size
Hyperplasia = increased cell number
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7
Q

What is metaplasia?

A

Reversible change of one differentiated cell type with another

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8
Q

What is dysplasia?

A

Abnormal change to cellular size, shape and/or organisation

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9
Q

What are the different types of necrosis?

A

1) Coagulative
2) Liquefactive
3) Fat
4) Gangrenous
5) Caseous

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10
Q

Where does coagulative necrosis take place?

A

Kidneys; Heart; Adrenals; Hypoxic environment

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11
Q

Where does liquefactive necrosis take place?

A

Brain

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12
Q

Where does fat necrosis take place?

A

Pancreas

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13
Q

Where does gangrenous necrosis take place?

A

GI tract; Peripheral limb

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14
Q

Where does caseous necrosis take place?

A

In TB infection (caseous = granulomatous)

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15
Q

What cell type is found at the endocervix?

A

Columnar

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16
Q

What cell type is found at the ectocervix?

A

Stratified squamous, non-keratinised

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17
Q

What is between the endo- and ecto-cervix?

A

The transformation zone (or SCJ) - where cervical smears are taken from

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18
Q

What cell type is found in the ovaries?

A

Cuboidal

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19
Q

What cell type is found in the fallopian tubes and endometrium?

A

Columnar

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20
Q

What obstetric phenomenon is of increased prevalence in women with bicornuate uterus?

A

Breech presentation

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21
Q

What causes bicornate uterus?

A

Incomplete fusion of the Mulllerian (paramesonephric) ducts

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22
Q

What outcomes are associated with a bicornate uterus?

A

Recurrent miscarriage
Breech presentation
Preterm delivery

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23
Q

What is uterus didelphus?

A

When there are two entirely separate uterine cavities

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24
Q

What is the genotype of a complete molar pregnancy?

A

Usually 46XX (as it usually occurs when a single sperm fuses with a single egg devoid of DNA)

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25
Q

What is the commonest cause of acute renal failure?

A

Acute tubular necrosis

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26
Q

What are the pathological features of acute tubular necrosis?

A

Urinary granular and hyaline casts

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27
Q

What is diabetic nephropathy otherwise known as?

A

Nodular glomerulosclerosis

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28
Q

What are the defining pathological features of diabetic nephropathy?

A

Glomerulus basement membrane
Mesangial sclerosis
Glomerulosclerosis

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29
Q

What is the greatest risk factors for the development of bladder cancer?

A

Smoking

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30
Q

What results from polyarteritis nodosa?

A

A necrotising transmural inflammation of the small and medium sized arteries resulting in associated microaneurysm formation, tissue infarction and necrosis. Can affect the GIT, kidneys, heart or the liver

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31
Q

What infection is associated with polyarteritis nodosa?

A

Hep B

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32
Q

Lung cancer and tumours of the CNS are associated with what paraneoplastic syndrome?

A

SIADH

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33
Q

Small cell lung cancers are associated with what paraneoplastic syndrome?

A

Cushing’s

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34
Q

Uterine cancer is associated with what paraneoplastic syndrome?

A

Acanthosis nigricans

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35
Q

Breast cancer is associated with what paraneoplastic syndrome?

A

Dermatomyositis

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36
Q

Renal cancer is associated with what paraneoplastic syndrome?

A

Polycythaemia

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37
Q

Hepatocellular and small cell lung cancers are associated with what paraneoplastic syndrome?

A

Lambert-Eaton myasthenic syndrome

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38
Q

What is a class I haemorrhage?

A

Up to 15% blood volume loss, approx. 750ml

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39
Q

What is a class II haemorrhage?

A

15-30% blood volume loss

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40
Q

What is a class III haemorrhage?

A

30-40% blood volume loss

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41
Q

What is a class IV haemorrhage?

A

> 40% blood volume loss

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42
Q

What is the most common inherited thrombophilia?

A

Factor V Leiden

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43
Q

How is the ductus arteriosus in preterm infants treated?

A

Indomethacin

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44
Q

What is used to keep the ductus arteriosis open in children with congenital heart defects awaiting surgery?

A

Prostaglandin infusion

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45
Q

What is the term for a malignancy of mesenchymal origin?

A

Sarcoma

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46
Q

By what route do choriocarcinomas metastasise?

A

Haematogenous route

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47
Q

What is the histological appearance of the endometrium soon after ovulation?

