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Pathology MRCS Part B > Pathology MRCS part B > Flashcards

Pathology MRCS part B Flashcards

1
Q

what are the parameters of the qSOFA score?

A

RR >22
SBP <100
Altered mental state/GCS <15

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2
Q

hypersensitivity reactions require pre-sensitisation , true or false?

A

True

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3
Q

what is a hypersensitivity reaction?

A

An exaggerated response of the hosts immune system to a particular stimulus

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4
Q

what classification system is used for hypersensitivity reactions?

A

Coombs and Gel classification

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5
Q

which antibody type governs Type I hypersensitivity reactions?

A

Type I

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6
Q

autoimmune haemolytic anaemia is an example of what type of hypersensitivity reaction?

A

Type II

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7
Q

which antibody type governs Type II hypersensitivity reactions?

A

IgG, IgM

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8
Q

which type of hypersensitivity reaction is immune complex mediated?

A

Type III

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9
Q

which cells are involved in type IV hypersensitivity reactions?

A

T cells

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10
Q

chronic transplant rejection is an example of what type of hypersensitivity reaction?

A

Type IV

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11
Q

which cells produce parathyroid hormone?

A

Chief cells of parathyroid gland

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12
Q

from which pharyngeal pouch are the parathyroid glands derived?

A

3rd and 4th

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13
Q

is polyuria associated with hypo or hypercalcaemia?

A

Hypercalcaemia

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14
Q

what devices are used in frozen section to prepare a specimen for microscopy?

A

Cryostat machine and microtome

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15
Q

does PTH bind to osteoblasts or osteoclasts?

A

Osteoblasts (which then signal osteoclasts)

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16
Q

what are the indications for surgery in primary hyperparathyroidism?

A

Symptomatic hypercalcaemia
Deteriorating renal function
Urinary tract calculi
Reduced bone density

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17
Q

what type of bacterium is h pylori?

A

Gram negative, microaerophilic spiral bacterium

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18
Q

which enzyme is produced by H pylori to neutralise stomach acid?

A

Urease

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19
Q

how many people with H pylori develop PUD?

A

10-20%

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20
Q

what are the diagnostic tests for H pylori?

A

Carbon 13 urea breath test
Stool antigen test
CLO test from mucosal biopsy

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21
Q

what are the main indications for cardiac transplant?

A
  1. advanced heart failure
  2. Severe ventricular dysfunction secondary to valve disease
  3. diastrolic dysfunction (usually secondary to restrictive or hypertrophic cardiomyopathy)
  4. heart failure secondary to congenital heart disease
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22
Q

what age is generally used for cardiac donors?

A

Age <55y

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23
Q

what should be the MAP and CVP of a cardiac donor?

A

MAP>60

CVP 8-12

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24
Q

what is a graft from 2 people of the same species?

A

Allograft

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25
Q

what is a graft from another species?

A

Xenograft

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26
Q

what is a graft between genetically identical individuals?

A

Isograft

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27
Q

what is the pathophysiology behind graft vs host disease?

A

Donor T cells recognise and react against host HLA antigens

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28
Q

what are some of the side effects of ciclosporin?

A

Nephrotoxicity, hirsutism, glucose tolerance

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29
Q

what are some of the side effects of tacrolimus?

A

Neuro and nephrotoxicity

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30
Q

what are the side effects of mycophenalate?

A

anaemia, nausea+vomiting, diarrhoea

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31
Q

pts with HIV are at increased risk of which cancers?

A

Kaposi’s sarcoma
CNS lymphoma
Hodgkins lymphoma
Cervical/anogenital ca

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32
Q

leukoplakia progresses to SCC in what proportion of patients?

A

5%

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33
Q

betel nut chewing is a risk factor for what cancer?

A

SCC of the oral cavity

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34
Q

occcupational exposure to wood/nickel dust is a risk factor for what cancer?

A

SCC of the oral cavity

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35
Q

what are the 4 main extrinsic tongue muscles?

A

genioglossus
Hyoglossus
Styloglossus
Palatoglossus

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36
Q

what are the 4 intrinsic tongue muscles?

A

Superior and inferior longitudinal
Vertical
Transverse

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37
Q

what is removed in a radical neck dissection?

