Pathology eMRCS Flashcards
Reporting of investigations in breast
U/M
1 No abnormality
2 Abnormality with benign features
3 Indeterminate probably benign
4 Indeterminate probably malignant
5 Malignant
Prominent oxyphil cells and scanty thyroid colloid in biopsy of thyroid
Follicular caricnoma
Papillary carcinoma histological features
papillary projections and pale empty nuclei
Seldom encapsulated
demonstrate psammoma bodies (areas of calcification) and so called ‘orphan Annie’ nuclei
Papillary carcinoma spread
Lymph node metastasis predominate
Haematogenous metastasis rare
Medullary carcinoma cells and biochem
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.
Treatment of anapaestic carcinoma
Treatment is by resection where possible, palliation may be achieved through isthmusectomy and radiotherapy. Chemotherapy is ineffective
When is fractures callus first visible
3 weeks
Cell types seen in sarcoidosis
T, B cells
Macrophages
Asteroid bodies- eosinophilic star-burst inclusion within a giant cel in granulomas
Staining used for TB
Ziehl - Neelsen
What is heterotopia
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
What is a DALM lesion and how is it treated in a patient with UC
Dysplasia associated mass or lesion
panproctocolectomy
Causes of illiopsoas abscess
Primary- staph aureus
Haematogenous spread of bacteria
Secondary- crohns most common
Diverticulitis
Types of para testicular mass tumours
Teratoma - benign in younger children
Rhabdomyosarcoma - more common malignant solid tumours in children (though all are rare)- mets early
Hyperechoic liver cyst normal AFP
Haemangioma
Hyperechoic- brighter on US
Cyst on US
Anaechoic
Fluid filled are anechoic
X Ray of Ewings sarcoma
large soft-tissue mass with concentric layers of new bone formation ( ‘onion-peel’ sign)
Where does Ewing most commonly occur
malignant round cell tumour occurring in the diaphysis of the long bones in the children
Most common location for osteosarcoma
Knee
X ray of osteosarcoma
Elevated periostreum
Mixed sclerotic & lytic
lesions, cortical breach,
Sun burst appearance
Bone formation within the
tumour
Histology of osteosarcoma
malignant mesenchymal cells
osteoblastic differentiation
What is a Ghon focus
Primary infection of TB
What may be present if a DCIS is high grade
Angiogenesis
Difference between carcinoma in situ vs invasive in breast
Not yet invaded BM
What can elevate PSA levels
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
Dercums disease
Extensive lipomas throughout the body
Causes of carpal tunnel syndrome
MEDIAN TRAP Mnemonic
Myxoedema
Edema premenstrually
Diabetes
Idiopathic
Acromegaly
Neoplasm
Trauma
Rheumatoid arthritis
Amyloidosis
Pregnancy
Tumour marker for ovarian pancreatic and breast
Ovarian- CA125
Pancreas- CA19-9
Breast- CA 15-3
Monoclonal AB
Tumour antigens for prostate, hepatocellula and CR
P- PSA
HC- AFP
CR- CEA
Problems with tumour markers
Low specificity
Breast has low specificity and sensitivity
Liver cell adenoma US and RF
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
Gene affected in FAP
APC
What would you see on colonoscopy of FAP
Typically over 100 colonic adenomas
Screening and management of known APC mutation
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)
HNPCC mutation
Germline mutations of DNA mismatch repair genes
Tumours in HNPCC
○ 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
Screening and tx of HNPCC
Colonoscopy every 1-2 years from age 25
Consideration of prophylactic surgery
Extra colonic surveillance recommended
Puetz jaeger features
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
Screening of peutz jaegar
Annual examination
Pan intestinal endoscopy every 2-3 years
If patient has ruptured aortic aneurysm but the haematoma is contained what should the fluid regime be
1L /4hrs
Rapid infusion may dislodge haematoma
Which cell responds in GVHD
Lymphocytes
AB. mediation of ABO incompatibility
IgM
Sx of ABO incompatibility
Dark urine
Fever
Restlessness
Low BP
High HR
IgA in blood transfusions
If IgA deficient
Produce IgA ABs
Therefore need IgA def transfusions
Transfusion associated GVHD sx
1-2 weeks after transfusion
● GI tract → diarrhoea
● Skin → desquamation, necrosis, maculopapular rash
● Liver failure, bone marrow failure
Only occurs in immunocomprimsied
Glioblastoma CT result
Can traverses the midline
Displays marked central necrosis
Extensive oedema surrounding the lesion
Neoangenesis
Most common brain tumour
Pilocytic astrocytoma in children- hairy
Glioblastoma multiforms in adults- polymorphic, microvascular changes, necrosis
APTT and PT are a measure of
APTT- intrinsic
PT- extrinsic
APTT, PT and bleeding time in haemophilia, vWD and Vit K def
Haemo- APTT increased, PT normal, BT normal
vWD- APTT increased, PT normal, BT increased
Vit K def- APTT and PT increased, BT normal
How massive transfusion affects clotting
Puts the patient at risk of thrombocytopaenia, factor 5 and 8 deficiency.
