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eMRCS questions > Pathology eMRCS > Flashcards

Pathology eMRCS Flashcards

1
Q

Reporting of investigations in breast

A

U/M

1 No abnormality
2 Abnormality with benign features
3 Indeterminate probably benign
4 Indeterminate probably malignant
5 Malignant

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2
Q

Prominent oxyphil cells and scanty thyroid colloid in biopsy of thyroid

A

Follicular caricnoma

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3
Q

Papillary carcinoma histological features

A

papillary projections and pale empty nuclei
Seldom encapsulated
demonstrate psammoma bodies (areas of calcification) and so called ‘orphan Annie’ nuclei

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4
Q

Papillary carcinoma spread

A

Lymph node metastasis predominate
Haematogenous metastasis rare

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5
Q

Medullary carcinoma cells and biochem

A

Tumours of the parafollicular cells (C Cells)
C cells derived from neural crest and not thyroid tissue
Serum calcitonin levels often raised

Both lymphatic and haematogenous metastasis are recognised, nodal disease is associated with a very poor prognosis.

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6
Q

Treatment of anapaestic carcinoma

A

Treatment is by resection where possible, palliation may be achieved through isthmusectomy and radiotherapy. Chemotherapy is ineffective

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7
Q

When is fractures callus first visible

A

3 weeks

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8
Q

Cell types seen in sarcoidosis

A

T, B cells
Macrophages
Asteroid bodies- eosinophilic star-burst inclusion within a giant cel in granulomas

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9
Q

Staining used for TB

A

Ziehl - Neelsen

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10
Q

What is heterotopia

A

The tissue type that is found in the abnormal location is present there from birth and does not migrate to that site subsequently or arise as a result of metaplasia

e.g Meckels diverticulum

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11
Q

What is a DALM lesion and how is it treated in a patient with UC

A

Dysplasia associated mass or lesion

panproctocolectomy

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12
Q

Causes of illiopsoas abscess

A

Primary- staph aureus
Haematogenous spread of bacteria

Secondary- crohns most common
Diverticulitis

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13
Q

Types of para testicular mass tumours

A

Teratoma - benign in younger children
Rhabdomyosarcoma - more common malignant solid tumours in children (though all are rare)- mets early

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14
Q

Hyperechoic liver cyst normal AFP

A

Haemangioma

Hyperechoic- brighter on US

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15
Q

Cyst on US

A

Anaechoic

Fluid filled are anechoic

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16
Q

X Ray of Ewings sarcoma

A

large soft-tissue mass with concentric layers of new bone formation ( ‘onion-peel’ sign)

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17
Q

Where does Ewing most commonly occur

A

malignant round cell tumour occurring in the diaphysis of the long bones in the children

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18
Q

Most common location for osteosarcoma

A

Knee

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19
Q

X ray of osteosarcoma

A

Elevated periostreum
Mixed sclerotic & lytic
lesions, cortical breach,
Sun burst appearance
Bone formation within the
tumour

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20
Q

Histology of osteosarcoma

A

malignant mesenchymal cells

osteoblastic differentiation

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21
Q

What is a Ghon focus

A

Primary infection of TB

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22
Q

What may be present if a DCIS is high grade

A

Angiogenesis

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23
Q

Difference between carcinoma in situ vs invasive in breast

A

Not yet invaded BM

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24
Q

What can elevate PSA levels

A

benign prostatic hyperplasia (BPH)

prostatitis and urinary tract infection (NICE recommend to postpone the PSA test for at least 1 month after treatment)

ejaculation (ideally not in the previous 48 hours)

vigorous exercise (ideally not in the previous 48 hours)

urinary retention

instrumentation of the urinary tract

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25
Q

Dercums disease

A

Extensive lipomas throughout the body

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26
Q

Causes of carpal tunnel syndrome

A

MEDIAN TRAP Mnemonic

Myxoedema
Edema premenstrually
Diabetes
Idiopathic
Acromegaly
Neoplasm
Trauma
Rheumatoid arthritis
Amyloidosis
Pregnancy

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27
Q

Tumour marker for ovarian pancreatic and breast

A

Ovarian- CA125
Pancreas- CA19-9
Breast- CA 15-3

Monoclonal AB

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28
Q

Tumour antigens for prostate, hepatocellula and CR

A

P- PSA
HC- AFP
CR- CEA

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29
Q

Problems with tumour markers

A

Low specificity

Breast has low specificity and sensitivity

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30
Q

Liver cell adenoma US and RF

A

RF- use of OCP

US- the lesions will typically have a mixed echoity and heterogeneous texture.

On CT most lesions are hypodense when imaged prior to administration of IV contrast agents

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31
Q

Gene affected in FAP

A

APC

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32
Q

What would you see on colonoscopy of FAP

A

Typically over 100 colonic adenomas

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33
Q

Screening and management of known APC mutation

A

Annual flexible sigmoidoscopy from 15 years

If no polyps found then 5 yearly colonoscopy started at age 20

Polyps found = resectional surgery (resection and pouch Vs sub total colectomy and IRA)

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34
Q

HNPCC mutation

A

Germline mutations of DNA mismatch repair genes

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35
Q

Tumours in HNPCC

A

○ Carcinomas usually in R colon before age of 50
○ Few polyps
○ Associated with endometrial, ovarian, small bowel, transitional cell and stomach cancer

Lynch syndrome
Little bowel
Yurine
eNdometrial and ovarian

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36
Q

Screening and tx of HNPCC

A

Colonoscopy every 1-2 years from age 25
Consideration of prophylactic surgery
Extra colonic surveillance recommended

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37
Q

Puetz jaeger features

A

​AD disorder, multiple polyps, mucocutaneous hyperpigmentation, freckles around the
mouth/palms/soles, increased risk of intussusception

hamartomas polyps

Episodic obstruction and intussceception
Increased risk of GI cancers (colorectal cancer 20%, gastric 5%)
Increased risk of breast, ovarian, cervical pancreatic and testicular cancers

Poo, pancreatic
Juggs- breast
Gondal- ovarian and test

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38
Q

Screening of peutz jaegar

A

Annual examination
Pan intestinal endoscopy every 2-3 years

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39
Q

If patient has ruptured aortic aneurysm but the haematoma is contained what should the fluid regime be

A

1L /4hrs

Rapid infusion may dislodge haematoma

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40
Q

Which cell responds in GVHD

A

Lymphocytes

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41
Q

AB. mediation of ABO incompatibility

A

IgM

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42
Q

Sx of ABO incompatibility

A

Dark urine
Fever
Restlessness
Low BP
High HR

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43
Q

IgA in blood transfusions

A

If IgA deficient

Produce IgA ABs

Therefore need IgA def transfusions

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44
Q

Transfusion associated GVHD sx

A

1-2 weeks after transfusion
● GI tract → diarrhoea
● Skin → desquamation, necrosis, maculopapular rash
● Liver failure, bone marrow failure

Only occurs in immunocomprimsied

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45
Q

Glioblastoma CT result

A

Can traverses the midline
Displays marked central necrosis
Extensive oedema surrounding the lesion
Neoangenesis

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46
Q

Most common brain tumour

A

Pilocytic astrocytoma in children- hairy

Glioblastoma multiforms in adults- polymorphic, microvascular changes, necrosis

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47
Q

APTT and PT are a measure of

A

APTT- intrinsic

PT- extrinsic

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48
Q

APTT, PT and bleeding time in haemophilia, vWD and Vit K def

A

Haemo- APTT increased, PT normal, BT normal

vWD- APTT increased, PT normal, BT increased

Vit K def- APTT and PT increased, BT normal

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49
Q

How massive transfusion affects clotting

A

Puts the patient at risk of thrombocytopaenia, factor 5 and 8 deficiency.

