Pathology deck Flashcards
Define amyloidosis
Improper collection of Beta pleated sheets of amyloid protein in the extracellular matrix. It is a life-threatening condition as humans lack the enzyme to break down this protein structure
How do you classify amyloidosis
Al - congenital and primary
This is caused by clonal proliferation of plasma cells producing this amyloid immunoglobulin
AA - secondary to chronic inflammation (in RA, IBD, TB, bronchiectasis, renal cell carcinoma)
Inflammation forces macrophages to secrete interleukin that then stimulates hepatocytes to produce amyloid protein A.
ATTR - autosomal dominant and most commonly affected protein is tranthyretin
What are the clinical features of AL amyloidosis
Kidneys: Proteinuria and nephrotic syndrome
Cardiac: Restrictive cardiac disease and arrythmias
Nervous system: Peripheral and central symptoms
GI: Malabsorbtion, bleeding, obstruction and perforation
Vascular: purpura
Clinical features of AA amyloid
Hepato and splenomegaly and proteinuria
How is amyloid diagnosed
Tissue biopsy
Subcut fat or rectal tissue is regarded as the best sample
Isotope scanning can also show hot spots of amyloid deposits
How is amyloidosis managed
AA can be controlled if underlying inflammation is controlled
AL needs chemo and eradicating abnormal plasma cells
Stem cellls
Supportive tx
It has poor survivial and the median survivial rate is 1-2 years
Which thyroid cancer causes amyloid deposition?
Meduallry as amyloid is composed of calcitonin
Where can isolated amyloid deposits be found
Larynx
Anwhere in the urinary tract
Aorta
Pituitary
Amyloid microsopy
Congo red stain shows apple gree birefingence under polarized light
What is the pathogenesis of calcification of the aortic valve in aortic stenosis
Lipid accumulation, inflammation and clacification
What are the symptoms of aortic stenosis
Syncope, angina and dyspnoea. The symptoms may not present until they are life-threatening and hence patients can also present with sudden cardiac death
How would you investigate for aortic stenosis
ECG, ECHO, CT angio, cardiac CT/MRI and exercise tolerance test
Aortic sclerosis vs aortic stenosis
Sclerosis is calcification of the valve without a significant gradient across the valve, this may progress into aortic stenosis
Do patients that undergo routine aortic valve replacement need prophylactic abx
No, I would consult the nice guidelines but the only exception to this would be if a patient was having a contaminated surgery, then abx to cover for those bacteria would be considered
What are organisms that commonly cause IE
HACEK organisms Strep Viridans and groups B and D, staph auerus (most common), Candida, enterococci, Pseudomonas aueriginosa
What is the definition of AKI
Abrupt reduction in GF resulting in the reduction in the ability of the kidneys to excrete nitrogenous waste. This is reflected by a rise in serum creatinine and urea
Biochemical cutoff is an increase in serum creatinine of 1.5-2x
Over what timescale does AKI normally develop
48 hours
What is a normal U and Cr
U 2.5-7.8 mmol/L
Cr 60-110 mcrmmol/L for men and 45-90mcrmmol/L for females
Emergency management of pulmonary oedema
ABCDE approach
Stop IV fluids
Sit the patient up
Oxygen
furosemide
Consider HF
CXR
What is normal urine output
0.5ml/kg/hr for adults and 1 for child
Define oliguria
<0.5ml/kg over a 6 hour period or <400mls over a 24 hour period
What is the most common cause of anuria in a surgical patient
Blocked catheter
In which decade is appendicitis most common
Second decade of life 10-20, slightly more common in males 1.4:1
In what positions can appendix be found
Retrocaecal 75%
Pre and post ileal 5%
Pelvic 20%
What are the boundaries of the foregut, midgut and hindgut
Foregut: mouth to 2nd part of du
Midgut: 2nd part of duo to 2/3rd the way of transverse colon
Hindgut: End of midugut to rectum
What is the obturator sign
Pain on flexion and internal rotation of the hip joint, this irritates the obturator internus
Through which general visceral nerve does the pain of appendicitis travel
Lesser splanchnic nerve, T10 and T11 is the root value
Scoring systems used for appendicitis
Alvarado and Appendicitis inflammatory response score
What are the types of acites
Transudative and exudative:
Transudate is protein <25g/mL
Exudate is >25g/mL protein
SAAG
Serum albumin and ascites albumin gradient
<11 exudative low gradient §
>11 is transudative highgradient
Give some examples of transudates
Portal hypertension caused by liver cirrhosis, portal vein thrombosis, budd chiari syndrome
Low albumin production: Liver impairment, starvation and nephrotic syndrome
Give some examples of exudates
Caused by inflammation and infection resulting in protein loss
4Ps
Peritonitis
post-irradiation
peritoneal mets
pancreatitis
How does acites form, with respect to the starling equation
The starling equation represents the movement of fluid across blood vessels and the interstitium with respect to hydrostatic and oncotic pressure
Blood moves from arteries to cap and then to veins
In the artery, hydrostatic pressure is higher than oncotic pressure and hence net movement of fluid is into the interstitium
In the vein, hydrostatic pressure is lower than the oncotic pressure and hence fluid is pulled back in, rest of the fluid is carried by the lymph
What is Rh
Symmetrical autoimmune inflammation of the joints with systemic manifestations. Commonly more females are affected than males. RH+ve in 70% of cases
5th or 6th decade is the most common decade of presentation
What is the pathology of RH
Joint effusions and inflammation, increase in the number of T cells and macrophages. Formation of granulation tissue and
What are some extra-articular manifestations of Rh
Nodules
Lymphadenopathy
Vasculitis
What are rheumatoid nodules
Most commonly seen on extensor surfaces
Seen in 20% of patients with RA
Accumulation of collagen with a central area of necrosis and surrounding cells including fibroblasts and macrophages
What happens on a radiograph of a joint with Rh
Loss of joint space and erosions, joint swelling, juxta-articular osteopenia
Define atherosclerosis
It is the thickening of vasculature as a result of buildup of fatty tissue on the inside of the vessels
What is the pathogenesis of atherosclerosis
It begins due to endothelial dysfunction. Then there is macrophages that form foam cells with a lipid-rich core.