Test for carcinoid tumour
Blood- Chromogranin A, gastrin
Urine- 5HIAA
CT
If primary unknown SS scintography
Mx of carcinoid tumours
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.
Gardners syndrome- inheritance, characteristic and tx
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
Mx of TCC of bladder
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.
Merkel tumour histology
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.
Merkel tumour treatment
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.
Histopathology of temporal arteritis
Vessel wall granulomatous arteritis with mononuclear cell infiltrates and giant cell formation
How temporal artery biopsy is done
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%
Li Fraumeni syndrome
Sarcoma, cancers of the breast, brain and adrenal glands
Mutation to p53 tumour suppressor gene
AD
High incidence of malignancies particularly sarcomas and leukaemias
Necrosis seen in malignant HTN
Fibrinoid necrosis
Investigations if Oesophageal candidiasis
Test for HIV
Acute mesenteric embolus sx
Sudden onset abdominal pain followed by profuse diarrhoea.
May be associated with vomiting.
Rapid clinical deterioration.
AIP features
abdominal: abdominal pain, vomiting
neurological: motor neuropathy
psychiatric: e.g. depression
hypertension and tachycardia common
AIP diagnosis
classically urine turns deep red on standing
raised urinary porphobilinogen
Pathophysiology of AIP
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
Nottingham prognostic Index score
Tumour Size x 0.2 + Lymph node score+Grade score
Score-LN- Grade
1 0 1
2 1-3 2
3 >3 3
What facilitates phagocytosis
Opsonisation
The micro-organism becomes coated with antibody, C3b and certain acute phase proteins
Infection with which micro-organisms may result in a clinical picture resembling achalasia
Trypanosoma Cruzi
Chagas disease
Result in destruction of the ganglion cells of the myenteric plexus, resulting in a clinical picture similar to achalasia.
Layers of blood vessel
Intima
Media
Adventita
What happens in vessels to cause aneurysms
Loss of elastic fibres from media - primary
Also degradation of collagen in adventitia
Pagets disease of breast
Exczema related changed associated with malignancy
Mondors disease
Localised thrombophlebitis of a breast vein.
Periductal mastitis
Common in smokers
Indurated area
Recurrent infections
Sx of acute on chronic mesenteric ischaemia
Weight loss and abdo discomfort -prodromal
Acute sx
Diaphragm disease
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
Aortic coarctation symptoms
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
Takayasu arteritis sx
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
Normal ESR
Males age/2
Females age+10/2
MEN 1
Parathyroid
Pituitary
Pancrease- ZE syndrome, insulinoma
MEN 2a and 2b
2a-
Parathyroid
Phaeo
Medullary thyroid
Itchy cutaneous lesions
2b-
Medullary thyroid cancer
Phaeochromocytoma
Mucosal neuroma
Marfanoid appearance
Tuberous sclerosis sx
Renal angiomyolipomata
Depigmented ‘ash-leaf’ spots which fluoresce under UV light
Epilepsy and dev delay
retinal hamartomas: dense white areas on retina
Leriche syndrome sx
- Claudication of the buttocks and thighs
- Atrophy of the musculature of the legs
- Impotence (due to paralysis of the L1 nerve)
Atherosclerotic occlusive disease involving the abdominal aorta and/or both of the iliac arteries.
Neutrophil disorders cause
Chronic granulomatous disease
Actions of neutrophils
Movement
Opsonise microorganisms, phagocytosis
Intracellular killing of microorganisms via aerobic (produce HYDROGEN PEROXIDE) & anaerobic mechanisms.
