Pathology (cortex ones better)

Question 1

what are autoimmune conditions characterised by

Answer 1

presence of autoantibodies

Question 2

what autoantibody is present in rheumatoid arthritis

Answer 2

rheumatoid factor

Question 3

what is rheumatoid arthritis

Answer 3

autoimmune disease, typically causing inflammation of the joints but can have many manifestations

Question 4

what is seen histologically in aute RA

Answer 4

pannus formation- inflammatory granulation tissue

hyperplasic/ reactive synovium

Question 5

what is seen in chronic RA

Answer 5

cartilage is destroyed by inflammatory process, loss of joint space= fibrosis, deformity

Question 6

what autoantibodies are seen in SLE

Answer 6

ones directed at structural parts of DNA- 95% ANA+ve

Question 7

what are inflammatory arthritides

Answer 7

inflammatory diseases that affect the joints and surrounding structures

Question 8

what is seen acutely is histology of a inflammatory arthritides

Answer 8

oedema, fibrin, reactive features in synovial cells

Question 9

what is seen chronically is histology of a inflammatory arthritides

Answer 9

lymphocytes and plasma cells

Question 10

what autoantibody in scleroderma

Answer 10

anti centromere, antitelomere

Question 11

what autoantibody in dermatositis

Answer 11

anti jo

Question 12

what is uric acid and why can it reach high concentrations

Answer 12

the end product of purine synthesis. Adenine and guanine and purine based, anything that increases turnover of these is associated with a crystal arthropathy

Question 13

what are the two types of crystal arthropathy

Answer 13

gout and psuedo gout

Question 14

what causes gout

Answer 14

hyperuricaemia- either increased urate production (e.g. increased cell turnover- psoriasis, cancer or tumour lysis) or reduced excretion (drug side effect- thiazide diuretics)

Question 15

what is the pathological manifestation of gout

Answer 15

precipitation of crystals (due to reduced solubility) usually in joints (due to lower temps) elicit inflammatory reaction

Question 16

what are the clinical implications of gout

Answer 16

causes secondary degeneration changes in joint, 
deposition in soft tissue causes gouty trophy. 
renal diseases (stones and direct deposition in tubules and interstitium)

Question 17

what is seen in cytology of gout

Answer 17

needle shaped crystals seen in cross polarised light

Question 18

what is seen histologically in gout

Answer 18

amorphous eosinophillic debris and inflammation (giant cells).

NOT crystals as lost during tissue processing

Question 19

what crystal causes pseudogout/ chrondrocalciosis

Answer 19

calcium phosphate (rhomboid shaped crystals)

Question 20

what are features of pseudo gout

Answer 20

older patient, larger joint. usually asymptomatic but can cause range of joint pain

Question 21

what is pagets disease

Answer 21

when there is an abnormailty of bone turnover- increased oestoclastic activity

Question 22

what is the cause of pagets

Answer 22

unknown, genetic components, RANKL, viral infection

Question 23

what are the three stages of pagets

Answer 23

osteolytic, mixed and burnt out

Question 24

what is the net result of pagets

Answer 24

thick excess bone with abnormal reversal lines- mosaic pattern

pain- microfractures or nerve compression (bone expansile)

enlargement and abnormal shape

increased metabolism- heat, warm skin, AV shunt, high output cardiac failure

secondary malignancy (osteosarcoma)

Question 25

what is histologically in the initially phases of a fracture

Answer 25

haematoma (fibrin mesh), influx of inflammatory cells, cytokine release, recruitment of osteoprogenitor cells from periosteum and medulla cavity (repair cells)

Question 26

what is seen histologically a week after a fracture

Answer 26

callous, organised haematoma, early recruitment and bone remodelling

Question 27

what can cause delay healing of a fracture

Answer 27

poor blood supply poor nutrition too much movement too great a distance

Question 28

what is a pathological fracture

Answer 28

when bone is not normal before fracture e.g. oestoperosis/ tumours (benign/ malignant)

Question 29

what are cancers that commonly metastasise to bone

Answer 29

lung, kidney, breasts prostate

Question 30

what does bone metastasis look like

Answer 30

most oestolytic- bone is resorbed and appears radiolucent prostate appears as osteosclerotic- areas of opacity (more dense)

Question 31

what are myeoma/plasmacytoma

Answer 31

malignant proliferation of plasma cells, causes bony lesion

Question 32

what is avascular necrosis

Answer 32

bone infarction, causes 10% of hip fractures

Question 33

what causes avascular necrosis

Answer 33

trauma, alcohol main causes steroid injection, dysbarism, sickle cell diseases, infection