Secondly, there is migration of smooth muscle cells to form a fibrous cap
This process ultimately leads to stenosis and can lead to obstruction of the lumen of the vessel. This leads to thrombosis or possible infarction of the tissue supplied by the vessel
How do tamsulosin and finasteride work
Finasteride: 5 alpha-reductase inhibitor and prevents the conversion of testosterone to dihydrotestosterone and hence reduces the size of the gland
Tamsulosin: Alpha 1 adrenergic receptor antagonist and relaxes smooth muscles to make urinary flow better
What is a fibroadenoma
Proliferation and collection of epithelium and stromal tissue of the duct lobes
Well rounded, oval shaped and mobile
Most common site is the upper and outer quadrant of the breast
Can be multiple and bilateral
How do you score the breast triple assessment
1-5 5 being malignant and 1 besing normal
What are breast cysts
They are distended, fluid-filled involuted lobules that develop in peri-menopausal females
They can be single or multiple and often present as smooth discrete lumps that are painful
Mammography and USS to confirm diagnosis, if aspirations are blood stained then patient needs triple assessment
What causes true mastalgia
Caused by an exaggerated response of breast tissue to hormones in menstruation
First line is OTC meds and soft fitting bra while sleeping
a secondary referral is then required and a medication called danazol that is an anti-gonadotrophin agent can be used
What is Mondor disease
Thrombophlebitis of the superficial veins of the breast and chest wall. Treatment os conservative with OTC pain meds and it can take months to heal
When is gestational nipple discharge the most common
2nd trimester
What is the commonest malignancy of the biliary tree
Cholangiocarcinoma: It is an adenocarcinoma of the epithelial lining of the bile duct
Commonest cause in the west is PSC followed by Hep C, HIV and congenital liver disease
In developing worlds it is most commonly caused by liver flukes
What is a klatskin tumour
A specific tumour originating at the junction of the left and right hepatic ducts
Any specific tumour markers for cholangiocarcinoma
CEA, CA19=9
Most tumours present when they are unresectable and hence patients are offered best supportive care.
Disease recurrence rates are also very high
What are the most common types of bladder cancer
Transitional and squamous cell carcinoma
Squamous cell carcinoma is more common in Africa due to present of Schisto H
In developing countries, 70% are SCC
Others include adenocarcinoma, small cell, sarcoma and secondary met
What are the surgical management options for bladder cancer
TRansurethral resection of bladder tumour, this is the most common
partial cystectomy: rarely offered
radical cystectomy: Involved removal of the bladder and the urethra and lymph nodes. In men, prostate, seminal vesicles and vas deferens are also removed
Intravesical mitomycin C chemo or BCG immunotherapy
Disinfection vs sterilization
Disinfection removes a number of viable organisms but not all. Sterilisation removes all including spores
Changes for hypokalaemia
What is the scoring system for NEC FASC
LRINEC
Types of nec fasc
What is clostridium
Gram positive, rod shaped, spore forming, anaerobic commonly found in soil, clothing and faeces
Perfringins, tetani, botulinum, difficile
In mild to moderate disease can give oral metro or vanc
In severe: oral vanc or oral fidoxamicin
IV immunotherapy or faecal transplant may be required in very severe cases
How are FAP and HNPCC inherited
Both are autosomal dominant
FAP: APC on Ch5
HNPCC: mutations on CH 2 and 3
APC gene mutation that then causes a mutation in KRAS and DCC and finally p53 tumour suppressor gene
Where does colorectal cancer predominantly metastasize to
Brain, bone, lung and liver
What types of liver tumours are there
Benign: Hemangioma, adenoma
Malignant: HCC, Cholangiocarcinoma, angiosarcoma, hepatoblastoma
Secondary: Metastasis (This is the most common type)
What is H.pylori
Gram-negative bacterium found in the stomach
It uses flagella to move away from acidic contents in the stomach and survive
It produces the enzyme urease that converts urea to CO2 and Ammonia. The ammonia then binds to the H+ to neutralise the gastric acid
it releases certain protease and along with the ammonia, erode the gastric contents
What is the lifetime risk of developing a peptic ulcer with H pylori
10-20 %
1-2% of the time H pylori is associated with gastric mucosa
How can H Pylori be diagnosed
Carbon 13 breath test or stool antigen
CLO test on a gastric mucosa sample but this depends on the urease production
What is the H Pylori eradication therapy
Twice daily for 7 days of PPI + amox + Metro/clarithromycin
If pen allergic then PPI + Clar + met
FACT
Thymus also develops from the 3rd pharyngeal arch and hence it may drag the inferior parathyroids down with it
What does normal parathyroid tissue contain
Chief cells and oxyphil cells
What are the gell and coombs hypersensitivity reactions
What are the contributors to an infection
Infectious agent, susceptible host and a poorly perfused area
Name to fungi that cause abscesses and sinuses
Histoplasma and candida
What are the common factors that create a good environment for infection
hypoxia, hypercapnia, poor perfusion, acidosis
What is the qSOFA score
Altered mental state/ GCS
RR >22
SBP <100
What is Rheumatic fever
Disease affecting the heart, joints, skin and bones. It can develop 2-4 weeks after an unrelated pharyngeal infection A beta-haemolytic streptococci.