A

SCM
Internal jugular vein
Accessory nerve
Level I-V nodes

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38
Q

which nerve supplies the anterior belly of the digastric muscle?

A

Inferior alveolar nerve (branch of V3)

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39
Q

which nerve supplies the posterior belly of digastric?

A

Facial nerve

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40
Q

which nerve innervates depressor anguli oris and depressor labii inferioris?

A

Marginal mandibular branch of facial nerve

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41
Q

which nerve supplies somatic sensation to the anterior 2/3 of the tongue?

A

Lingual nerve (V3)

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42
Q

which nerve supplies taste sensation to the anterior 2/3 of the tongue?

A

Chorda tympani (CN VII)

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43
Q

how is a flap defined?

A

A unit of tissue moved from a donor to recipient site with its own blood supply intact

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44
Q

what are the features of thyroid malignancy on US?

A 
Solid appearance
Absence of halo
Microcalcification
Vascularity
Irregular margins
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45
Q

in the cytological classification of thyroid nodules what would correspond to no. 1?

A

Non diagnostic/unsatisfactory biopsy

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46
Q

in the cytological classification of thyroid nodules what would correspond to no. 2?

A

Benign

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47
Q

in the cytological classification of thyroid nodules what would correspond to no. 3?

A

Indeterminate

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48
Q

in the cytological classification of thyroid nodules what would correspond to no. 4?

A

Follicular neoplasm

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49
Q

in the cytological classification of thyroid nodules what would correspond to no. 5?

A

Suspicious for malignancy

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50
Q

in the cytological classification of thyroid nodules what would correspond to no. 6?

A

Malignant

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51
Q

the development of autonomous hyperplastic parathyroid glands in a patient with secondary hyperparathyroidism describes what condition?

A

Tertiary hyperparathyroidism

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52
Q

increase in PTH production in response to low ionised calcium describes what condition?

A

Secondary hyperparathyroidism

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53
Q

secondary hyperparathyroidism is generally caused by what conditions?

A

Renal disease

Malabsorption

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54
Q

the commonest cause of primary hyperparathyroidism is what?

A

Parathyroid adenoma

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55
Q

digeorges syndrome is associated with which endocrine condition?

A

Hypoparathyroidism

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56
Q

deficiency of which electrolyte can cause hypoparathyroidism?

A

Hypomagnesaemia

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57
Q

what happens to aldosterone and renin levels in primary hyperaldosteronism?

A

Elevated aldosterone

Supressed Renin

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58
Q

what happens to aldosterone and renin levels in secondary hyperaldosteronism?

A

Elevated aldosterone and elevated renin

59
Q

the zone glomerulosa produces what type of hormones?

A

Mineralcorticoids eg. aldosterone

60
Q

glucocorticoids eg. cortisol is produced by what part of the adrenal cortex?

A

Zone fasiculata

61
Q

what is an abscess?

A

Collection of pus surrounded by granulation tissue

62
Q

what is pus?

A

Collection of neutrophils with dead/dying microorganisms

63
Q

how does a pseudocyst differ from a cyst?

A

Lacks endothelial/epithelial cells

64
Q

what is a sinus?

A

Blind ending tract lined by granulation tissue

65
Q

what is a fistula?

A

An abnormal connection between 2 epithelial surfaces

66
Q

what is a stoma?

A

A surgical opening into a hollow viscus

67
Q

what is an aneurysm?

A

An abnormal, permanent, localised dilatation of a blood vessel to >1.5 x its normal diameter

68
Q

what is a diverticulum?

A

An abnormal outpouching of a hollow viscus into the surrounding tissues

69
Q

what is a thrombus?

A

Solid material formed from the constituents of blood in flowing blood

70
Q

what is a clot?

A

Solid material formed from the constituents of blood in stationary blood

71
Q

what is an embolus?

A

Abnormal mass of undissolved material that is carried in the bloodstream from one place to another

72
Q

what is necrosis?

A

Abnormal tissue death during life

73
Q

what is a hypersensitivity reaction?

A

An exaggerated response of the hosts immune system to a particular stimulus

74
Q

what is a tumour marker?

A

Substance which can be found in the circulation of a pt with neoplasia

75
Q

what is a polyp?

A

Mass of tissue arising from an epithelial surface (mucosa)

76
Q

what is a neoplasm?