What features would suggest alternative diagnosis over lipoma
Size >5cm
Increasing size
Pain
Deep anatomical location
Poor prognostic factors with SCC
Size >20mm (local recurrence rate of up to 15%)
Depth greater than 4mm (risk of metastasis up to 30%)
Dysphagia lusoria and ix
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
NFM 1 features
1 limb longer than the other
Schwannoma, > 6
Cafe au lait spots, axillary freckling
Thrombomodulin function
Activate protein C
Which factor does vWF affect
Factor 8
Heparin and LMWH MOA
Bind to AT3- inactivate thrombin and factor X
LMWH has less affect on thrombin
Reversal agent for heparin
Protamine Sulphate
Other cells shown on film tin IDA
Pencil cells
Reticulocytes (nucleated)
Which condition do you get spherocytes
HS, AIHA
Which condition do you get Heinz bodies
G6PD def
Which condition do you get target cells
Thalassaemia
Which condition do you get hyperhsegmented neutrophils
Megaloblastic anaemia
Which condition do you get Howell Jolly Bodies
Hyposplenism (SCD, IBD, post spelnectomy)
Which condition do you get Echinocytes (Burr cells)
PK DEF
Which condition do you get basophilic stippling
Lead poisoning
Pyrimidine 5 nuc def
Which condition do you get schistocytes
MAHA (TTP, HUS, DIC)
Which condition do you get Rouleaux formation
MM
TTP vs ITP vs HUS
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
Effect of B12 def on bone marrow and spinal cord
BM- hypercellular megaoblasts
SC- myelin degeneration in posterior and lateral columns- SADC
Where absorption of iron occurs
Duodenum and upper jejenum
Pernicious anaemia sx
Macrocytic normochromia blood cells
Hyperplasia of BM
Gastric atrophy
Subacute degeration of spinal cord
Atrophy of vagina and tongue
Cell lineage of CML
B cell
Differentiating leukaemia
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
Types of grafts
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
When flaps are used and types of flaps
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
Healing of peritoneum
Suture- local ischaemia
Clean defect- heals without adhesions
Healing of GI anastomoses
Better in upper GI tract SI>Colon
Very dependent of own blood supply
Interrupted sutures of sero-muscular layer prevents ischaemia of mucosa
Effect of ionising radiation of tissues
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
When each type of therapeutic radiation is used
Treatment- BCC, SCC
Adjuvant- aimed at clinically undetectable masses- axillary LN clearance with breast
Palliative- bony mets aids pain
Local Burn injury response
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
Systemic burn injury response
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
Calculating BSA of burns
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
Types of burn due to thickness- characterisations
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
Escharotomy and its placement
To receive dead tissue’s constriction of tissue underneath
Chest
Ulnar border, radial border
Inner leg
Outer leg
What chromosome abnormality occurs in Cri Du chat
5p-
Deletion of short arm of 5
Examples of angenesis
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
Examples of atresia
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
Examples of hypoplasia
Developmental dysplasia of hip- failure to develop acetabulum causing disclocation due to flat roof
Examples of metaplasia in epithelial tissue
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
Characteristics of dysplasia
Increased tissue bulk, mitotic activity
Cellular atrypia- pleomorphism, high nuclear-cytoplasmic ratio, hyper chromatic nuclei
Decreased differentiation- more primitive
Which molecules increase leucocytes adhesion
Leucocyte surface
Complement 5a
TNF
Leukotriene B4
Endothelial
IL1
Endotoxins
TNF
Actions of prostaglandin in acute inflammation
Increase vascular permeability
Platelet aggregation
Diasaggregation
Role of bradykinin
Can increase permeability and vasodilation
Chemical mediator of pain
Lymphatics response to inflammation
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
Role of macrophages in acute inflammation
Produce Il1 and TNFa to stimulate endothelial cells to produce adhesion molecules to allow neutrophils to enter
Phagocytose
Role of neutrophils in acute inflammation
Bind to organisms that have been opsonised
Phagocytose- lysosome
Release of lysosymes into tissue
Types of inflammation
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
Sequalae of acute inflammation
Resolution - min damage, regenerative organ,
Suppuration - pus formation
Organisation - replacement of tissue by granulation tissue
Chronic inflammation - causative agent not removed
Chronic inflammation features
Lymphocytes, plasma, macrophages predominate
Granuloma
Types of giant cell
Langhans- horseshoe- TB, syphillis, sarcoid, crohns
FB- large cells scattered throughout
Touton- ring of central nuclei, lipid in cytoplasm- fat necrosis, xanthderma, Xanthogranulomas, Dermatofibroma
AB in pernicious anaemia
AB against parietal cells
Nerve injury and there resolution
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
Inheritance of achondroplasia
AD
What vessel is more likely to be involved in mesenteric artery embolus
SMA
Antiphospholipid syndrome sx ,coag results and ABs
Thromboembolism
Miscarriage
APTT raised
Lupus anticoagulant present
Biochem of Pagets and tx
All normal
Raised ALP
Bisphosphonates
Where are sarcomas most commonly found
Extremeties
Test to confirm ABO incompatibility
Direct Coombs Test
Trotters triad (NP carcinoma)
Unliateral conductive hearing loss
Ipsilateral facial and ear pain
Ipsilateral paralysis of soft palate
Apple green birefringence with polarised light
Amyloid
Differentiating lung cancers
Adenocarcinoma- non smokers
Small cell- paraneoplastic, mets early
SCC- bronchus, central lung- slow growing
Blood group associated with gastric cancer, most common types and poor prognosis
Group A
Adenocarcinoma
Signet ring- higher mets
Ix if lymphoma is suspected
Excision biopsy of lymph node
Differentiating in situ disease of breast
Ductal carcinoma in situ
Comedo- microcalcifications
Cribiform- multifocal
Micropapillary- multifocal
Lobular in situ
No micro calcifications
Single growth patter
Hard to detect on mammography
Most common adverse event in RCC and FFP
Pyrexia with RCC
Urticaria- FFP
Papillary carcinoma on FNA and how it spreads
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
Gastric gastro-intestinal stromal tumour cell origin
Interstitial pacemaker cells (of Cajal)
Medical treatment of carcinoid
Octreotide
Which breast cancer most commonly invades the contralateral breast
Invasive lobular carcinoma
Tx of ductal ectasia
Multiple duct- total duct excision
Single- microdochectomy
Median arcuate ligament syndrome
Compresses coeliac artery
The classic signs of epigastric pain with an audible bruit are only found in a minority.