It is a type 2 hypersensitivity reaction
It is uncommon in the west but still common in developing countries
What are the properties that you look for in a drape
Breathable, non-inflammable, can handle cold, hot and wet stresses
accept or dissipate electrical current
Non-toxic
What are the risk factors of developing thyroid cancer
being female
radiation
FHx
Obesity
history of goitre
20-25 % of medullary is familial and papillary and follicular is more sporadic with only 5-10% being familial
What are the causes of hypoparathyroidism
Thyroid surgery
Autoimmune
Post irradiation
What is a nevus
A benign proliferation of normal constituent cells of the skin
Spitz nevus, shagreen patch, port wine stain, Strawberry neveus
Is melanoma more common in males or females
50-50
How can you tell a melanoma
Irregular shape and multicoloured
growing rapidly
Change in size or sensation
What is more common UC or Chrons
UC
What are the extraintestinal manifestations of UC and chrons
Aphthous ulcers
Pyoderma gangrenosum
Iritis
Erythema nodosum
Sclerosing cholangitis
Arthritis
Clubbing of fingertips
A PIE SAC
What are the different kinds of necrosis
What is the difference between apoptosis and necrosis
What are 2 pathological examples of hyperplasia
BPH and adrenal glands in cushings syndrome
What are 2 physiological and 2 pathological causes of hypertrpphy
Physio: Uterus in preg and skeletal muscles on exercise
Path: Thyroid in graves disease and cardiomopathy
What is a hamartoma
Tumour like malformation due to disorganised arrangement of different amounts of normal cells
Eg: Peutz Jeghers polyps, hemangiomas
What is the difference between carcinoma and sarcoma and their spread
Carcinoma is abnormal growth of epithelial tissue and sarcoma is connective tissue
Carcinoma spread through lymph and sarcoma spread through blood
What cancers typically spread to the bone
Breast, Prostate, renal, thyroid, bronchus
What are the stages of acute inflammation
Vasoconstriction initially and then vasodilation
Increased vascular permeability
Migration of white blood cells
Phagocytosis
resolution or progression to chronic inflammation
What is the complement cascade
It is a part of the innate immune response that aids in development of membrane attack complexes.
Classic activation involved antigen and antibody binding
Alternative pathway is when c3 comes in direct contact with micro-organisms
Lectin pathway
What is a granuloma
Collection of epitheloid macrophages
Granulomatous inflammation is type of chronic inflammation that is caused by the presence of above mentioned cells as they form giant cells
Caseating: TB
Non caseating: sarcoid, chrons
Define a clot
A collection of solid material formed by the constituents of bloods
What is an embolus
A collection of undissolved material that partially breaks off and is carried from one place to another
What leads to the development of thrombus
Virchows triad: Abnormal blood flow, hypercoagulable state and endothelial injury
What are the benefits of cytology
Cheap and easy with quick result
Minimally invasive procedure to get sample
How do you diagnose IE
2 major criteria or 1 major and 3 minor on the Dukes criteria
Major
2 separate + blood cultures with IE organisms
Evidence of endocardial involvement
How do you diagnose rheumatic fever
2 major criteria or 1 major and 2 minor according to the Modified Jones criteria
Major (CEPS)
Carditis
Erythema marginatum
Polyarthritis
Sydenhams chorea
Why is IE so hard to treat
The valves of the heart do not recieve specifi blood supply and hence this makes it harder for immune cells and antibiotics to get through
What are the possible benefits of the use of tumour markers
Screening
Diagnostic
Measuring response to treatment
Monitoring for reccurence
What is the difference between staging and grading
Staging is describing the extent of the tumour based on size, spread.
