Pathology MRCS part B Flashcards
what are the parameters of the qSOFA score?
RR >22
SBP <100
Altered mental state/GCS <15
hypersensitivity reactions require pre-sensitisation , true or false?
True
what is a hypersensitivity reaction?
An exaggerated response of the hosts immune system to a particular stimulus
what classification system is used for hypersensitivity reactions?
Coombs and Gel classification
which antibody type governs Type I hypersensitivity reactions?
Type I
autoimmune haemolytic anaemia is an example of what type of hypersensitivity reaction?
Type II
which antibody type governs Type II hypersensitivity reactions?
IgG, IgM
which type of hypersensitivity reaction is immune complex mediated?
Type III
which cells are involved in type IV hypersensitivity reactions?
T cells
chronic transplant rejection is an example of what type of hypersensitivity reaction?
Type IV
which cells produce parathyroid hormone?
Chief cells of parathyroid gland
from which pharyngeal pouch are the parathyroid glands derived?
3rd and 4th
is polyuria associated with hypo or hypercalcaemia?
Hypercalcaemia
what devices are used in frozen section to prepare a specimen for microscopy?
Cryostat machine and microtome
does PTH bind to osteoblasts or osteoclasts?
Osteoblasts (which then signal osteoclasts)
what are the indications for surgery in primary hyperparathyroidism?
Symptomatic hypercalcaemia
Deteriorating renal function
Urinary tract calculi
Reduced bone density
what type of bacterium is h pylori?
Gram negative, microaerophilic spiral bacterium
which enzyme is produced by H pylori to neutralise stomach acid?
Urease
how many people with H pylori develop PUD?
10-20%
what are the diagnostic tests for H pylori?
Carbon 13 urea breath test
Stool antigen test
CLO test from mucosal biopsy
what are the main indications for cardiac transplant?
- advanced heart failure
- Severe ventricular dysfunction secondary to valve disease
- diastrolic dysfunction (usually secondary to restrictive or hypertrophic cardiomyopathy)
- heart failure secondary to congenital heart disease
what age is generally used for cardiac donors?
Age <55y
what should be the MAP and CVP of a cardiac donor?
MAP>60
CVP 8-12
what is a graft from 2 people of the same species?
Allograft
what is a graft from another species?
Xenograft
what is a graft between genetically identical individuals?
Isograft
what is the pathophysiology behind graft vs host disease?
Donor T cells recognise and react against host HLA antigens
what are some of the side effects of ciclosporin?
Nephrotoxicity, hirsutism, glucose tolerance
what are some of the side effects of tacrolimus?
Neuro and nephrotoxicity
what are the side effects of mycophenalate?
anaemia, nausea+vomiting, diarrhoea
pts with HIV are at increased risk of which cancers?
Kaposi’s sarcoma
CNS lymphoma
Hodgkins lymphoma
Cervical/anogenital ca
leukoplakia progresses to SCC in what proportion of patients?
5%
betel nut chewing is a risk factor for what cancer?
SCC of the oral cavity
occcupational exposure to wood/nickel dust is a risk factor for what cancer?
SCC of the oral cavity
what are the 4 main extrinsic tongue muscles?
genioglossus
Hyoglossus
Styloglossus
Palatoglossus
what are the 4 intrinsic tongue muscles?
Superior and inferior longitudinal
Vertical
Transverse
what is removed in a radical neck dissection?
SCM
Internal jugular vein
Accessory nerve
Level I-V nodes
which nerve supplies the anterior belly of the digastric muscle?
Inferior alveolar nerve (branch of V3)
which nerve supplies the posterior belly of digastric?
Facial nerve
which nerve innervates depressor anguli oris and depressor labii inferioris?
Marginal mandibular branch of facial nerve
which nerve supplies somatic sensation to the anterior 2/3 of the tongue?
Lingual nerve (V3)
which nerve supplies taste sensation to the anterior 2/3 of the tongue?
Chorda tympani (CN VII)
how is a flap defined?
A unit of tissue moved from a donor to recipient site with its own blood supply intact
what are the features of thyroid malignancy on US?
Solid appearance Absence of halo Microcalcification Vascularity Irregular margins
in the cytological classification of thyroid nodules what would correspond to no. 1?
Non diagnostic/unsatisfactory biopsy
in the cytological classification of thyroid nodules what would correspond to no. 2?