Which organ do sarcomas usually spread to
Lung
Brain and liver spared
Which sarcomas spread via lymphatics
Synovial sarcoma
Clear cell sarcoma
Angiosarcoma
Rhabdomyosarcoma
Epithelioid sarcoma
Tx with Abc and develop dysphagia and odynophagia
Oesophageal candidacies
Def in what leads to poor wound healing
Ascorbic acid (Vit C)
AB in anti phospholipid syndrome
Lupus anticoagulant
Anti-cardiolipin
Anti-β2-glycoprotein
How thyroid cancers spread
Papillary- usually multimodal - lymphatics- disease confined to neck
Follicular- haematogenously- skull, lungs
Virus risk of causing anal cancer
HPV 16/18
Same for penile, vulva, cervical, oralpharyngeal
Glucagonoma
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
Lead poisoning sx
abdominal pain
peripheral neuropathy (mainly motor)
fatigue
constipation
blue lines on gum margin
Hypersensitivty of TB
Type 4
Granuloma
What affect 5HIAA levels
Food- spinach, cheese, wine, caffein
Drugs- naproxen, MOAi
Recent surgery
Most common extra colonic lesion in FAP
Duodenal polyps
Hypospelnism blood film
Howell-Jolly bodies
Pappenheimer bodies
Poikilocytes (Target cells)
Erythrocyte containing siderotic granules
Heinz bodies
Basophillia
Pitted RBC
Tumour type in Lynch syndrome
Right sided colonic cancers occur at a young age.
These tumours are often poorly differentiated and mucinous.
Endometrial
Retroperitoneal fibrosis sx
Lower back pain
Abdo fullness on examination
Hydronephrosis
Medially displaced ureters
Peri aortic mass
Features used to grade breast cancer
Tubule formation
Mitoses
Nuclear pleomorphism
Coarse chromatin
What is effected in marfans
Fibrillin
RF for osteosarcoma
Pagets
Conditions to exhibit Koebner phenomenon
Psoriasis
Vitiligo
Warts
Lichen planus
Lichen sclerosus
Molluscum contagiosum
CNS tumour that arises in the 4th ventricle and can grow through the foramina
Ependymoma
Which chemical is associated with bladder cancer
B naphtalamine
Coag factors affected in liver disease
Factors 1,2,5,7,9,10,11
Dysphagia after tx of lung cancer
Radiation stricture
Amoebic abcess sx
Presenting complaints typically include fever and right upper quadrant pain
Ultrasonography will usually show a fluid filled structure with poorly defined boundaries
Hyatid cyst on USS
Ultrasound may show septa and hyatid sand or daughter cysts.
Changes in cells in stomach that are at risk of cancer
Intestinal metaplasia of columnar type
Atrophic gastritis
Low to medium grade dysplasia
Patients who have previously undergone resections
Lobular carcinoma in situ management
Breast MRI
Low chance of malignancy
Mx of carcinoid tumours
Right hemicolectomy if large
X ray of osteoclastoma
Multiple lytic and Lucent areas
Soap bubble
Sx of von hippie Lindau syndrome
cerebellar haemangiomas
retinal haemangiomas: vitreous haemorrhage
renal cysts (premalignant)
phaeochromocytoma
extra-renal cysts: epididymal, pancreatic, hepatic
Encapsulated pathogens
Neisseria men
Strep pneumonia
Klebiella
H influenza
E coli
USS surveillance of AAA
3cm- 4.4cm - 1 year
4.5-5.4cm- 3 monthly
Tumours types most frequently found in person with aggressive fibrzomatosis
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.
Abdomen is distended and filled with gelatinous substance and tx
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.
Lesion suspicious of melanoma tx
Excisions biopsy
If confirmed then wide excision
Which clotting factors does DIC consume most of initially
5,8
Oesophageal cancer at increased risk after Hellers cardiomyotomy
SCC
Reason for oedema forming 2 weeks post burns
Hypoalbuminaemia
Mediators that produce vascular dilation in acute inflammation
histamine, prostaglandins, nitric oxide, platelet activating factor, complement C5a (and C3a) and lysosomal compounds
Types of parotid lesions
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
NFM 1 vs 2
1- cafe au late, optic gliomas, Lisch nodule, learning difficulties
2- bilateral acoustic neuromas, optic tumours, spinal
Most common child polyp
Juvenile polyp- hamartomatous lesions- usually in rectum
Initial investigation for recurrence of follicular carcinoma of thyroid
Thyroglobulin
Cowden disease
PTEN mutation-harmatomas
Macrocephaly
Intestinal hamartomas
Breast cancer risk
Klatskin tumour
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.