Grading is describing differentiation of the tumour based on histology
Can you name some staging methods
Dukes
Clarkes
Breslow
TNM
What is the Dukes staging
For Colorectal cancer
A - confined to bowel wall (95-100 survival)
B - through bowel wall (65-75)
C- lymph nodes (30-40)
D - Distant mets (5-10)
What is a grading system that you know if
Gleason score for prostate cancer
2-10
What is the differnece between submandibular calculi and parotid calculi
Parotid tend to be multiple and small and within the gland
Submandibular tend to be large and single and intraductal
What % of salivary glands are radio-opaque
80-90% of the submandibular stones and 60% of parotid
Parotid gland tumours
85% benign - pleomorphic adenoma and Warthins tumour
15% malignant: Mucoepidermoid carcinoma and adenoid cystic carcinoma
What is actinic keratoses
It is a pre-malignant skin condition caused by UV exposure. It can progress to SCC
What are the histological features of squamous cell carcinoma
Atypical squamous cells, keratin pearls and invasion of dermis
When should patients have sutures removed
Face: 5 days
Scalp: 7 days
Trunk: 10-14 days
Limbs: 10-14 days
What is the benefit of using lidocaine with bupivocaine
Lidocaine has a quick onset of action but does not last as long
Using it with bupivocaine that oes last long can have an LA that has a quick onset and also lasts long
When would you refer a patient for an OGD with epigastric pain
Urgent
- dysphagia
- upper abdominal mass
Aged over 55 or over with weigth loss and any of the following: upper abdo pain, reflux and dyspepsia
Non-urgent
Haematemesis
Dyspepsia tx resistant
Upper abdo pain and low Hb
Raised platlet count
NV
Is H.Pylori more associated with gastric or duodenal ulcers
Duodenal more than gastric
What are bilroth 1 and 2 operations
Bilroth 1: Anastomosis with the gastric remnant and the duodenum
Bilroth 2: The Duodenum is oversewn and the gastric remnant is anastomosed with the proximal jejunum
What is PSA
It is a glycoprotein ‘peptidase’ enzyme that is secreted by epithelial cells of the prostatte gland
it liquifies semen, allowing sperm to move freely and dissolve in the cervical mucus
It is elevated in certain prostatic disorders
How frequently should you check the PSA post resection
6 weeks following treatment
Then every 6 months for the first 2 years and then once every year
Is PSA is 7 6 weeks post op, what will one do?
PSA should fall within 2-3 days post resection.
It should be undetectable.
Raised PSA can mean disseminated prostate cancer
What is the purpose of anti-androgen therapy in prostate cancer
It competitively binds to androgen receptors, preventing testosterone from further growing cancer cells
What are mycobacterium
Non motile
Non sporulating
Usually aerobic
Weekly gram positive rods
Acid fast
Name a mycobacterium other than TB
Mycobacterium avium
What is Potts disease
Dissemination of TB into the bone causing pathological fractures.
Abscesses can also form and it can result in cord compression
How is TB diagnosed
Active TB
1) Fluid sample sputum for ZN staining
2) PCT
3) CXR and CT scan
Latent
1) Quantiferon test
2) Monospot test
How is TB treated
RIPE medications
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
These 4 drugs for atleast 2 months and RI for atleast 4 months
What are the risk factors for prostate cancer
Age
Obestity
FHx
Ethinicity (afro-carribean)
How do you define the Gleason score
Looking at histological pattern
1-5 for the first and second most common patterns
The score is out of 10
What is the prostate utricle
It is the part of the prostate that he seminal vesicles open into
How can wound healing be classified
Primary, secondary or tertiary intention
What is healing by tertiary intention
Purposefully delayed closure of wounds, washed and debrided wound
What are the stages of wound healing
Haemostasis (Immediate)
Acute inflammation (up to 3 days)
Proliferation (3 days - 3 weeks)
Maturation (3 weeks to 2 years)
What is the most common benign thyroid tumour
Follicular adenoma
What is the definition of a laparotomy
An incision that assesses the peritoneal region
What layers are cut through in a laparotomy
Skin
Campers
Scarpas
Linea alba
Transversalis fascia
Extra peritoneal fat
Peritoneal
What principles must be adhered to in abdominal incisions
Incision should allow plenty of access
It should have capacity to be extended
Muscles should be split and not cut
Nerve damage should be minimal
What are the different kinds of incisions
What is diethermy
Use of electricity to generate heat up to 1000 degree C. Can be used for cutting or coagulation
What is cutting vs coagulation vs blend
Cutting: Continuous current and sinus wave form. Greater heat application
Coag: Pulsing current and square wave form. Heat produced is less.
Blend: Blend of the two above
How are bone tumours classified
Benign or malignant
Primary or secondary
Soem benign bone tumours: Simple bone cyst, giant cell tumours
Some primary bone tumours: Ewings, Osteosarcoma, Chondrosarcoma, Multiple myeloma
What is the most common type of benign bone tumour
Osteochondroma
What is the most common type of primary and malignant bone tumour
Multiple myeloma
Osteosarcoma is the second most common type
Which bone tumour has an onion skin appearance
Ewings sarcoma affecting the ages between 5 and 20
What is important to take into account when doing a biopsy of a bone tumour
Care should be taken to take biopsies at limb salvage lines. It is the last step of the bone tumour work up and only the sugeon that is going to perform the operation should take the biopsy
What are the 4 key components needed for a viable limb
Bone, blood vessels, nerves and adequate soft tissue envelope.