Question 34

what does avascular necrosis look like histologically

Answer 34

wedge shaped area of discolouration, often subcortical creeping substitution (new bone grows over old dead bone)

Question 35

what is osteoarthitis

Answer 35

a degenerative disease cause by mechanical injury due to abnormal load distribution, previous fracture or anatomical abnormality

Question 36

what are the changes of osteoarthritis

Answer 36

damage to cartilage surfaces then later damage to the underlying bone

Question 37

what is seen histologically in osteoarthitis

Answer 37

fibrillation, erosion/ eburnation (subchondral sclerosis), subchondral cyst formation (synovial fluid accumulation), osteophyte (disorganised bone formation limits joint movement), loss of joint space

Question 38

what causes osteophytes

Answer 38

cortical bone thickens to cope with load, rapid bone remodelling= abnormal outgrowths

Question 39

what is subchondral sclerosis a sign of

Answer 39

eburnation

Question 40

describe karotyping

Answer 40

culture cells and then arrest during cell division- provides overview of chromosomal structure but will not detect small or subtle lesions

Question 41

what is FISH useful for

Answer 41

to find known translocations- if signals move together then translocation

Question 42

what does immunohistochemistry do

Answer 42

places a pigment on an antibody to target a protein to see whether it is present

Question 43

describe ganglion cysts

Answer 43

lump peripheral and near a joint capsule or tendon sheath, common around the wrist degenerative change within connective tissue. not a true cyst no epithelial lining

Question 44

what is seen histologically in in a ganglion cyst

Answer 44

space with myxoid material, secondary inflammatory changes

Question 45

where are common places for superficial fibromatoses

Answer 45

dupuytrens, knuckle pads, plantar, penile (peyronie's)

Question 46

what causes dupuytrens

Answer 46

idiopathic- associated with alcohol and anticonvulsants

Question 47

what is deep fibromatoses

Answer 47

mesenteric or pelvic tumours desmoid tumours- deeper in viscera of body association with gardner's syndrome

Question 48

what is pigmented villonodular synovitis

Answer 48

giant cell tumour that you get in large joints

Question 49

where do you get giant cell tumours of tendon sheath

Answer 49

digits

Question 50

describe angiolipoma

Answer 50

usually multiple and peripheral, vascular with fibrin thrombin, painful

Question 51

what is a leiomyoma

Answer 51

smooth muscle tumour

Question 52

what are the main proteins in smooth muscles

Answer 52

actin, desmin and caldesom

Question 53

who gets cardiac phabdomyomas

Answer 53

kids

Question 54

what are the forms of skeletal muscle malignant tumours

Answer 54

embryonal rhabdomyosarcoma (children), alveolar (young adults), pleomorphic (young adults)

Question 55

do cartilage sarcomas affect the paediatric population

Answer 55

no

Question 56

what is more worrying, a cartilage tumour in the extremities or central body

Answer 56

central more likely to be sarcoma

Question 57

what is gardners syndrome

Answer 57

multiple bone lesions

Question 58

what is characteristic of osteoid osteoma

Answer 58

nidus (focus of infection), associated with tenderness

Question 59

what is an osteoma

Answer 59

benign tumour of the bone

Question 60

who and where do you get osteosarcoma

Answer 60

usually paediatric age group, long bones

Question 61

what is a pathology diagnostic sign of osteosarcoma

Answer 61

any malignant tumour that produces osteoid is oestosarcoma until proven otherwise

Question 62

where do osteosarcomas metastasise to first

Answer 62

lung fields

Question 63

who gets ewings sarcoma, what is it like

Answer 63

children and adolescents destructive, rapildy growing and highly malignant

Question 64

what do the ewings family of tumours look like

Answer 64

small round blue cell tumours

Question 65

what cancer is commonly missdiagnosed as sarcoma

Answer 65

carcinoma

Question 66

what is nodular fascitis

Answer 66

reactive lesion, affects any age group, rapid growth, snall

Question 67

what is seen histologically in nodular fascitis

Answer 67

chaotic appearance, haemorrhage, pseudocystic spaces, large atypical cells, frequent mitoses, normal mitoses

Question 68

what is myositis ossificans

Answer 68

reactive lesion, small, preceeds trauma

Question 69

what are rheumatoid nodules

Answer 69

common, elbow, reactive lesion