Osteopetrosis
Defective osteoclast function resulting in failure of normal bone resorption
Bone becomes very dense
Kartageners syndrome
Immotile ilia- prone to infection
situs inversus (organs in chest and abdo reversed), chronic sinusitis, and bronchiectasis
Ix for pharyngeal pouch
Swallow study
Gi endo CI
Growth around breast implants
Dystrophic calcification
Hydatid cyst sx, x ray, tx
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
Which metastatic bone tumours is at the greatest risk of pathological fracture ?
Peritronchanteric from breast carcinoma
Due to them being lytic lesions and high loading area
Popcorn cells in Hodgkin lymphoma
Nodular lymphocyte predominant
What makes mesenteric venous thrombosis more likely
Prothrombotic state-e.g septic
Patchy areas of infarction
Causes of Vit K def
Prolonged Abx
Cholestatic jaundice
Desmoid tumour
Desmoids are clonal proliferations of myofibroblasts and tend to arise from aponeurotic structures.
Organism causing filariasis and lymphatic obstruction
W. Bancrofti
Thyroid cancer most likely to cause local invasion
Anaplastic carcinoma
Thyroid specimen showing intense lymphocytic infiltrate with acinar destruction and fibrosis
Hashimotos thyroiditis
Tx of gastric cancer
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
Tumour linked with PVC factory in liver
Angiosarcoma
Rate of nerve repair
1mm/day
When should plts be given in pt with ITP having splenectomy
After splenic artery is ligated
Amino acid in all collagen
Glycine
Conditions With defects in collagen
Osteogenesis imperfecta - defect of type 1
Ehlers Danlos- type 1 and 3- hyper mobility and organ prolapse
Change in blood cells after splenectomy
Increase in neutrophils- eventually replaced by lymphcytosis and monocytosis
Plts increase
Reticulocyte increase
Target, siderocytes
What is often found in biopsy of sarcoid
Asteroid bodies
ECG changes with several packed red cells
Hyperkalaemia- tented t waves, flat p, prolonged PR and QRS
Where dermoid cysts occur and sx
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
Gram + organism with sulphur granules
Actinomycosis
Lumbar canal stenosis sx
Pain in legs and back
Neuro symptoms
walking up hill improves
Pagets disease of nipple appearance
A weeping, crusty lesion such as this is most likely to represent Pagets disease of the nipple (especially since the areolar region is spared).
Linitis plastica features
Adenocaricinoma of stomach
Diffuse infiltrating lesion, the stomach is fibrotic and rigid and will not typically distend.
Pathologically signet-ring cell proliferation occurs.
Mx of AAA that has ruptured
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*
What can happen to the cells in duodenum with H pylori infection
Metaplasia to gastric antrum cells
Hassals corpuscle is located where
Medulla of Thymus
Causes of chronic inflammation
Primary
Persisting infection- which result in delayed reactions
Prolonged exposure to non biodegradable substances
AI conditions
Secondary - less likely
Acute inflammation
What cancer does schisto cause
Squamous cell carcinoma
Margins of excision of melanoma
Breslow thickness
0-1mm- 1cm margin
1-2 1-2cm
2-4 2-3cm
>4 3cm
When does someone with a carcinoid tumour start experiencing carcinoid syndrome sx
When mets occur- spread to liver
Most likely reason for splenomegaly with FH and anaemia
Hereditary spherocytosis
TB pathology reasoning
Mycobacteria stimulate a specific T cell response of cell mediated immunity
Neck lump that is CD20 positive
Thyroid gland lymhoma
CD20 marker for lymphocytes
Types of NHL lymphoma
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
Half life of plts
10d
Location of Paneth cells
Crypt of liverkunh
Space involved in Ludwig angina
Submandibular
Post tooth extraction, pus, yellow granules
Actinomycetes
Where each type of necrosis is seen
Coagulative- all apart from brain
Caseous- TB
Liquefactive- brain and wet gangrene
Fat- pancreatitis and breast
Fibrinoid- Mal HTN, vasculitis, Aschoff body
Clearest evidence of malignancy from primary tumour
Infiltration of surrounding structure
MOA of doxorubicin
Inhibits DNA and RNA synthesis by intercalating base pairs
MAO of cisplatin
Crosslinks DNA, this then distorts molecule and induces apoptosis (similar to alkylating agents)
MOA of cyclophosphamide
Phosphoramide mustard forms DNA crosslinks and then cell death
Slow growing bone tumour. Their favored origin is remnants of the notochord.