It 2/4 need to be taken then the limb can be salvaged, if 3/4 then salvage is not generally possible
What are the indications for a heart transplant
Severely low EF
Low diastolic function
Low systolic function
Congenital abnormalities
What are the different types of grafting
Auto - self
Allo - same species
Xeno - another species
Iso - identical twin
What tumours are associated with HIV
Kaposi sarcoma and CNS lymphoma
What genetic condition is associated with renal cell cancer
VHL
What def can occur if ileum is resected just proximal the the IC valve
Vit B12 def.
Difference between Osler nodes and Janeway lesions
Osler nodes are painful, tender nodules that are found primarily on the pads of the fingers and toes. Janeway lesions are painless, nontender, hemorrhagic nodular lesions seen on the palms and soles, especially on thenar and hypothenar eminences. Both lesions are rare in children with endocarditis.
Most common valve to be affected in IVDU
Tricuspid valve
What pathway does warfaring affect
extrinsic pathway
What is the ross procedure
Borrowing healthy valve and moving it to the position of a damaged aortic valve
What is the difference between a metallic heart valve and a normal tissue valve
Metallic will require warfarin and has a high risk of bleeding and thromboembolism. It is, however, easier to insert than a tissue valve
What part of the vessel if affected in a GCA
Tunica media
What is the mechanism by which corticosteroids cause osteoporosis
Reduced osteoblast activity
Increased osteoclast activity and bone resorbtion
Inhibition of sex steroids
Stimulation of renal calcium losses
What is multiple myeloma
It is a lytic plasma cell bone tumour.
CRAB summarizes the most typical clinical manifestations of multiple myeloma, these being hypercalcemia, renal failure, anemia, and bone disease
Large amounts of IgG or IgA
What are bence jones proteins
Monoclonal globulin proteins, light chains found in the urine
What is the difference between dry gangrene and wet gangrene
What is the cause for clubbing in lung cancer
several reasons given, however, mainly believed to be due to increased growth factors or platlets/ megakaryocytes dislodged into the nail bed
What paraneoplastic syndrome does a Pancoast tumour costs
Increased ACTH leading to cushings syndrome
How would you manage a patient that is MSRA positive
Mupirocin in the nose for 5 days pre-op
Hairwash with chlorohex on day 1 and day 5
Chlorohex skin and body wash for 5 days
What are the mutations associated with insulinomas
MEN1, PTEN, DAXX mutations as well as mTOR signalling pathway
What is a telomere
End DNA sequence on a chromosome that prevents degradation and also attachment to another chromosome
MEN syndromes inheritance pattern
Autosomal dominant
What is the appearance of pleomorphic adenoma on histology
Benign lesion that consists of epithelial and myoepithelial cells.
What is anaplasia of cells
Lack of differentiation in the cell architechture
What are the risk factors for developing a nasopharyngeal carcinoma
Gender: twice as common in males than in females
Most common ethnicity is Chinese and asian
High salt diet containing carcinogenic nitrosamines
EBV
Genetic
FH
Smoking
What is the structure of an abscess
A large area of necrosis that is rimmed off by preserved neutrophils. Showing on scans as a ring enchanting lesion.
Where are carcinoid tumours most commonly found
small intestine
appendix
They can also be found in the rectum, stomach and the lungs
They arise from enterochromaffin cells
Can commonly metastasize to the liver
What do carcinoid tumours release
serotonin, prostaglandins, substance P, histammine
Why does a person not really have symptoms of a carcinoid tumour unless it has metastasized to the liver
This is as most blood from the GI tract flows to the liver first and then to the rest of the body
How do you diagnose a carcinoid tumour
5HIAA in the urine
Chromogranin in the blood
What surgery would you offer somone with UC
Total colectomy as all the colon is susceptible
What type of vit deficiencies do you have in IBD
ADEK
What is the management of FAP
Prophylactic colectomy before the age of 25
What is healing by secondary intention
Re-epithelialisation, granulation and contraction of the wound
What is the oculocardiac reflex
Oculocardicac reflex (OCR; also known as the Aschner reflex or trigeminovagal reflex) is a reduction of the heart rate resulting from direct pressure placed on the extraocular muscles (EOM), globe, or conjunctiva.[1] The reflex is defined by a decrease in heart rate by greater than 20% following the exertion of the aforementioned eye pressure.[2] The reflex is mediated by the connection between the ophthalmic branch of the trigeminal nerve and the vagus nerve. Most commonly, the reflex induces bradycardia, though it has also been reported to cause arrhythmias and, in extreme cases, cardiac arrest.