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50
Q

Test for carcinoid tumour

A

Blood- Chromogranin A, gastrin

Urine- 5HIAA

CT
If primary unknown SS scintography

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51
Q

Mx of carcinoid tumours

A

Well differentiated- surgical resection usuallly curative

Poorly diff- chemo with surgical

Gastric- endoscopic resection

SI- malignant- LN clearance

Appendix
<2cm and limited to the appendix- removed
>2cm- atypia, invasion of mesoappendix or base
right hemi.

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52
Q

Gardners syndrome- inheritance, characteristic and tx

A

Autosomal dominant
Mutation of APC gene located on chromosome 5

Multiple colonic polyps
Extra colonic diseases include: skull osteoma, thyroid cancer, epidermoid cysts, more teeth, hypertrophy of retinal pigments, sebaceous cysts
Desmoid tumours are seen in 15%

Due to colonic polyps most patients will undergo colectomy to reduce risk of colorectal cancer

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53
Q

Mx of TCC of bladder

A

Those with superficial lesions may be managed using TURBT in isolation.

Those with recurrences or higher grade/ risk on histology may be offered intravesical chemotherapy.

Those with T2 disease are usually offered either surgery (radical cystectomy and ileal conduit) or radical radiotherapy.

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54
Q

Merkel tumour histology

A

Primitive neuroendocrine cells

Histologically they consist of sheets and nodules of hyperchromatic epithelial cells, with high rates of mitosis and apoptosis
Appear within the dermis and subcutis.

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55
Q

Merkel tumour treatment

A

Surgical excision is first line. Margins of 1cm are required.

Lesions >10mm in diameter should undergo sentinel lymph node biopsy.
Adjuvant radiotherapy is often given to reduce the risk of local recurrence.

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56
Q

Histopathology of temporal arteritis

A

Vessel wall granulomatous arteritis with mononuclear cell infiltrates and giant cell formation

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57
Q

How temporal artery biopsy is done

A

USS doppler to locate the superficial temporal artery or palpate
Local anaesthetic
Artery within temporoparietal fascia
Clamp and ligate the vessel
Cut 3-5cm
Ligate the remaining ends with absorbable suture

Non diagnostic in >50%

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58
Q

Li Fraumeni syndrome

A

Sarcoma, cancers of the breast, brain and adrenal glands

Mutation to p53 tumour suppressor gene

AD

High incidence of malignancies particularly sarcomas and leukaemias

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59
Q

Necrosis seen in malignant HTN

A

Fibrinoid necrosis

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60
Q

Investigations if Oesophageal candidiasis

A

Test for HIV

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61
Q

Acute mesenteric embolus sx

A

Sudden onset abdominal pain followed by profuse diarrhoea.
May be associated with vomiting.
Rapid clinical deterioration.

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62
Q

AIP features

A

abdominal: abdominal pain, vomiting
neurological: motor neuropathy
psychiatric: e.g. depression
hypertension and tachycardia common

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63
Q

AIP diagnosis

A

classically urine turns deep red on standing
raised urinary porphobilinogen

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64
Q

Pathophysiology of AIP

A

AD condition caused by a defect in porphobilinogen deaminase, an enzyme involved in the biosynthesis of haem.

The results in the toxic accumulation of delta aminolaevulinic acid and porphobilinogenD

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65
Q

Nottingham prognostic Index score

A

Tumour Size x 0.2 + Lymph node score+Grade score

Score-LN- Grade
1 0 1
2 1-3 2
3 >3 3

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66
Q

What facilitates phagocytosis

A

Opsonisation

The micro-organism becomes coated with antibody, C3b and certain acute phase proteins

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67
Q

Infection with which micro-organisms may result in a clinical picture resembling achalasia

A

Trypanosoma Cruzi

Chagas disease

Result in destruction of the ganglion cells of the myenteric plexus, resulting in a clinical picture similar to achalasia.

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68
Q

Layers of blood vessel

A

Intima
Media
Adventita

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69
Q

What happens in vessels to cause aneurysms

A

Loss of elastic fibres from media - primary
Also degradation of collagen in adventitia

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70
Q

Pagets disease of breast

A

Exczema related changed associated with malignancy

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71
Q

Mondors disease

A

Localised thrombophlebitis of a breast vein.

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72
Q

Periductal mastitis

A

Common in smokers
Indurated area
Recurrent infections

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73
Q

Sx of acute on chronic mesenteric ischaemia

A

Weight loss and abdo discomfort -prodromal

Acute sx

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74
Q

Diaphragm disease

A

Lumen of the small bowel is divided into short compartments by circular membranes of mucosa and sub-mucosa;

Leads to frequent bouts of intestinal obstruction

Caused by long term NSAID use

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75
Q

Aortic coarctation symptoms

A

The x-ray shows evidence of rib notching.
Auscultation of his chest reveals a systolic murmur which is loudest at the posterior aspect of the fourth intercostal space.

Weak arm pulses may be seen, radiofemoral

May be caused by ductus arteriosus acting as a band

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76
Q

Takayasu arteritis sx

A

Large vessels affected- aorta occluded

Symptoms may include upper limb claudication
Clinical findings include diminished or absent pulses
ESR often affected during the acute phase

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77
Q

Normal ESR

A

Males age/2
Females age+10/2

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78
Q

MEN 1

A

Parathyroid
Pituitary
Pancrease- ZE syndrome, insulinoma

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79
Q

MEN 2a and 2b

A

2a-
Parathyroid
Phaeo
Medullary thyroid
Itchy cutaneous lesions

2b-
Medullary thyroid cancer
Phaeochromocytoma
Mucosal neuroma
Marfanoid appearance

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80
Q

Tuberous sclerosis sx

A

Renal angiomyolipomata

Depigmented ‘ash-leaf’ spots which fluoresce under UV light

Epilepsy and dev delay

retinal hamartomas: dense white areas on retina

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81
Q

Leriche syndrome sx

A
  1. Claudication of the buttocks and thighs
  2. Atrophy of the musculature of the legs
  3. Impotence (due to paralysis of the L1 nerve)

Atherosclerotic occlusive disease involving the abdominal aorta and/or both of the iliac arteries.

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82
Q

Neutrophil disorders cause

A

Chronic granulomatous disease

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83
Q

Actions of neutrophils

A

Movement
Opsonise microorganisms, phagocytosis

Intracellular killing of microorganisms via aerobic (produce HYDROGEN PEROXIDE) & anaerobic mechanisms.

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84
Q

What features would suggest alternative diagnosis over lipoma

A

Size >5cm
Increasing size
Pain
Deep anatomical location

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85
Q

Poor prognostic factors with SCC

A

Size >20mm (local recurrence rate of up to 15%)
Depth greater than 4mm (risk of metastasis up to 30%)

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86
Q

Dysphagia lusoria and ix

A

Dysphagia lusoria is caused by compression of the esophagus from any of several congenital vascular abnormalities.