Chordoma
Chordomas can arise anywhere from the skull base to the sacrum. The two most common locations are the skull base and sacrum.
Where are oxyphil cells located
Parathyroid
Achalasia pathology
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.
What are anti centromere, mitochondrial, canca and pcnaca seen with
Centro- CREST
Mito- PBC
cANCA- GPA
pANCA- Churg
Other antibody in Hashimoto
Anti microsomal
Types of hypoxic injuries
Histolic- metabolic
Stagnant- crush
Anaemic
Hypoxic hypoxia- reduction in inspired such as altitude
Features of bone mets bloods
Immature cells
Low plt
Low Hb
Antimetabolite examples
Inhibiting formation of nucleic acids
Methotrexate, 5 flurouracil, 6 mercaptopurine
Bone scans
Use Technicium labelled phosphate
Show fractures, tumours, healing after necrosis
Show destructive lesions >50%
Genes associated with melanoma
CDNK, BRCA, CDK4
Hep B Ab for vaccine and prev infection
Vaccine/inf- Anti HBs
Inf- prev- Anti Hb c
Current IgM
Test and timing of HIV
p24 antigen and ab
After 4 weeks of exposure
What is associated with mycotic aneurysm
Arise from bac infection in arterial wall- commonly after ednocartditis
S
They are painful, rapid evolving
Spread of sarcoma and most common deposition
Fascial planes and blood
Lungs
Types of amyloid
AA- chronic inflammation
AL- MM or other lymphoproliferative
Moa of ciclosporin
Inhibiting IL2 release inhibiting proliferation
Cause of mycotic aneurysm
Staph, salmonella, strep
Growth factor oncogenes
Sis
Programmed cell death regulator
bcl 2
Structure damaged with medial tibial platea fracture
Meniscus
What time period do keloid scars form
Up to a year later
Tumour markers in pancreases carcinoma
CA19-9 - raised in >90%
Also CEA
Bone callus formation sequence
Haematoma
Vascular granulation tissue
Sub periosteal osteoblast stimulatioon
Bone matriculates deposition
Endochondral formation
Callous formation
Remodelling
Hypertriglycerideamia vs hypercholsterolaemia deficiency
HTG- lipoprotein lipase enzyme
HC- LDL receptor deficient
Function of kinins
Attracts phags
Promote vasodilation and increase permeability
What is benzidine and cyclophosphamide linked with
Bladder cancer
Leukotriene actions
Increased vascular permeability
Bronchoconstriction
Chemotaxis
Find a enlarged thymus how should it be manage
Midline sternotomy and thymectomy
Blood cells origin
Eosinophil, baso, neutrophil- myeloblasts (granulocytes)
Lymph- lymphoblasts
Monocyte- monoblast
Platelts- megakaryoblast
Erythrocytes- proerthyroblasts
Hinchley staging
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
What is seen on a cellular level of atrophy
Greater number of autophagic vacuoles
Complement activation
Classic- immunoglobins- C1,2,4
Bacteria- alternative - C3b
Mannose-C2,4
Converge to C3- C5 lytic pathway
Cause of type 3 hypersensitivity
Immune complexes
post-streptococcal glomerulonephritis, systemic lupus erythematosus, farmers’ lung (hypersensitivity pneumonitis), and rheumatoid arthritis, IgA vas
What are target cells seen in
Thalassaemia, sickle and liver disease
Lytic vs sclerotic bone met lesions
Prostate- sclerotic
Breast and lung- both
Renal and thyroid- lytic
Chagas disease pathology and organism
Tryp Cruzi
Destroy ganglionic cells in myenteric plexus
Similar to achalasia
Cardiomyopathy
Heparin moa
Enhance antithrombin 3
2,7,9,10,11,12
Cardiac conditions causing sudden death
Bicuspid aortic valve
Long QT
Brugada
HOCM
Thrombomodulin moa
Cofactor in thrombin induced activation of protein C
Which inhibits V and VIII
erb 2 function
Growth factor receptor oncogene
PDCD 1 fucntion
Programmed cell death
What neoplastic cells rely on to mets
Secretion of protease- overcome cohesion
Integrin expression
Adhere to BM
TNM of lung
T1- <3cm
2- 3-5cm
3-5-7cm- or invades parietal pleura, chest wall, diaphragm
4- mediastinum
AB with highest conc
IgG
What protein does HPV interfere with
p53
Hyaline cartilage nutrients supply
Avascular
Relies on diffusion from synovial fluid
Collagen in hyaline cartilage
Type 2
Baroreceptor firing rate in dehydration
Inhibition- stretch receptors
Fires when too high
Presentation 21 OH def
Complete - cannot produce cortisol or aldo- crisis
Partial- later presentation- can produce cortisol- increased testosterone
Syphillis histology
Granuloma with tertiary
Hypogamagloeamia presentation
Recurrent sinopulmonary infections
H influenzas, strep
Liver enzyme results interpretation
AST/ALT- liver
ALP- cholestatic- AST, ALT normal
AST:ALT 2:1- alcohol
GGT- alcohol intake
Oral contraceptive, now has mass by cervix dx and histology?