A

Glands with subnuclear vaculoation in oedematous stroma

48
Q

What is pyknosis?

A

Shrinkage

49
Q

What is karyorrhexis?

A

Fragmentation

50
Q

What is autolysis?

A

Cell death occuring postmortem or after having been removed from the body, as in surgery

51
Q

What are the different types of chemical mediators of inflammation?

A
  1. Histamine
  2. Serotonin
  3. Prostaglandins
  4. Cytokines
  5. Kinins
52
Q

From what are kinins produced?

A

Plasma

53
Q

From what are cytokines produced?

A

Macrophages

Endothelium

54
Q

From what are prostaglandins produced?

A

Leucocytes
Platelets
Endothelium

55
Q

From what is serotonin produced?

A

Platelets

Mast cells

56
Q

From what is histamine produced?

A

Mast cells

Platelets

57
Q

What are the effects of inflammation?

A 
Rubor - redness
Calor - heat
Dolor - pain
Tumour - swelling
Function Laesa - loss of function
58
Q

What are the theories of the causes of endometriosis?

A
  1. Retorgrade menstruation
  2. Vascular dissemination theory - theory that endometrium can travel through blood/lymph vessels
  3. Metaplastic theory - whereby peritoneal tissue can turn into endometrium
59
Q

What are the favoured metastasis sites of choriocarcinoma?

A

Lungs
Vagina
Brain

60
Q

What is a placental site nodule?

A

When hyalinised nodule of indeterminate type, or placental site trophoblast remains in the endometrial lining, often causing persistent bleeding

61
Q

What is the tumour marker of a placental site trophoblastic tumour?

A

Human placental lactogen

62
Q

What are the characteristic microscopic findings in a uterus of a woman with pre-eclampsia?

A

Fibrinoid necrosis of uterine spiral arteries with intramural infiltration of foam cells

63
Q

What is a battledore placenta?

A

When the umbilical cord insertion point is at the edge rather than the centre of the placenta

64
Q

What is a velamentous insertion of the cord?

A

When the insertion point of the cord is so far to the edge that it is actually into the membranes

65
Q

What is the precursor lesion of cervical squamous cell carcinoma?

A

CIN

66
Q

What is the precursor lesion of cervical adenocarcinoma?

A

CGIN - cervical glandular intraepithelial neoplasia

67
Q

What is a Krukemberg tumour?

A

A metastatic gastrointestinal neoplasia to the ovaries resulting in bilateral enlargement with infiltrating malignant cells containing intracellular mucin

68
Q

What is classical VIN?

A

Occurs in younger women, associated with high risk HPV, graded into VIN I, 2, 3

69
Q

What is differentiated VIN?

A

Occurs in older women, associated with lichen sclerosis, no further grading

70
Q

What is sarcoma botyroides?

A

Embryonal rhabdomyosarcoma, occurring in children <5 years old - a polypoid mass that fills the vagina and resembles a bunch of grapes

71
Q

Which cell types cannot regenerate?

A

Myocardium and spinal cord

72
Q

What is the histological appearance of the pancreas in T2DM?

A

The islets have amyloid infiltration.

73
Q

Which HLA antigens are associated with T1DM?

A

HLA DR3 and DR4

74
Q

What is the order of anaesthetic for LA administration?

A

Local anaesthetic agents block the smaller (<1 micrometer in diameter) unmyelinated C fibres first, then the B fibres (1-3 micrometers) and finally the larger A fibres (1-20 micrometers)

75
Q

Temperature and pain sensation are carried by which nerve fibres?

A

Temperature and pain sensation are carried by the small C fibres

76
Q

Proprioception is carried by which nerve fibres?

A

Proprioception is carried by A-alpha fibres

77
Q

What is the histological change seen in benign ectropion?

A

Metaplasia

78
Q

What is koilocytosis?

A

Abnormally large and irregularly shaped nuceli

79
Q

What mediators induce vasodilation?

A

Histamine

NO

80
Q

Which vessels are affected by vasodilation first?

A

Arterioles

81
Q

What are the causes of atrophy?

A
  1. Decreased workload
  2. Loss of innervation
  3. Diminished blood supply
  4. Inadequate nutrition
82
Q

What are the hallmarks of cell injury?