The vascular abnormality is usually an aberrant right subclavian artery arising from the left side of the aortic arch, a double aortic arch, or a right aortic arch with left ligamentum arteriosum.

Diagnostic CT angio

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87
Q

NFM 1 features

A

1 limb longer than the other
Schwannoma, > 6
Cafe au lait spots, axillary freckling

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88
Q

Thrombomodulin function

A

Activate protein C

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89
Q

Which factor does vWF affect

A

Factor 8

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90
Q

Heparin and LMWH MOA

A

Bind to AT3- inactivate thrombin and factor X
LMWH has less affect on thrombin

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91
Q

Reversal agent for heparin

A

Protamine Sulphate

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92
Q

Other cells shown on film tin IDA

A

Pencil cells
Reticulocytes (nucleated)

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93
Q

Which condition do you get spherocytes

A

HS, AIHA

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94
Q

Which condition do you get Heinz bodies

A

G6PD def

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95
Q

Which condition do you get target cells

A

Thalassaemia

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96
Q

Which condition do you get hyperhsegmented neutrophils

A

Megaloblastic anaemia

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97
Q

Which condition do you get Howell Jolly Bodies

A

Hyposplenism (SCD, IBD, post spelnectomy)

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98
Q

Which condition do you get Echinocytes (Burr cells)

A

PK DEF

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99
Q

Which condition do you get basophilic stippling

A

Lead poisoning
Pyrimidine 5 nuc def

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100
Q

Which condition do you get schistocytes

A

MAHA (TTP, HUS, DIC)

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101
Q

Which condition do you get Rouleaux formation

A

MM

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102
Q

TTP vs ITP vs HUS

A

TTP-
● Pentad: M​ AHA, thrombocytopenia, , renal impairment, fever
● Pathology: (aka vWF cleaving protease) → large vWF multimers-microthrombi formation

HUS-
● Triad = t​ hrombocytopenia, acute RF, MAHA
● Following E.coli O157 infection

ITP- ABs against plts

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103
Q

Effect of B12 def on bone marrow and spinal cord

A

BM- hypercellular megaoblasts

SC- myelin degeneration in posterior and lateral columns- SADC

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104
Q

Where absorption of iron occurs

A

Duodenum and upper jejenum

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105
Q

Pernicious anaemia sx

A

Macrocytic normochromia blood cells
Hyperplasia of BM
Gastric atrophy
Subacute degeration of spinal cord
Atrophy of vagina and tongue

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106
Q

Cell lineage of CML

A

B cell

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107
Q

Differentiating leukaemia

A

ALL- children

AML- fast onset, anaemia and thrombocytopaenia, auer rods

CML- Very high WCC,, Philadelphia chromosome 9;22

CLL- Very high WCC, LN affected, smudge cells

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108
Q

Types of grafts

A

Splits thickness- Epidermis and a bit of dermis
Can take larger amount from recipient site due to contraction- for larger grafts
Buttock, thigh

Full thickness- epidermis and dermis- smaller grafts due to requiring direct closure
Post/preauricular, groin, supraclavicular

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109
Q

When flaps are used and types of flaps

A

Flaps- has its own blood supply
Used for large defects
Where graft would produce poor cosmetics- face

Local - tissue adjacent to defect

Advancement- move forward without use of transposition or rotation

Transpositional- moved laterally onto defect- leaves secondary defect needing closure

Rotational- semi circular- rotated onto defect

Z plasty

Free flap- forearm- radial artery
ALT- lateral circumflex
DIEP/TRAM- inferior epigastric

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110
Q

Healing of peritoneum

A

Suture- local ischaemia
Clean defect- heals without adhesions

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111
Q

Healing of GI anastomoses

A

Better in upper GI tract SI>Colon
Very dependent of own blood supply
Interrupted sutures of sero-muscular layer prevents ischaemia of mucosa

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112
Q

Effect of ionising radiation of tissues

A

BM- suspends renewal of all cells
Skin- cessation of mitosis and desquamination
Intestines- loss of epithelium - diarrhoea
Gonads- small dose- sterility
Lung- fibrosis
Kidney- loss of parynchemal cells- impaired function

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113
Q

When each type of therapeutic radiation is used

A

Treatment- BCC, SCC
Adjuvant- aimed at clinically undetectable masses- axillary LN clearance with breast
Palliative- bony mets aids pain

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114
Q

Local Burn injury response

A

Zone of necrosis - inner zone, irreversible
Zone of stasis- damaged tissue perfusion - can progress to necrotic
Zone of hyperaemia - increased perfusion due to inflammatory- will recover

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115
Q

Systemic burn injury response

A

Seen in >20%- massive inflammatory mediators

CV- increased permeability, peripheral and splanchnic vasoconstriction
Hypotension, tachy

Resp- airway oedema
ARDS

Metabolism- can triple- catabolism, muscle wasting

MSK- compartment syndrome

Renal- hypoperfused- ARF
Myoglobin- ATN

GI- ulceration- curling

Immuno- depression- increase sepsis

Haem- Haemolysis due to damage of erythrocytes by heat and microangiopathy

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116
Q

Calculating BSA of burns

A

Rule of 9s
Head- 9
Each arm- 9
Leg- 18
Front torso- 18
Back torso-18
Crotch- 1

Paeds- same but head 18
Legs-14

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117
Q

Types of burn due to thickness- characterisations

A

Superficial- epidermal - erythema
No blister
Good cap refill
Not counted in BSA estimation

Superficial dermal- epidermis and papillary dermis
Pink oedematous and blisters
Good refill, intact sensation
Counted in BSA

Deep- include dermis
Reduced/absent cap refill
Not as painful

Full thickness- deeper than dermis
Eschar
Absent cap refill and sensation

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118
Q

Escharotomy and its placement

A

To receive dead tissue’s constriction of tissue underneath
Chest
Ulnar border, radial border
Inner leg
Outer leg

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119
Q

What chromosome abnormality occurs in Cri Du chat

A

5p-
Deletion of short arm of 5

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120
Q

Examples of angenesis

A

Renal- failure of mesonephric ducts to give rise to ureteric bud, with failure of induction of metanephric blastema

Thymic- Di George syndrome - T cell def
Anencephaly- neural defect and fatal

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121
Q

Examples of atresia

A

Atresia is the lack of formation of lumen where it is suppose to form

Oesophageal - failure to separate trachea and oesophagus- may result in fistula

Biliary - absence of bile ducts- obstructive jaundice

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122
Q

Examples of hypoplasia

A

Developmental dysplasia of hip- failure to develop acetabulum causing disclocation due to flat roof

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123
Q

Examples of metaplasia in epithelial tissue

A

Squamous - in ciliary of smokers (columnar)
Squamous- transitional of bladder in schisto
Columnar- Barrets
Squamous (columnar) - gallbladder from chronic inflammation
Squamous nose, bronchi, urinary- vit a def

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124
Q

Characteristics of dysplasia

A

Increased tissue bulk, mitotic activity

Cellular atrypia- pleomorphism, high nuclear-cytoplasmic ratio, hyper chromatic nuclei
Decreased differentiation- more primitive