Endocervical polyp
Microglandular hyperplasia
What is included in cellular immunity
lysozyme
complement
acute phase proteins
NK cells
FH of teratoma increases risk by
4x
What cell does not have fc receptor
T cell
Virus causing HPC
Hep B
Levels measured in carcinoid syndrome
5 HIAA
Carcinoid effect on the heart
Deposit on valve
Organism with fishy discharge
Gardenerella vaginalis
Bacili, non pathogenic, excessive discharge organism
Lactobacilus
Pathological process in BPH
Hyperplasia
Acute severe hypercalcaemia
> 3.4
Symptomatic
Tertiary hyperparathyroid, high Ca not severe, asymptomatic mx
Elective aprathyroid
Fixed ill defined lump on US but not on mammography
Lobular carcinoma
Uterus in preg growth cellular vs breast in puberty
Uterus- hyperplasia nad hypertrophy
Breast- hyperplasia
Histological findings in ARDS
Increase cap perm
Interstiital oedema
Hyaline formation
Fibrosis
MCV formula
MCV=hct x 1000/RBC
Where do neuroblastoma arise
Adrenal medulla
From neural crest cells
Fluid by recent surgical scar, clear fluid, ulcerated
Suture granuloma
Pro inflammatory cytokines
IL1
Il6
TNFa
Consistency of bilestone in crohns and reason
Cholesterol - due to terminal ileum impairment - less absorbed- so cannot emulsify the cholesterol
Most common benign ovarian tumour pre menopousal
Dermoid cyst
IL in coagulation cascade
IL6
Sudden collapse on warfarin dx
Acute subdural
What is screened in donated blood
Hep B C, HIV 1+2, HTLV and syphillis
Zone where prostate cancer forms
Peripheral zone
How immediate HS reaction works
IgE binds to Fc portion on cells
Lights criteria for exudative effusion
Pleural protein :serum >0.5
Pleural LDH:serum >0.6
Effusion LDH greater than 2/3 of serum
Peronie disease
Inflammation of tunica albuginea- causing curvature
Thalassaemia MCV
Microcytic
What are platelets deficient of in Gray pet syndrome
Alpha granules
What malignancy does vit A def predispose you to
Resp tract squamous metaplasia
Tumour supressor genes
p53- mutation prevents apoptosis
BRCA1
APC
TP53
Rb
PTEN
Proto oncogenes
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]
Tumour markers in teste cancer
Seminoma- LDH, bhcg + 10%
Non seminaoma- <30
Teratoma- none
Yolk sac- AFP+++
Chorio bhcg +++
Which cells secrete IF
Parietal
Siderblastic anaemia MCV
Normo/micro
Hyperacute reaction mediators
Complement
What features do B cells have
Can undergo somatic hypermutation
Isotope switching
IgG on surface
Artery ruptured with ACL
Middle geniculate
Bias in screening programes
Lead time bias-longer survival times due to earlier diagnosis in screening
Length time- asymptomatic less fast developing diagnosed
What can scleroderma do to the kidneys
Hyperplastic arteriosclerosis with fibrinoid necrosis
Malignant HTN
Which sex cord tumour causes females to become masculin
Sertoli leydig
Small yellow tumour causing endometrial hyperplasia
Fibrothecoma
Anascara
Generalised oedema
Caused by cardiac/liver failure, chemo- docetaxel
Ig in complement fixation in alternate and classic pathway
Classic- IgM/G
Alternate- IgA
Women who are offered BRCA testing
Under 50 with triple neg BC
Hamartoma
Overgrowth with disordered architecture
of a variety of normal fully differentiated tissue
Sarcoid electrolyte disturbance cause
High Ca due to high Vit D from macrophages in granuloma
Haemolytic anaemia hypersensitivity type
2
Location of cancer most likely to mets to adrenal s
Lung or breast
Substance stimulating proliferation of smooth muscles and collagen in plaque formation
PDGF
Colorectal polyp most metastatic potential
Villous adenoma
What is NO derived from
Cyclic GMP
IPPV physiological effects
Reduced Venous return
Reduce CO
Mutation for Wilm tumour
WT1
Which part of cell cycle is under p53 influence
G1- where cells with significant damage to DNA is arrested
Malignancy most common following exposure to radiation
Leukaemia
Ig type in Graves
IgG
Biggest cause of hyperthyroid
Graves
Most adenomas are v v small only picked up on in iodine scan
Glucose and protein in CSF vs blood
Less in CSF normally
Ix in early RA
US
Anaemia pO2 effect
Reduced mixed venous
Arterial same
HS reaction in acute transplant rejection
4