A

Abnormal growth of tissue that displays:

  • uncoordinated growth
  • growth that exceeds that of normal tissue
  • growth which continues despite removal of the original stimulus
77
Q

what is a hamartoma?

A

Tumour like malformation composed of a disorganised arrangement of different amounts of tissue normally found at that site

78
Q

what is dysplasia?

A

Disordered cellular development characterised by increased mitosis and pleomorphism but without the ability to invade the basement membrane

79
Q

what is a carcinoma?

A

Malignant tumour of epithelial cells

80
Q

what is a sarcoma?

A

Malignant tumour of connective tissue

81
Q

what is a metastasis?

A

Survival + growth of cells that have migrated from a malignant tumour to site distant from the primary tumour

82
Q

what is atrophy?

A

Reduction in size of organ/tissue due to reduction in cell size or number of cells or both

83
Q

what is apoptosis?

A

Normal programmed cell death

Auto-digestion of cells without causing an inflammatory response

84
Q

for an abdominal x ray to be adequate it will show what?

A

Hernial orifices to lung bases

85
Q

Large bowel obstruction is commonly due to what?

A

Tumour
adhesions
Diverticular stricture
sigmoid/caecal volvulus

86
Q

FAP is due to a mutation of what gene?

A

APC gene on chromosome 6

87
Q

HNPCC occurs due to mutation on what chromosome?

A

Chromosome 2 + 3

88
Q

what does Duke’s stage A correspond to?

A

Limited to muscularis propria

89
Q

what does Duke’s stage B correspond to?

A

Extending beyond muscularis propria

90
Q

what are the 4 main layers of the GI tract? (internal to external)

A

Mucosa
Submucosa
Muscularis propria
Adventitia

91
Q

what are the 3 main layers of the mucosa?

A

Epithelium
Lamina propria
Muscularis mucosa

92
Q

what layer must be penetrated for a neoplasm to be considered malignant in the GI tract?

A

Mucosa - specifically muscularis mucosa

93
Q

mutations in what genes are part of the adenoma-carcinoma sequence?

A

APC
KRAS
DCC
p53

94
Q

what is a neoplasm?

A

Abnormal mass of tissue in which growth is uncoordinated, exceeds that of normal tissue and persists after cessation of a stimulus

95
Q

what is used to screen for recurrence in Colorectal cancer?

A

CT scan

CEA

96
Q

an exudate typically has a protein count of what?

A

> 30g/l

97
Q

What fluid is associated with maligancy in ascites?

A

Exudate

98
Q

what can be tested in ascitic fluid?

A 
Protein
Glucose
Lactate
Cytology (for malignant cells)
microbiology (organism)
Cultures (and sensitivities)
99
Q

what type of bacteria are clostridia?

A

Gram positive
Spore forming
anaerobic

100
Q

what are the risk factors for symptomatic C diff infection?

A 
Elderly
H2/PPI use
Immunosupression
Prev C.diff infection
perioperative Abx use
comorbidities
101
Q

how is C diff diagnosed?

A 
Acute diarrhoea (>2 ep in 24 hrs)
stool culture c diff toxins A +B
Pseudomembranes on colonoscopy
102
Q

how is C diff treated?

A

metronidazole +/- vancomycin

Monoclonal antibody/faecal transplant

103
Q

what is toxic megacolon?

A

Acute Colonic distention characterised by dilated colon, abdominal distention +/- fever, abdominal pain and shock

104
Q

what is the most common type of breast cancer?

A

Invasive ductal carcinoma

105
Q

how is HER2 receptor status determined?

A 
IHC = immunohistochemistry
FISH = fluorescence in situ hybridization
106
Q

what is Herceptin?

A

Trastuzumab = monoclonal antibody against HER2 receptor

107
Q

a lesion occupying what percentage of the femoral shaft is recommended for prophylactic IM femoral nailing?

A

> 50%

108
Q

along what lines should bone biopsy be performed?

A

Limb salvage lines

109
Q

what is a marginal resection when referring to bone cancer?

A

Surgical dissection extends into reactive zone

110
Q

what is a radical resection when referring to bone cancer?

A

Resection of bony and myofascial compartments containing tumour

111
Q

what is a wide local excision when referring to bone cancer?