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125
Q

Which molecules increase leucocytes adhesion

A

Leucocyte surface
Complement 5a
TNF
Leukotriene B4

Endothelial
IL1
Endotoxins
TNF

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126
Q

Actions of prostaglandin in acute inflammation

A

Increase vascular permeability
Platelet aggregation
Diasaggregation

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127
Q

Role of bradykinin

A

Can increase permeability and vasodilation
Chemical mediator of pain

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128
Q

Lymphatics response to inflammation

A

Gaps open allowing protein to enter- can carry to lymph nodes for lymphocytes to recognise antigens
Channels become dilated to increase flow and limit oedema

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129
Q

Role of macrophages in acute inflammation

A

Produce Il1 and TNFa to stimulate endothelial cells to produce adhesion molecules to allow neutrophils to enter
Phagocytose

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130
Q

Role of neutrophils in acute inflammation

A

Bind to organisms that have been opsonised
Phagocytose- lysosome
Release of lysosymes into tissue

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131
Q

Types of inflammation

A

Serous- protein rich fluid- serous cavities- peritonitis
Catarrhal - mucus in mucus membrane
Fibrinous- fibrinogen - peritonitis
Haemorrhagic- bleed- pancreatic, meningitic
Suppurative- pus- empyema
Membranous- epithelium coated with membrane of fibrin, desquamintated epithelial - diptheria
Psuedomembranous- C diff
Nectotising - gangrenous appendicitis

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132
Q

Sequalae of acute inflammation

A

Resolution - min damage, regenerative organ,
Suppuration - pus formation
Organisation - replacement of tissue by granulation tissue
Chronic inflammation - causative agent not removed

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133
Q

Chronic inflammation features

A

Lymphocytes, plasma, macrophages predominate
Granuloma

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134
Q

Types of giant cell

A

Langhans- horseshoe- TB, syphillis, sarcoid, crohns

FB- large cells scattered throughout

Touton- ring of central nuclei, lipid in cytoplasm- fat necrosis, xanthderma, Xanthogranulomas, Dermatofibroma

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135
Q

AB in pernicious anaemia

A

AB against parietal cells

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136
Q

Nerve injury and there resolution

A

Neuropraxia- nerve intact but electrical conduction affected- no WD

Axonotmeis- axon damaged, myelin preserved- Wallerian degernation

Neurotmesis- disruption in axon, myelin and surrounding
Wallerin occurs

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137
Q

Inheritance of achondroplasia

A

AD

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138
Q

What vessel is more likely to be involved in mesenteric artery embolus

A

SMA

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139
Q

Antiphospholipid syndrome sx ,coag results and ABs

A

Thromboembolism
Miscarriage
APTT raised
Lupus anticoagulant present

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140
Q

Biochem of Pagets and tx

A

All normal
Raised ALP

Bisphosphonates

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141
Q

Where are sarcomas most commonly found

A

Extremeties

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142
Q

Test to confirm ABO incompatibility

A

Direct Coombs Test

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143
Q

Trotters triad (NP carcinoma)

A

Unliateral conductive hearing loss
Ipsilateral facial and ear pain
Ipsilateral paralysis of soft palate

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144
Q

Apple green birefringence with polarised light

A

Amyloid

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145
Q

Differentiating lung cancers

A

Adenocarcinoma- non smokers
Small cell- paraneoplastic, mets early
SCC- bronchus, central lung- slow growing

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146
Q

Blood group associated with gastric cancer, most common types and poor prognosis

A

Group A
Adenocarcinoma
Signet ring- higher mets

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147
Q

Ix if lymphoma is suspected

A

Excision biopsy of lymph node

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148
Q

Differentiating in situ disease of breast

A

Ductal carcinoma in situ
Comedo- microcalcifications
Cribiform- multifocal
Micropapillary- multifocal

Lobular in situ
No micro calcifications
Single growth patter
Hard to detect on mammography

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149
Q

Most common adverse event in RCC and FFP

A

Pyrexia with RCC
Urticaria- FFP

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150
Q

Papillary carcinoma on FNA and how it spreads

A

Well differentiated
Usually contain a mixture of papillary and colloidal filled follicles
Histologically, they may demonstrate psammoma bodies (areas of calcification) and so called ‘orphan Annie’ nuclei

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151
Q

Gastric gastro-intestinal stromal tumour cell origin

A

Interstitial pacemaker cells (of Cajal)

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152
Q

Medical treatment of carcinoid

A

Octreotide

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153
Q

Which breast cancer most commonly invades the contralateral breast

A

Invasive lobular carcinoma

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154
Q

Tx of ductal ectasia

A

Multiple duct- total duct excision

Single- microdochectomy

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155
Q

Median arcuate ligament syndrome

A

Compresses coeliac artery

The classic signs of epigastric pain with an audible bruit are only found in a minority.

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156
Q

Which organ do sarcomas usually spread to

A

Lung

Brain and liver spared

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157
Q

Which sarcomas spread via lymphatics

A

Synovial sarcoma
Clear cell sarcoma
Angiosarcoma
Rhabdomyosarcoma
Epithelioid sarcoma

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158
Q

Tx with Abc and develop dysphagia and odynophagia

A

Oesophageal candidacies

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159
Q

Def in what leads to poor wound healing

A

Ascorbic acid (Vit C)

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160
Q

AB in anti phospholipid syndrome

A

Lupus anticoagulant
Anti-cardiolipin
Anti-β2-glycoprotein

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161
Q

How thyroid cancers spread

A

Papillary- usually multimodal - lymphatics- disease confined to neck

Follicular- haematogenously- skull, lungs

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162
Q

Virus risk of causing anal cancer

A

HPV 16/18

Same for penile, vulva, cervical, oralpharyngeal

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163
Q

Glucagonoma

A

Diarrhoea
Weight loss
Necrolytic migratory erythema- skin rash of erythematous blisters involving the abdomen and buttocks. The blisters have an irregular border and both intact and ruptured vesicle

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164
Q

Lead poisoning sx

A

abdominal pain
peripheral neuropathy (mainly motor)
fatigue
constipation
blue lines on gum margin

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165
Q

Hypersensitivty of TB

A

Type 4
Granuloma

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166
Q

What affect 5HIAA levels

A

Food- spinach, cheese, wine, caffein

Drugs- naproxen, MOAi

Recent surgery

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167
Q

Most common extra colonic lesion in FAP

A

Duodenal polyps

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168
Q

Hypospelnism blood film

A

Howell-Jolly bodies
Pappenheimer bodies
Poikilocytes (Target cells)
Erythrocyte containing siderotic granules
Heinz bodies
Basophillia
Pitted RBC

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169
Q

Tumour type in Lynch syndrome

A

Right sided colonic cancers occur at a young age.
These tumours are often poorly differentiated and mucinous.

Endometrial

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170
Q

Retroperitoneal fibrosis sx

A

Lower back pain
Abdo fullness on examination
Hydronephrosis
Medially displaced ureters
Peri aortic mass

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171
Q

Features used to grade breast cancer

A

Tubule formation
Mitoses
Nuclear pleomorphism
Coarse chromatin

172
Q

What is effected in marfans

A

Fibrillin

173
Q

RF for osteosarcoma

A

Pagets

174
Q

Conditions to exhibit Koebner phenomenon

A

Psoriasis
Vitiligo
Warts
Lichen planus
Lichen sclerosus
Molluscum contagiosum

175
Q

CNS tumour that arises in the 4th ventricle and can grow through the foramina

A

Ependymoma

176
Q

Which chemical is associated with bladder cancer

A

B naphtalamine

177
Q

Coag factors affected in liver disease

A

Factors 1,2,5,7,9,10,11

178
Q

Dysphagia after tx of lung cancer

A

Radiation stricture

179
Q

Amoebic abcess sx

A

Presenting complaints typically include fever and right upper quadrant pain

Ultrasonography will usually show a fluid filled structure with poorly defined boundaries

180
Q

Hyatid cyst on USS

A

Ultrasound may show septa and hyatid sand or daughter cysts.