RF for H Lymphoma
EBV
HIV
Organ transplant
What does metastatic calcification occur in
Hyperparathyroid
Osteopenia definition
T score between -1 and -2.5
TB organisms
Mycobacterium tuberculosis hominis
Bovis- cows- spread by milk
Which part of the brain regulates appetite
Hypothalamus in diencephalon
Activation of cytotoxic t cells
MHC 1 presented by APC
How long after gastrectomy would you get osteomalacia
10 years
IL 1, 4, 5 function
1- inflammatory- mucus in GI
4- T cell prolif and IgE
5- eosinophils
B12 use in red cells
Maturation process
Histology of rheumatoid nodule
Central necrotic area surrounded by histiocytic macrophages
Enveloped by lymphocytes, olasma and fibroblasts
Acute renal tubular dysfunction tx, damaged and urine osmolality
Omsotic and supportive
Medullar ischaemia
Low urine osmolality
AB for ABO vs rheusus
ABO- IgM
Rh- IgG- can cross placenta
Management of Kaposi Sarcome
Biopsy
If AIDS- chemo
Transplant- change meds
What IL has anti inflammatory
Il 10
Where medulloblastoma forms
Cerebellar vermis
What acoustic neuroma arrises from
Schwann cells
Jamaican with chest pain and low Hb
Sickle cell
What acts as opsinon
IgG
C3b
Coeliac and mantoux hypersensitivty
4
Where factor 8 is produced
Liver and vascular endothelium
Hereditary angioedema tx
FFP as require C1 esterase inhibitor
Main cell in sjorgrens
CD4
Proportion of colorectal cancer CEA is rasied in and what can also cause it to rise
90%
Smoking
BRCA 1 + 2 location
17 and 13
Where is EPO produced
Peritubular fibroblast in kidney
Erythroproduction in fetus location
Liver
What are epithelia cells
Enlarged macrophages
Irregular firm lump in diabetic young lady
Lymphocytic lobulitis
Most useful in establishing IgE related mechanism
Skin prick
Timeline of repair of cleft lip and palate
Lip repaired before 6m
Then palate 12-18m
How prostate spread
Haem
Where are pappenheimer bodies seen
Siderocyte-result of sideroblastic erythropoiesis producing siderotic, non-heme iron intracytoplasmic granules
Myelodysplastic, sideroblastic, haemolytic, SCD
Def in what after splenecomty
Properdin- complement activator
Pre formed vs newly formed mediator in mast cell
Tryptase histamine pre formed
Thromboxane new
Liver flukes reaction
Type 1
eosinophilia
Endothelin 1
Vasoconstrictor
polypeptide
Hypercalcaemia lung cancer
Non small cell - squamous
NO function
inhibit platelet aggregation
Relax
freely diffuses
pCO2 on coronaries
Increase causes vasodilation
Which immune cell contains perforin
NK cells
Changes seen in GORD
Basal cell hyperplasia and elongation of papillae
SCC in situ vs actinic
SCC in situ full thickness of epidermis
Lobular carcinoma histology
Discrete single file of small uniform cells
Loss of E cadherin
Thyroid cancer histology
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
RA findings on synovial biopsy
Proliferative synovitis swith synovial cell hyperplasia
Histology of thyroglosal duct
Resp like, follicle in cyst wall
MRSA septicaemia tx
Vanc
Thymoma histolgy
Calcification
Abnormal epithelial cells and lymph
Mesothelioma histology
Epithelial growth with tubules and glands
What are MMPs
Group of proteolytic enzymes
All contain zinc ion
Bosniak classification
Renal cysts
1- simple cyst- no FU
2- thin septa, calc- no FU
3-indeterminate
4- clearly malignant solid
Cells mobilising for angiogenesis and stimulating factor
Endothelial
VEGF
Antibiotic MOA
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
Best method to sample parathryoid
Frozen intraoperative section
Inheritance of malignant hypertermia
AD with variable penetrance
Post fracture repair- periosteal reaction
Osteomyelitis
Sheehan vs apoplexy
Sheehan -PPH causing hypopituitism
Apoplexy bleed of tumour
ACA infarct presentation
Leg weakness
Gait apraxia
Urinary incontinence
Dysarthria
Fracture of coronoid vs condyle
Coronoid- fall onto chin
Condyle- traumatic event
Tonsilitis and spheorcytes dx
EBV- causes cold AIHA
Warm vs cold AIHA
Warm- IgG
AI, lympho
Cold- IgM
EBV, mycoplasma, lympho
Dissatisfactory SE of sympathetic resection
Increased hyperhydrasisi in other parts of body
Where iron is found in biopsy in haemachronomatosis
Kupffer cells