A

if plane of dissection does not breach reactive zone

112
Q

what are the 4 key components of a viable limb?

A

Bone
Nerves
Blood Vessels
Adequate soft tissue coverage

113
Q

what are the 2 gold standard investigations for a patient with visible haematuria?

A 
Flexible cystoscopy + biopsy
CT urogram (visualize kidneys + ureters)
114
Q

what is the lymphatic drainage of the bladder?

A

External iliac
Internal iliac
Common iliac
Sacral

115
Q

what adjuvant treatments are used to reduce recurrence rate in bladder cancer?

A 
intravesical chemotherapy (mitomycin C)
BCG immunotherapy
116
Q

what type of epithelium lines the biliary tree?

A

Columnar epithelium

117
Q

what type of cancer is cholangiocarcinoma?

A

Adenocarcinoma of biliary ducts (most commonly extra hepatic)

118
Q

what are the risk factors for developing cholangiocarcinoma in the western world?

A

Primary sclerosing cholangitis
Chronic liver disease (alcohol, HBV, HCV)
HIV
Congenital liver disease

119
Q

what is a klatskin tumour?

A

Cholangiocarcinoma originating at junction of L and R hepatic ducts

120
Q

which part of the biliary system is affected in primary biliary cirrhosis?

A

Interlobular bile ducts

121
Q

which tumour markers may be raised in cholangiocarcinoma?

A

CEA, CA19-9

122
Q

what is a fibroadenoma?

A

Proliferation og epithelium and stromal tissue of duct lobules (biphasic)

123
Q

what are the histological features of a phyllodes tumour?

A 
achitectural frond formation
stromal cytological atypia
stromal mitotic activity
irregular gland dilatation
morphoic hetrogenecity
124
Q

what is a breast cyst?

A

Fluid filled, distended, involuted lobules in peri menopausal women

125
Q

what is true mastalgia?

A

Exaggerated response of breast tissue to hormones during the menstrual cycle (causes breast pain, enlargement and nodularity)

126
Q

which drug can be used in the treatment of true mastalgia?

A

Danazol - anti gonadotrophin agent

127
Q

what is periductal mastitis ?

A

Mastitis in non lactational young female smokers, characterised by inflammation of subareolar ducts

128
Q

sclerosing thrombophlebitis of superficial veins of the breast and chest well - describes what condition?

A

Mondors disease

129
Q

which type of testicular tumour is associated with gynaeocomastia?

A

Leydig cell tumour

130
Q

which genetic syndrome is associated with lack of testosterone and gynaecomasia?

A

Klinfelters syndrome

131
Q

what is the definition of ascites?

A

Accumulation of fluid in the peritoneal cavity

132
Q

a transudate has a protein count of what?

A

<25g/L

133
Q

an exudate has a protein count of what?

A

> 25g/L

134
Q

what are the 4 main causes of exudates (ascites)?

A 
4 Ps
Peritonitis - bacterial/TB
Post-irradiation
Peritoneal mets
Pancreatitis
135
Q

what is obturator sign in acute appendicitis?

A

Pain on flexion and internal rotation of R hip due to appendix irritating obturator internus

136
Q

through which main visceral afferent nerve does the initial pain of appendicitis travel?

A

Lesser sphlanchnic nerve (T10)

137
Q

what scoring systems are used in diagnosing appendicitis?

A 
Alvarado score (also called Mantrels)
Appendicitis inflammatory response score (AIR)
138
Q

calcific aortic disease is characterised by which 3 main features?

A

Lipid accumulation
inflammation
Calcification

139
Q

what are the 3 main symptoms of aortic stenosis?

A

Syncope
Angina
Dyspnoea

140
Q

what are the ECG findings in LVH?

A

High voltage QRS
Left axis deviation
Left ventricular strain - T wave inversion in lateral leads

141
Q

what is aortic sclerosis?

A

Calcific aortic valve disease without significant gradient across valve

142
Q

what is aortic dissection?

A

Forceful separation of layers of aortic wall due to tear in the initima

143
Q

what is amyloidosis?

A

disease where abnormal fibrillar protein known as amyloid is deposited in extracellular tissue
Proteins are deposited in beta pleated sheet structure

Pathology MRCS Part B (1 decks)

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