181
Q

Changes in cells in stomach that are at risk of cancer

A

Intestinal metaplasia of columnar type
Atrophic gastritis
Low to medium grade dysplasia
Patients who have previously undergone resections

182
Q

Lobular carcinoma in situ management

A

Breast MRI
Low chance of malignancy

183
Q

Mx of carcinoid tumours

A

Right hemicolectomy if large

184
Q

X ray of osteoclastoma

A

Multiple lytic and Lucent areas
Soap bubble

185
Q

Sx of von hippie Lindau syndrome

A

cerebellar haemangiomas
retinal haemangiomas: vitreous haemorrhage
renal cysts (premalignant)
phaeochromocytoma
extra-renal cysts: epididymal, pancreatic, hepatic

186
Q

Encapsulated pathogens

A

Neisseria men
Strep pneumonia
Klebiella
H influenza
E coli

187
Q

USS surveillance of AAA

A

3cm- 4.4cm - 1 year
4.5-5.4cm- 3 monthly

188
Q

Tumours types most frequently found in person with aggressive fibrzomatosis

A

Desmoid tumour

The main risk factor (for abdominal desmoids) is having APC variant of familial adenomatous polyposis coli. Most cases are sporadic.
Treatment is by surgical excision.

189
Q

Abdomen is distended and filled with gelatinous substance and tx

A

Pseudomyxoma Peritonei
Rare mutinous tumour arising from appendicitix

Is usually surgical and consists of cytoreductive surgery (and often peritonectomy c.f Sugarbaker procedure) combined with intra peritoneal chemotherapy with mitomycin C.

190
Q

Lesion suspicious of melanoma tx

A

Excisions biopsy
If confirmed then wide excision

191
Q

Which clotting factors does DIC consume most of initially

A

5,8

192
Q

Oesophageal cancer at increased risk after Hellers cardiomyotomy

A

SCC

193
Q

Reason for oedema forming 2 weeks post burns

A

Hypoalbuminaemia

194
Q

Mediators that produce vascular dilation in acute inflammation

A

histamine, prostaglandins, nitric oxide, platelet activating factor, complement C5a (and C3a) and lysosomal compounds

195
Q

Types of parotid lesions

A

Benign pleomorphic adenoma-
Most common parotid neoplasm (80%)
(classic biphasic histological appearance)
Slow growing, lobular, and not well encapsulated

Warthin tumor- Most common bilateral benign neoplasm of the parotid

Haemangioma- most common in child <1- hyper vascular

Malignant
Adenoid cystic carcinoma- Tendency for perineural spread
Distant metastasis more common

Andenocarcinoma

Mucoepidermoid- 30%
Low potential for local invasiveness and mets

196
Q

NFM 1 vs 2

A

1- cafe au late, optic gliomas, Lisch nodule, learning difficulties
2- bilateral acoustic neuromas, optic tumours, spinal

197
Q

Most common child polyp

A

Juvenile polyp- hamartomatous lesions- usually in rectum

198
Q

Initial investigation for recurrence of follicular carcinoma of thyroid

A

Thyroglobulin

199
Q

Cowden disease

A

PTEN mutation-harmatomas
Macrocephaly
Intestinal hamartomas
Breast cancer risk

200
Q

Klatskin tumour

A

A Klatskin tumor (or hilar cholangiocarcinoma) is a cholangiocarcinoma (cancer of the biliary tree) occurring at the confluence of the right and left hepatic bile ducts.

201
Q

Osteopetrosis

A

Defective osteoclast function resulting in failure of normal bone resorption
Bone becomes very dense

202
Q

Kartageners syndrome

A

Immotile ilia- prone to infection
situs inversus (organs in chest and abdo reversed), chronic sinusitis, and bronchiectasis

203
Q

Ix for pharyngeal pouch

A

Swallow study
Gi endo CI

204
Q

Growth around breast implants

A

Dystrophic calcification

205
Q

Hydatid cyst sx, x ray, tx

A

Hydatid disease is more common in those who work with sheep or dogs.

Liver function tests may be abnormal and an eosinophilia is often present.

Plain radiographs may reveal a calcified cyst wall
Daughter cyst

Surgery

206
Q

Which metastatic bone tumours is at the greatest risk of pathological fracture ?

A

Peritronchanteric from breast carcinoma

Due to them being lytic lesions and high loading area

207
Q

Popcorn cells in Hodgkin lymphoma

A

Nodular lymphocyte predominant

208
Q

What makes mesenteric venous thrombosis more likely

A

Prothrombotic state-e.g septic
Patchy areas of infarction

209
Q

Causes of Vit K def

A

Prolonged Abx
Cholestatic jaundice

210
Q

Desmoid tumour

A

Desmoids are clonal proliferations of myofibroblasts and tend to arise from aponeurotic structures.

211
Q

Organism causing filariasis and lymphatic obstruction

A

W. Bancrofti

212
Q

Thyroid cancer most likely to cause local invasion

A

Anaplastic carcinoma

213
Q

Thyroid specimen showing intense lymphocytic infiltrate with acinar destruction and fibrosis

A

Hashimotos thyroiditis

214
Q

Tx of gastric cancer

A

Proximally sited disease greater than 5-10cm from the OG junction may be treated by sub total gastrectomy

Total gastrectomy if tumour is <5cm from OG junction

215
Q

Tumour linked with PVC factory in liver

A

Angiosarcoma

216
Q

Rate of nerve repair

A

1mm/day

217
Q

When should plts be given in pt with ITP having splenectomy

A

After splenic artery is ligated

218
Q

Amino acid in all collagen

A

Glycine

219
Q

Conditions With defects in collagen

A

Osteogenesis imperfecta - defect of type 1
Ehlers Danlos- type 1 and 3- hyper mobility and organ prolapse

220
Q

Change in blood cells after splenectomy

A

Increase in neutrophils- eventually replaced by lymphcytosis and monocytosis
Plts increase
Reticulocyte increase

Target, siderocytes

221
Q

What is often found in biopsy of sarcoid

A

Asteroid bodies

222
Q

ECG changes with several packed red cells

A

Hyperkalaemia- tented t waves, flat p, prolonged PR and QRS

223
Q

Where dermoid cysts occur and sx

A

A cutaneous dermoid cyst may develop at sites of embryonic developmental fusion.

They are most common in the midline of the neck, external angle of the eye and posterior to the pinna of the ear.

They typically have multiple inclusions such as hair follicles that bud out from its wall

224
Q

Gram + organism with sulphur granules

A

Actinomycosis

225
Q

Lumbar canal stenosis sx

A

Pain in legs and back
Neuro symptoms
walking up hill improves

226
Q

Pagets disease of nipple appearance

A

A weeping, crusty lesion such as this is most likely to represent Pagets disease of the nipple (especially since the areolar region is spared).