Where does GB cancer spread to first
The liver, commonly segments 4/5
How do diverticula form
Increased intraluminal pressure due to exaggerated peristalsis secondary to low fibre diet. The nerves and blood vessels of the bowel lining are included in this outpouching
Faecal matter then gets lodged into these spaces leading to local inflammatory reaction and infection causing divertiulitis
How does endometrial tissue get into the colon
Retrograde menstruation theory
Metastasis theory i.e via lymph and blood vessel channel
Look like chocolate cysts
Can endometriosis increase the risk of cancer
Yes, especially ovarian (3-5 fold)
What type of cancers can H.Pylori cause
Adenocarcinoma and MALT
Why can we not use paraffin for histology
Paraffin takes weeks to embed into the tissues
How do you interpret parathyroid adenoma histology
If there are chief cells then there is an adenoma and if there is oxyphil cells and then there is involution
What are the different types of gastric carcinoma
Tubular adenocarcinoma: Made up of tubules
Papillary
Mucinous
Poorly cohesive
Mixed
What is the lauren classification
Classification of gastric carcinomas
Intestinal: Slow growing and well differentiated, forms glands
Diffuse: Aggressive and invading, grows fast and can rapidly invade adjacent structures and become metastatic
What is the borrmann classification of gastric cancers
It is a classification based on macroscopic appearance of the cancer
Polypoid
Fungating
Ulcerating
diffuse
What paraneoplastic syndromes are associated with gastric cancer
Acanthosis nigracans and dermatomyositosis
What is the dukes staging for colorectal cancers
A: Not through submucosa
B1: Not throught MP
B2: Through MP
C1: 1-3 nearby lymph nodes
C2: >4 LN
D: Distant mets
What is the function of a thrombus
Healthy response to injury in order to prevent bleeding
How do you differentiate a melanoma vs an SCC
Breslow thickness chart
<1mm = 1cm
1-2mm = 1-2 cm
2-3mm = 2-3cm
4mm = 3cm
What is the Virchow’s triad for thrombus formation
Endotheolial injury
Turbulant blood flow
Hypercoagulable state
What is epitheliod melanoma
Melanoma with epitheloid and spindle cells
What is a satellite lesion
Lesion of the melanoma that spreads around it. 2 cm or closer to the original lesion
What are the genetic mutations associated with melanoma
BRAF, NRAS, NF1, KIT
What are the treatment options for a BCC
Mohns
Excision and closure
Cryo
electrodissection
Topically you can use 5FU and imiquimod
How would you manage MRSA
OP: Oral clinda, Amox, tetra
IP: Vanc, linezolid, clinda
Define sickle cell disease
Sickle cell disease is a common hereditary hemoglobinopathy caused by a point mutation in β-globin that promotes the polymerization of deoxygenated hemoglobin, leading to red cell distortion, hemolytic anemia, microvascular obstruction, and ischemic tissue damage.
What are some of the complications of sickle cell disease
Vaso-occlusive crisis
Sequestration crisis
Aplastic crisis
Chronic tissue hypoxia
Increased susceptibility to infections
What is the mechanism of autosplenectomy
Mechanism of autosplenectomy? In early childhood, the spleen is enlarged up to 500 gm by red pulp congestion, which is caused by the trapping of sickled red cells in the cords and sinuses. With time, however, the chronic erythrostasis leads to splenic infarction, fibrosis, and progressive shrinkage, so that by adolescence or early adulthood only a small nubbin of Fibrous splenic tissue is left; this process is called autosplenectomy
Because of autosplenectomy with increased susceptibility of infection with encapsulated organisms
What are the most common organisms affecting patients after a splenectomy
Streptococcus pneumoniae * Haemophilus influenzae * Neisseria meningitidis
What is the mode of inheritance of autosomal dominant kidney disease
PKD1 and PKD2 genes
Pathogenesis of cyst formation? The cells of the renal tubules divide repeatedly until causing an outpocketing of the tubular wall with the formation of a saccular cyst that fills with fluid derived from glomerular filtrate that enters from the afferent tubule segment. Progressive expansion eventually causes most of the emerging cysts to separate from the parent tubule, leaving an isolated sac that fills with fluid by transepithelial secretion. This isolated cyst expands relentlessly as a result of continued proliferation of the mural epithelium together with the transepithelial secretion of sodium chloride and water into the lumen
Why is there pain in PCKD
Because of the orang getting larger dragging on the pedicle as well as stretching the fibrous capsule
What malignancy can occur in immunocompromised patients
Malignancy: this is 5 times greater than the normal population. Most commonly squamous cell carcinoma of skin, cervix, basal cell carcinoma’s, lymphoma and Kaposi’s sarcoma.
Define cryptorchidism?
Cryptorchidism is a complete or partial failure of the intra-abdominal testes to descend into the scrotal sac and is associated with testicular dysfunction and an increased risk of testicular cancer
It can also lead to Infertility, inguinal hernia, testicular torsion
The cryptorchid testis carries a 3 to 5-fold higher risk for testicular cancer, which arises from foci of intratubular germ cell neoplasia within the atrophic tubules
What are the risk factors for cryptorchadism
FH, Down syndromes, Low birth weight and premature birth and high abdominal pressure
Types of germ cell tumors?