A
  1. Decreased oxidative phosphorylation
  2. Depleted ATP
  3. Cellular swelling
83
Q

What are the different types of cell death?

A
  1. Necrosis - traumatic cell death
  2. Apoptosis - programmed cell death
  3. Autolysis - non-traumatic cell death occurring through action of the cells own enzymes
84
Q

What is cell death characterised by?

A
  1. Pyknosis - condensation of chromatin
  2. Karyorrhexis - fragmentation
  3. Karyolysis - dissolution of the nucleus
85
Q

What are the stages of wound healing?

A
  1. Inflammatory - ADP cause thrombus aggregation, cytokine attract macrophages and lymphocytes, histamine increase permeability
  2. Proliferative - fibroblasts lay down collagen type 3, angiogenesis and re-epithelialization
  3. Remodelling - maturation of collagen from type 3 to type 1, and wound contraction
86
Q

When does a scar become devoid of inflammatory cells?

A

Week 4

87
Q

What is wound strength at week 1 relative to that of un-wounded skin?

A

10%

88
Q

What is wound strength at 3 months relative to that of un-wounded skin?

A

80%

89
Q

Over what time period do scars mature?

A

2 years

90
Q

What are the different types of mature scar?

A
  1. Atrophic
  2. Hypertrophic - excessive scar tissue that doesn’t pass beyond the boundaries of the original wound
  3. Keloid
91
Q

What promotes good wound healing?

A 
Good blood supply
Vitamin C
Zinc
Protein
Insulin
UV light
92
Q

What inhibits good wound healing?

A

Glucocorticoids
Infection
Extreme temperatures

93
Q

What is a teratoma?

A

A neoplasm containing more than one germ cell layer

94
Q

Are teratomas malignant or benign?

A

Ovarian teratoma = benign

Testicular teratoma = malignant

95
Q

At what size is a tumour radiologically detectable?

A

10mm

96
Q

Which cancers cannot metastasise?

A

BCC and gliomas

97
Q

What is the lifetime risk of endometrial cancer/ovarian cancer with HNPCC?

A

Endometrial - 30-50%

Ovarian - 10%

98
Q

What risk does diethylstilbestrol increase?

A

Risk of vaginal clear cell carcinoma

99
Q

Which tumour marker is increased in breast cancer?

A

CA 15-3

100
Q

How is Factor V Leiden inherited?

A

Autosomal dominant

101
Q

How do platelets change in pregnancy?

A

Physiological drop in serum platelet levels due to haemodilution, despite increased platelet production

102
Q

What are the ONLY coagulant factors that DON’T increase in pregnancy?

A

XI and XIII

103
Q

What is Virchow’s triad?

A
  1. Endothelial injury
  2. Stasis
  3. Hypercoagulability
104
Q

What are the genetic hypercoagulable states?

A

Protein C deficiency
Protein S deficiency
Anti-thrombin III deficiency
Factor V Leiden

105
Q

What are the acquired hypercoagulable states?

A

Pregnancy
COCP
Antiphospholipid antibodies
Nephrotic syndrome

106
Q

What is the presence of antiphospholipid antibodies in recurrent miscarriage?

A

15%

107
Q

What is the presence of antiphospholipid antibodies in SLE?

A

30%

108
Q

What is the mortality rate of amniotic fluid embolism?

A

60%

109
Q

When are symptoms seen in air embolus?

A

> 100ml of air

110
Q

At what platelet count is regional anaesthesia considered safe?

A

> 80

111
Q

What are the complications of transfusions?

A 
Haemolytic transfusion reaction
Febrile transfusion reaction
Allergic reaction
Infections
Air embolism
Thrombophlebitis
Transfusion related acute lung injury
112
Q

How long is the progression to cancer from CIN?

A

15 years

113
Q

What proportion of women with endometriosis will be infertile?

A

40%

114
Q

What is Meig’s syndrome?

A

Characterised by an ovarian tumour - a fibroma-thecoma - a hydrothorax (more common on the right side), and ascites

115
Q

What is the most common symptoms of vulval cancer?

A

Itching

116
Q

What level of proteinuria indicates severe pre-eclampsia?

A

Proteinuria >5g/24hours

117
Q

What does Kleihauer’s test measure?

A

Fetal RBCs in the maternal circulation - normally fetal maternal haemorrhage is <4ml at delivery

MRCOG - Part 1 (13 decks)

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