227
Q

Linitis plastica features

A

Adenocaricinoma of stomach

Diffuse infiltrating lesion, the stomach is fibrotic and rigid and will not typically distend.

Pathologically signet-ring cell proliferation occurs.

228
Q

Mx of AAA that has ruptured

A

keep the BP≤100mmHg

If the patient is unstable, they will require immediate transfer to theatre for open surgical repair
If the patient is stable, they will require a CT angiogram to determine whether the aneurysm is suitable for endovascular repair*

229
Q

What can happen to the cells in duodenum with H pylori infection

A

Metaplasia to gastric antrum cells

230
Q

Hassals corpuscle is located where

A

Medulla of Thymus

231
Q

Causes of chronic inflammation

A

Primary
Persisting infection- which result in delayed reactions

Prolonged exposure to non biodegradable substances

AI conditions

Secondary - less likely
Acute inflammation

232
Q

What cancer does schisto cause

A

Squamous cell carcinoma

233
Q

Margins of excision of melanoma

A

Breslow thickness
0-1mm- 1cm margin
1-2 1-2cm
2-4 2-3cm
>4 3cm

234
Q

When does someone with a carcinoid tumour start experiencing carcinoid syndrome sx

A

When mets occur- spread to liver

235
Q

Most likely reason for splenomegaly with FH and anaemia

A

Hereditary spherocytosis

236
Q

TB pathology reasoning

A

Mycobacteria stimulate a specific T cell response of cell mediated immunity

237
Q

Neck lump that is CD20 positive

A

Thyroid gland lymhoma

CD20 marker for lymphocytes

238
Q

Types of NHL lymphoma

A

NHL

B cell
High grade
Burkitts- jaw mass, EBV, starry sky
Diffuse, large- most common

Low grade
Follicular
Mantle
MALT- H pylori, Sjogren, Hashimoto

T cell
ATLL- HTLV1, clover cells
EATL- coeliac
Cutaneous

239
Q

Half life of plts

A

10d

240
Q

Location of Paneth cells

A

Crypt of liverkunh

241
Q

Space involved in Ludwig angina

A

Submandibular

242
Q

Post tooth extraction, pus, yellow granules

A

Actinomycetes

243
Q

Where each type of necrosis is seen

A

Coagulative- all apart from brain
Caseous- TB
Liquefactive- brain and wet gangrene
Fat- pancreatitis and breast
Fibrinoid- Mal HTN, vasculitis, Aschoff body

244
Q

Clearest evidence of malignancy from primary tumour

A

Infiltration of surrounding structure

245
Q

MOA of doxorubicin

A

Inhibits DNA and RNA synthesis by intercalating base pairs

246
Q

MAO of cisplatin

A

Crosslinks DNA, this then distorts molecule and induces apoptosis (similar to alkylating agents)

247
Q

MOA of cyclophosphamide

A

Phosphoramide mustard forms DNA crosslinks and then cell death

248
Q

Slow growing bone tumour. Their favored origin is remnants of the notochord.

A

Chordoma

Chordomas can arise anywhere from the skull base to the sacrum. The two most common locations are the skull base and sacrum.

249
Q

Where are oxyphil cells located

A

Parathyroid

250
Q

Achalasia pathology

A

Achalasia results from progressive degeneration of ganglion cells in the myenteric plexus in the oesophageal wall, leading to failure of relaxation of the lower oesophageal sphincter (LES), accompanied by a loss of peristalsis in the distal esophagus.

251
Q

What are anti centromere, mitochondrial, canca and pcnaca seen with

A

Centro- CREST
Mito- PBC
cANCA- GPA
pANCA- Churg

252
Q

Other antibody in Hashimoto

A

Anti microsomal

253
Q

Types of hypoxic injuries

A

Histolic- metabolic
Stagnant- crush
Anaemic
Hypoxic hypoxia- reduction in inspired such as altitude

253
Q

Features of bone mets bloods

A

Immature cells
Low plt
Low Hb

254
Q

Antimetabolite examples

A

Inhibiting formation of nucleic acids

Methotrexate, 5 flurouracil, 6 mercaptopurine

255
Q

Bone scans

A

Use Technicium labelled phosphate

Show fractures, tumours, healing after necrosis

Show destructive lesions >50%

256
Q

Genes associated with melanoma

A

CDNK, BRCA, CDK4

257
Q

Hep B Ab for vaccine and prev infection

A

Vaccine/inf- Anti HBs

Inf- prev- Anti Hb c
Current IgM

258
Q

Test and timing of HIV

A

p24 antigen and ab
After 4 weeks of exposure

259
Q

What is associated with mycotic aneurysm

A

Arise from bac infection in arterial wall- commonly after ednocartditis
S
They are painful, rapid evolving

260
Q

Spread of sarcoma and most common deposition

A

Fascial planes and blood

Lungs

261
Q

Types of amyloid

A

AA- chronic inflammation
AL- MM or other lymphoproliferative

262
Q

Moa of ciclosporin

A

Inhibiting IL2 release inhibiting proliferation

263
Q

Cause of mycotic aneurysm

A

Staph, salmonella, strep

264
Q

Growth factor oncogenes

A

Sis

265
Q

Programmed cell death regulator

A

bcl 2

266
Q

Structure damaged with medial tibial platea fracture

A

Meniscus

267
Q

What time period do keloid scars form

A

Up to a year later

268
Q

Tumour markers in pancreases carcinoma

A

CA19-9 - raised in >90%

Also CEA

269
Q

Bone callus formation sequence

A

Haematoma
Vascular granulation tissue
Sub periosteal osteoblast stimulatioon
Bone matriculates deposition
Endochondral formation
Callous formation
Remodelling

270
Q

Hypertriglycerideamia vs hypercholsterolaemia deficiency

A

HTG- lipoprotein lipase enzyme

HC- LDL receptor deficient

271
Q

Function of kinins

A

Attracts phags
Promote vasodilation and increase permeability

272
Q

What is benzidine and cyclophosphamide linked with

A

Bladder cancer

273
Q

Leukotriene actions

A

Increased vascular permeability
Bronchoconstriction
Chemotaxis

274
Q

Find a enlarged thymus how should it be manage

A

Midline sternotomy and thymectomy

275
Q

Blood cells origin

A

Eosinophil, baso, neutrophil- myeloblasts (granulocytes)

Lymph- lymphoblasts

Monocyte- monoblast

Platelts- megakaryoblast

Erythrocytes- proerthyroblasts

276
Q

Hinchley staging

A

1- colonic inflammation with pericolic abcess
2- retroperitoneal or pelvic abcess
3- purulent peritonitis, ascites, pneumoperitoneum
4- faecal peritonitis

1-2 drained by radiology
3-4 emergent surgery

277
Q

What is seen on a cellular level of atrophy

A

Greater number of autophagic vacuoles

278
Q

Complement activation

A

Classic- immunoglobins- C1,2,4
Bacteria- alternative - C3b
Mannose-C2,4

Converge to C3- C5 lytic pathway

279
Q

Cause of type 3 hypersensitivity

A

Immune complexes

post-streptococcal glomerulonephritis, systemic lupus erythematosus, farmers’ lung (hypersensitivity pneumonitis), and rheumatoid arthritis, IgA vas