- Seminomatous tumors
o Seminoma
o Spermatocytic seminoma - Nonseminomatous tumors
o Embryonal carcinoma
o Yolk sac (endodermal sinus) tumor
o Choriocarcinoma - Teratoma
- Sex Cord-Stromal tumors o Leydig cell tumor o Sertoli cell tumor
What are the most common testicular tumours
Seminomas in the young and non-Hodgkins lymphoma in the old
Why is it important to take multiple biopsies from the prostate glands
Prostatic cancer can be focal, so it’s important to take samples from different sites
How to differentiate between rectum and prostate cells in a needle biopsy?
Using immunohistochemical marker (α-methylacyl-coenzyme A-racemase) (AMACR) * CEA (in rectal cells)
What is the rationale in treating prostate cancer by bilateral orchidectomy?
Androgen deprivation
Describe the lobes of the prostate gland
What tissue is the wall of an abscess characteristically composed of?
Granulation tissue
When would you give antibiotics in an abscess
Antibiotics are indicated if the abscess is not localised (e.g. evidence of cellulitis) or the cavity is not left open to drain freely
What is the most common infective cause of granuloma formation
TB
What is the most common cause of osteomyelitis in adults and in children
Exogenous from an open wound for example in adults
Haematogenous - Due to sepsis in children
What is sequestrum
Dead bone that has become separated during the process of necrosis from normal or sound bone. It is a complication (sequela) of osteomyelitis
What is an involcrum
Thick sheath of periosteal new bone surrounding a sequestrum
What is the protein that is deposited in chronic OM
Amyloid AA
Difference between gout and pseudogout on sampling
Which thyroid cancer will not show Radioiodine update
Medullary thyroid cancer as its origin is from parafollicular C cells so it is not of a follicular origin
What is the precursor of platelets
Megakaryocytes
Extrinsic and intrinsic pathways
- Intrinsic pathway is activated by vessel injury which will lead to activation of factor 12 * Extrinsic pathway is activated by tissue thromboplastin released by the damaged cells * APTT tests for intrinsic pathway * PT tests for extrinsic pathway and the common pathway
What are the stages of bone healing
Hematoma formation (mass of clotted blood) at fracture site. Tissue in fracture site swells, very painful, obvious inflammation, and bone cells are dying.
Fibrocartilaginous callus develops over a 3 to 4-week period. This process involves * Capillary growth in the hematoma * Phagocytic cells invading and cleaning-up debris in injury site * Fibroblasts and osteoblasts migrating into site and beginning reconstruction of bone Note that the fibrocartilaginous callus serves to splint the fracture.
- Bony callus begins forming after 3 to 4 weeks after injury and is prominent 2 to 3 months following the injury. Continued migration and multiplying of osteoblasts and osteocytes result in the fibrocartilaginous callus turning into a bony callus.
- Remodeling. Any excess material of the bony callus is removed and compact bone is laid down in order to reconstruct the shaft. Remodeling is the final stage
What is PVL staph auerus
Panton-Valentine leukocidin (PVL) is a cytotoxin produced by Staphylococcus aureus that causes leukocyte destruction and tissue necrosis. It is one of the β-pore-forming toxins. The presence of PVL is associated with increased virulence of certain strains (isolates) of Staphylococcus aureus. It is present in the majority of community-associated Methicillin Resistant Staphylococcus aureus
What is the type of necrosis in HCV infection
Coagulative
What is CRP and where it is produced
C-reactive protein (CRP) is a substance produced by the liver early in response to inflammation (acute phase reactant)
* It is not very specific, it isn’t unique to one disease * Can help to monitor disease progress and flares.
Causes of DIC
Infection
Bleeding
Shock
Adenocarcinoma
Transfusion
Trauma
When can you use protein C infusions
In DIC
What are the different tests for varicose veins
Tap test, cough test and tourniquet test
And put the doppler at the SFJ and press the calf to hear a whoosh sound. If there is a retrograde whoosh then there is incompetence
What is the composition of gallstones
Gallstones are crystallized deposits in the gallbladder or biliary tree that are made up of a mixture of cholesterol, calcium salts, proteins, mucin, and bile. The type of gallstone is determined by its main components:
Mixed pigmented stones is the most common
Cholesterol stones
These stones form when bile in the gallbladder has more cholesterol than bile salts can dissolve. They are usually found in people who have a genetic or environmental predisposition to bile that is supersaturated with cholesterol.
Black pigment stones
These stones are the result of hemolysis and are made up of calcium bilirubinate.