280
Q

What are target cells seen in

A

Thalassaemia, sickle and liver disease

281
Q

Lytic vs sclerotic bone met lesions

A

Prostate- sclerotic

Breast and lung- both

Renal and thyroid- lytic

282
Q

Chagas disease pathology and organism

A

Tryp Cruzi

Destroy ganglionic cells in myenteric plexus

Similar to achalasia

Cardiomyopathy

283
Q

Heparin moa

A

Enhance antithrombin 3

2,7,9,10,11,12

284
Q

Cardiac conditions causing sudden death

A

Bicuspid aortic valve
Long QT
Brugada
HOCM

285
Q

Thrombomodulin moa

A

Cofactor in thrombin induced activation of protein C

Which inhibits V and VIII

286
Q

erb 2 function

A

Growth factor receptor oncogene

287
Q

PDCD 1 fucntion

A

Programmed cell death

288
Q

What neoplastic cells rely on to mets

A

Secretion of protease- overcome cohesion
Integrin expression
Adhere to BM

289
Q

TNM of lung

A

T1- <3cm
2- 3-5cm
3-5-7cm- or invades parietal pleura, chest wall, diaphragm
4- mediastinum

290
Q

AB with highest conc

A

IgG

291
Q

What protein does HPV interfere with

A

p53

292
Q

Hyaline cartilage nutrients supply

A

Avascular

Relies on diffusion from synovial fluid

293
Q

Collagen in hyaline cartilage

A

Type 2

294
Q

Baroreceptor firing rate in dehydration

A

Inhibition- stretch receptors

Fires when too high

295
Q

Presentation 21 OH def

A

Complete - cannot produce cortisol or aldo- crisis

Partial- later presentation- can produce cortisol- increased testosterone

296
Q

Syphillis histology

A

Granuloma with tertiary

297
Q

Hypogamagloeamia presentation

A

Recurrent sinopulmonary infections

H influenzas, strep

298
Q

Liver enzyme results interpretation

A

AST/ALT- liver
ALP- cholestatic- AST, ALT normal

AST:ALT 2:1- alcohol

GGT- alcohol intake

299
Q

Oral contraceptive, now has mass by cervix dx and histology?

A

Endocervical polyp

Microglandular hyperplasia

300
Q

What is included in cellular immunity

A

lysozyme
complement
acute phase proteins
NK cells

301
Q

FH of teratoma increases risk by

A

4x

302
Q

What cell does not have fc receptor

A

T cell

303
Q

Virus causing HPC

A

Hep B

304
Q

Levels measured in carcinoid syndrome

A

5 HIAA

305
Q

Carcinoid effect on the heart

A

Deposit on valve

306
Q

Organism with fishy discharge

A

Gardenerella vaginalis

307
Q

Bacili, non pathogenic, excessive discharge organism

A

Lactobacilus

308
Q

Pathological process in BPH

A

Hyperplasia

309
Q

Acute severe hypercalcaemia

A

> 3.4

Symptomatic

310
Q

Tertiary hyperparathyroid, high Ca not severe, asymptomatic mx

A

Elective aprathyroid

311
Q

Fixed ill defined lump on US but not on mammography

A

Lobular carcinoma

312
Q

Uterus in preg growth cellular vs breast in puberty

A

Uterus- hyperplasia nad hypertrophy

Breast- hyperplasia

313
Q

Histological findings in ARDS

A

Increase cap perm
Interstiital oedema
Hyaline formation
Fibrosis

314
Q

MCV formula

A

MCV=hct x 1000/RBC

315
Q

Where do neuroblastoma arise

A

Adrenal medulla
From neural crest cells

316
Q

Fluid by recent surgical scar, clear fluid, ulcerated

A

Suture granuloma

317
Q

Pro inflammatory cytokines

A

IL1
Il6
TNFa

318
Q

Consistency of bilestone in crohns and reason

A

Cholesterol - due to terminal ileum impairment - less absorbed- so cannot emulsify the cholesterol

319
Q

Most common benign ovarian tumour pre menopousal

A

Dermoid cyst

320
Q

IL in coagulation cascade

A

IL6

321
Q

Sudden collapse on warfarin dx

A

Acute subdural

322
Q

What is screened in donated blood

A

Hep B C, HIV 1+2, HTLV and syphillis

323
Q

Zone where prostate cancer forms

A

Peripheral zone

324
Q

How immediate HS reaction works

A

IgE binds to Fc portion on cells

325
Q

Lights criteria for exudative effusion

A

Pleural protein :serum >0.5
Pleural LDH:serum >0.6
Effusion LDH greater than 2/3 of serum

326
Q

Peronie disease

A

Inflammation of tunica albuginea- causing curvature

327
Q

Thalassaemia MCV

A

Microcytic

328
Q

What are platelets deficient of in Gray pet syndrome

A

Alpha granules

329
Q

What malignancy does vit A def predispose you to

A

Resp tract squamous metaplasia

330
Q

Tumour supressor genes

A

p53- mutation prevents apoptosis
BRCA1
APC
TP53
Rb
PTEN

331
Q

Proto oncogenes

A

RAShed ToGo cMyc SIS ER Bell A

ras - (signal transducer) GTP

TGF-α

N-my c - (transcription factor, TF) Burkitt’s lymphoma

SIS gene GF) [osteosarcoma+astrocytoma]

ERB-B1/B2 - (GF receptor)

BCL-2
(programmed cell death regulator)

Abl(signal transducer)
[anti-apoptosis gene]

332
Q

Tumour markers in teste cancer

A

Seminoma- LDH, bhcg + 10%

Non seminaoma- <30
Teratoma- none
Yolk sac- AFP+++
Chorio bhcg +++

333
Q

Which cells secrete IF

A

Parietal

334
Q

Siderblastic anaemia MCV

A

Normo/micro

335
Q

Hyperacute reaction mediators

A

Complement

336
Q

What features do B cells have

A

Can undergo somatic hypermutation
Isotope switching
IgG on surface

337
Q

Artery ruptured with ACL

A

Middle geniculate

338
Q

Bias in screening programes

A

Lead time bias-longer survival times due to earlier diagnosis in screening

Length time- asymptomatic less fast developing diagnosed

339
Q

What can scleroderma do to the kidneys

A

Hyperplastic arteriosclerosis with fibrinoid necrosis
Malignant HTN

340
Q

Which sex cord tumour causes females to become masculin

A

Sertoli leydig

341
Q

Small yellow tumour causing endometrial hyperplasia

A

Fibrothecoma

342
Q

Anascara

A

Generalised oedema

Caused by cardiac/liver failure, chemo- docetaxel

343
Q

Ig in complement fixation in alternate and classic pathway

A

Classic- IgM/G
Alternate- IgA

344
Q

Women who are offered BRCA testing

A

Under 50 with triple neg BC

345
Q

Hamartoma

A

Overgrowth with disordered architecture
of a variety of normal fully differentiated tissue

346
Q

Sarcoid electrolyte disturbance cause

A

High Ca due to high Vit D from macrophages in granuloma

347
Q

Haemolytic anaemia hypersensitivity type

A

2

348
Q

Location of cancer most likely to mets to adrenal s

A

Lung or breast

349
Q

Substance stimulating proliferation of smooth muscles and collagen in plaque formation

A

PDGF

350
Q

Colorectal polyp most metastatic potential

A

Villous adenoma

351
Q

What is NO derived from

A

Cyclic GMP

352
Q

IPPV physiological effects

A

Reduced Venous return
Reduce CO

353
Q

Mutation for Wilm tumour

A

WT1

354
Q

Which part of cell cycle is under p53 influence

A

G1- where cells with significant damage to DNA is arrested

355
Q

Malignancy most common following exposure to radiation

A

Leukaemia

356
Q

Ig type in Graves

A

IgG

357
Q

Biggest cause of hyperthyroid

A

Graves
Most adenomas are v v small only picked up on in iodine scan

358
Q

Glucose and protein in CSF vs blood

A

Less in CSF normally

359
Q

Ix in early RA

A

US

360
Q

Anaemia pO2 effect

A

Reduced mixed venous
Arterial same

361
Q

HS reaction in acute transplant rejection

A

4

362
Q

RF for H Lymphoma

A

EBV
HIV
Organ transplant

363
Q

What does metastatic calcification occur in

A

Hyperparathyroid

364
Q

Osteopenia definition

A

T score between -1 and -2.5

365
Q

TB organisms

A

Mycobacterium tuberculosis hominis

Bovis- cows- spread by milk

366
Q

Which part of the brain regulates appetite

A

Hypothalamus in diencephalon

367
Q

Activation of cytotoxic t cells

A

MHC 1 presented by APC

368
Q

How long after gastrectomy would you get osteomalacia

A

10 years

369
Q

IL 1, 4, 5 function

A

1- inflammatory- mucus in GI
4- T cell prolif and IgE
5- eosinophils

370
Q

B12 use in red cells

A

Maturation process

371
Q

Histology of rheumatoid nodule

A

Central necrotic area surrounded by histiocytic macrophages
Enveloped by lymphocytes, olasma and fibroblasts

372
Q

Acute renal tubular dysfunction tx, damaged and urine osmolality

A

Omsotic and supportive

Medullar ischaemia

Low urine osmolality

373
Q

AB for ABO vs rheusus

A

ABO- IgM
Rh- IgG- can cross placenta

374
Q

Management of Kaposi Sarcome

A

Biopsy

If AIDS- chemo
Transplant- change meds

375
Q

What IL has anti inflammatory

A

Il 10

376
Q

Where medulloblastoma forms

A

Cerebellar vermis

377
Q

What acoustic neuroma arrises from

A

Schwann cells

378
Q

Jamaican with chest pain and low Hb

A

Sickle cell

379
Q

What acts as opsinon

A

IgG
C3b

380
Q

Coeliac and mantoux hypersensitivty

A

4

381
Q

Where factor 8 is produced

A

Liver and vascular endothelium

382
Q

Hereditary angioedema tx

A

FFP as require C1 esterase inhibitor

383
Q

Main cell in sjorgrens

A

CD4

384
Q

Proportion of colorectal cancer CEA is rasied in and what can also cause it to rise

A

90%

Smoking

385
Q

BRCA 1 + 2 location

A

17 and 13

386
Q

Where is EPO produced

A

Peritubular fibroblast in kidney

387
Q

Erythroproduction in fetus location

A

Liver

388
Q

What are epithelia cells

A

Enlarged macrophages

389
Q

Irregular firm lump in diabetic young lady

A

Lymphocytic lobulitis

390
Q

Most useful in establishing IgE related mechanism

A

Skin prick

391
Q

Timeline of repair of cleft lip and palate

A

Lip repaired before 6m
Then palate 12-18m

392
Q

How prostate spread

A

Haem

393
Q

Where are pappenheimer bodies seen

A

Siderocyte-result of sideroblastic erythropoiesis producing siderotic, non-heme iron intracytoplasmic granules

Myelodysplastic, sideroblastic, haemolytic, SCD

394
Q

Def in what after splenecomty

A

Properdin- complement activator

395
Q

Pre formed vs newly formed mediator in mast cell

A

Tryptase histamine pre formed

Thromboxane new

396
Q

Liver flukes reaction

A

Type 1
eosinophilia

397
Q

Endothelin 1

A

Vasoconstrictor
polypeptide

398
Q

Hypercalcaemia lung cancer

A

Non small cell - squamous

399
Q

NO function

A

inhibit platelet aggregation
Relax
freely diffuses

400
Q

pCO2 on coronaries

A

Increase causes vasodilation

401
Q

Which immune cell contains perforin

A

NK cells

402
Q

Changes seen in GORD

A

Basal cell hyperplasia and elongation of papillae

403
Q

SCC in situ vs actinic

A

SCC in situ full thickness of epidermis

404
Q

Lobular carcinoma histology

A

Discrete single file of small uniform cells

Loss of E cadherin

405
Q

Thyroid cancer histology

A

Medullary- amyloid, pink

Papillary- psammoma, ophan annie eye - gound glass nuclei

Lymphoma- Cd20 and heratin

Anaplastic - spindle, high mitotic, pleomorphic

FOlicular- follicles, cuboidal epithelial cells

406
Q

RA findings on synovial biopsy

A

Proliferative synovitis swith synovial cell hyperplasia

407
Q

Histology of thyroglosal duct

A

Resp like, follicle in cyst wall

408
Q

MRSA septicaemia tx

A

Vanc

409
Q

Thymoma histolgy

A

Calcification
Abnormal epithelial cells and lymph

410
Q

Mesothelioma histology

A

Epithelial growth with tubules and glands

411
Q

What are MMPs

A

Group of proteolytic enzymes
All contain zinc ion

412
Q

Bosniak classification

A

Renal cysts
1- simple cyst- no FU
2- thin septa, calc- no FU
3-indeterminate
4- clearly malignant solid

413
Q

Cells mobilising for angiogenesis and stimulating factor

A

Endothelial

VEGF

414
Q

Antibiotic MOA

A

B lactam- pen, ceph, carb- inhibit crosslink of proteins in cell wall
Glyco- vanc, teic- bind to precusor- inhibit cross link

Amnio- protien synth
Tetra
Macro
Clinda
Linezolid

DNA synth- quinilone- cipro, levo
Metronidazole

RNA- rifampicin

Folate- sulpf and trimethoprim

415
Q

Best method to sample parathryoid

A

Frozen intraoperative section

416
Q

Inheritance of malignant hypertermia

A

AD with variable penetrance

417
Q

Post fracture repair- periosteal reaction

A

Osteomyelitis

418
Q

Sheehan vs apoplexy

A

Sheehan -PPH causing hypopituitism

Apoplexy bleed of tumour

419
Q

ACA infarct presentation

A

Leg weakness
Gait apraxia
Urinary incontinence
Dysarthria

420
Q

Fracture of coronoid vs condyle

A

Coronoid- fall onto chin

Condyle- traumatic event

421
Q

Tonsilitis and spheorcytes dx

A

EBV- causes cold AIHA

422
Q

Warm vs cold AIHA

A

Warm- IgG
AI, lympho

Cold- IgM
EBV, mycoplasma, lympho

423
Q

Dissatisfactory SE of sympathetic resection

A

Increased hyperhydrasisi in other parts of body

424
Q

Where iron is found in biopsy in haemachronomatosis

A

Kupffer cells

425
Q
A

eMRCS questions (45 decks)

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