Brown pigment stones
These stones are associated with a bacterial infection or parasitic infestation of the biliary system
What is a cyst and how does it differ from a pseudocyst
A cyst is an abnormal membraneous sac containing a gaseous, liquid or semisold substance
This differs from a pseudo cyst as pseudocysts lack epithelial or endothelial tissue
What is a sinus
A sinus is a blind-ended sac lined by granulation tissue, Which abnormally connects an abscess to the skin
What is a fistula
It is an abnormal connection between 2 epithelial surfaces. The most common fistula is an ear piercing
What is a stoma
A surgical opening into a hollow viscus. It can be classified by anatomical site, temporary or permanent and the number of openings
What is a diverticula
Abnormal outpouching of a hollow viscus
What is the difference between a clot, a thrombus and an embolus
A thrombus is solid material formed by the constituents of blood in flowing blood. When formed in stationary blood, this is termed a clot
An embolus is an abnormal mass of undissolved material that is carried in the bloodstream from one place to another
What is a hypersensitivity reaction
Abnormal host immune response to a particular substance
What is a polyp
A mass of tissue arising from an epithelial surface
What is metaplasia
Reversible change in one fully differentiated cell type into another fully differentiated cell type
What is leukoplakia
It is a white plaque on the oral mucosa. Characteristically, these patches are not painful, irregularly shaped and slightly raised, can be scraped away
It is not always malignant and is classically characterised as a pre-malignant condition. . Patients are encouraged to stop smoking and reduce alcohol intake. This can progress to SCC in 5% of patients
Where does malignancy from the tongue drain
The tip - submental
Anterior 2/3rd - submandibular
Posterior 1/3rd - deep cervical lymph nodes
What is better in SCC of the head and neck region? Chemo or radio therapy
Radio
What is a flap
It is a unit of tissue that is moved from a donor site to a recipient site and has its own blood supply
What is your understanding of BRCA 1 and BRCA 2 genes
BRCA 1: Found on chromosome 17, associated with breast cancer, ovarian and fallopian tube cancer, Lifetime risk is 80%
BRCA 2: Ch13, slightly lower risk of cancer. It is also associated with pancreatic malignancy and malignant melanoma
These only account for about 2% of the breast cancer cases now
What is the role of blue dye in sentinel node biopsies
Injected pre-op for detection of the lymph nodes
Tech 99 human colloid albumin
At surgery, sentinel lymph node biopsy is done either by blue dye or hand held gieger counter
Detection rate is 95% with these methods
What are the levels of the axillary lymph nodes
Inferolateral to the pec minor is level 1
Post to pec minor is level 2
Superomedial to the pec minor is level 3
Breast reconstruction
TRAM FLAP: Transverse rectus abdominis muscle flap, pedicled or free
DIEP - Flap baed on the deep inf epigastric perforator vessels
SGAP or IGAP: Sup and ing gluteal artery flaps
Who should have radiotherapy post breast cancer resection
Positive resection margins
Tumour >5 cm
4 or more pathological lymph nodes
Nodal radiotherapy should be offered in node positive disease
This should commence within a month of the surgery
What are the hormonal therapies in Brease Ca
Tamoxifen for pre-meno and anastrozole in post menopausal
What are the major and minor criteria for infective endocarditis
major blood culture criteria:
- 2 blood cultures positive for micro organisms typically
found in patients with IE. - Blood cultures persistently positive for one of these
micro organisms drawn 12 hours apart. - 3 or more separate blood cultures drawn at least 1 hour
apart.
◌ major echocardiographic criteria: - Valve vegetations.
- Myocardial abscess.
- New partial dehiscence of a prothetic valve.
Minor criteria
◌ predisposing factor: known cardiac lesion or iv drug abuser.
◌ Fever: > 38°C.
◌ Vascular problems: Arterial emboli, Janeway lesions, conjuctival hge.
◌ Immunological proplems: Glomerulonephrits, Roth’s spots, Osler’s nodes.
◌ Positive blood cultures that doesn’t meet the criteria above.
◌ Echocardiographic findings consistent with IE that does not meet the criteria above
Can endometriosis increase the risk of having cancer
Yes, by 3 fold ovarian cancer
Which pathway will not be affected by warfarin
Intrinsic pathway
What are some common sites to have a brain aneurysms
85% are anterior circulation
30% ACA and ACOM
30% is ICA and PCOM
20% MCA
5% basilar and 5% PCA
Structure of a lymph node
capsule: A dense connective tissue capsule that encloses the lymph node and sends trabeculae into the node
Subcapsular sinus: A space between the capsule and the cortex that allows lymphatic fluid to pass through
Cortex: The outer layer of the lymph node that contains lymphoid follicles, B cells, macrophages, and follicular dendritic cells
Paracortex: The inner part of the cortex that contains T cells and dendritic cells
Medulla: The innermost layer of the lymph node that contains large blood vessels, sinuses, and medullary cords
Medullary cords: Contain antibody-secreting plasma cells, B cells, and macrophages
What is the indication for each type of biopsy
Excisional for small lesion
Incisional for large lesion
Punch for flat lesion like and ulcer
Core or true cut for deep-seated lesions
What are the histological features of malignancy
Invasion of other organs
Perineural invasion
Abnormal tissue architecture
Key differences between benign and malignant lesions
Benign lesions: Less invasion of neighbouring structures, slow growing, well differentiated, less likely to metastasize, low angiogenesis
Can benign lesions become significant
Yes, osteoblastoma/ osteochondroma
Give some examples of neural crest tumours
Malignant melanoma
Med thy carc
Phaeo
Neuroblastoma
What is VEGFc
Metastasize to lymph node
What changes do you see in lymph node swelling
Follicular enlargement