Benign
in the cytological classification of thyroid nodules what would correspond to no. 3?
Indeterminate
in the cytological classification of thyroid nodules what would correspond to no. 4?
Follicular neoplasm
in the cytological classification of thyroid nodules what would correspond to no. 5?
Suspicious for malignancy
in the cytological classification of thyroid nodules what would correspond to no. 6?
Malignant
the development of autonomous hyperplastic parathyroid glands in a patient with secondary hyperparathyroidism describes what condition?
Tertiary hyperparathyroidism
increase in PTH production in response to low ionised calcium describes what condition?
Secondary hyperparathyroidism
secondary hyperparathyroidism is generally caused by what conditions?
Renal disease
Malabsorption
the commonest cause of primary hyperparathyroidism is what?
Parathyroid adenoma
digeorges syndrome is associated with which endocrine condition?
Hypoparathyroidism
deficiency of which electrolyte can cause hypoparathyroidism?
Hypomagnesaemia
what happens to aldosterone and renin levels in primary hyperaldosteronism?
Elevated aldosterone
Supressed Renin
what happens to aldosterone and renin levels in secondary hyperaldosteronism?
Elevated aldosterone and elevated renin
the zone glomerulosa produces what type of hormones?
Mineralcorticoids eg. aldosterone
glucocorticoids eg. cortisol is produced by what part of the adrenal cortex?
Zone fasiculata
what is an abscess?
Collection of pus surrounded by granulation tissue
what is pus?
Collection of neutrophils with dead/dying microorganisms
how does a pseudocyst differ from a cyst?
Lacks endothelial/epithelial cells
what is a sinus?
Blind ending tract lined by granulation tissue
what is a fistula?
An abnormal connection between 2 epithelial surfaces
what is a stoma?
A surgical opening into a hollow viscus
what is an aneurysm?
An abnormal, permanent, localised dilatation of a blood vessel to >1.5 x its normal diameter
what is a diverticulum?
An abnormal outpouching of a hollow viscus into the surrounding tissues
what is a thrombus?
Solid material formed from the constituents of blood in flowing blood
what is a clot?
Solid material formed from the constituents of blood in stationary blood
what is an embolus?
Abnormal mass of undissolved material that is carried in the bloodstream from one place to another
what is necrosis?
Abnormal tissue death during life
what is a hypersensitivity reaction?
An exaggerated response of the hosts immune system to a particular stimulus
what is a tumour marker?
Substance which can be found in the circulation of a pt with neoplasia
what is a polyp?
Mass of tissue arising from an epithelial surface (mucosa)
what is a neoplasm?
Abnormal growth of tissue that displays:
- uncoordinated growth
- growth that exceeds that of normal tissue
- growth which continues despite removal of the original stimulus
what is a hamartoma?
Tumour like malformation composed of a disorganised arrangement of different amounts of tissue normally found at that site
what is dysplasia?
Disordered cellular development characterised by increased mitosis and pleomorphism but without the ability to invade the basement membrane
what is a carcinoma?
Malignant tumour of epithelial cells
what is a sarcoma?
Malignant tumour of connective tissue
what is a metastasis?
Survival + growth of cells that have migrated from a malignant tumour to site distant from the primary tumour
what is atrophy?
Reduction in size of organ/tissue due to reduction in cell size or number of cells or both
what is apoptosis?
Normal programmed cell death
Auto-digestion of cells without causing an inflammatory response
for an abdominal x ray to be adequate it will show what?
Hernial orifices to lung bases
Large bowel obstruction is commonly due to what?
Tumour
adhesions
Diverticular stricture
sigmoid/caecal volvulus
FAP is due to a mutation of what gene?
APC gene on chromosome 6
HNPCC occurs due to mutation on what chromosome?
Chromosome 2 + 3
what does Duke’s stage A correspond to?
Limited to muscularis propria
what does Duke’s stage B correspond to?
Extending beyond muscularis propria
what are the 4 main layers of the GI tract? (internal to external)
Mucosa
Submucosa
Muscularis propria
Adventitia
what are the 3 main layers of the mucosa?
Epithelium
Lamina propria
Muscularis mucosa
what layer must be penetrated for a neoplasm to be considered malignant in the GI tract?
Mucosa - specifically muscularis mucosa
mutations in what genes are part of the adenoma-carcinoma sequence?
APC
KRAS
DCC
p53
what is a neoplasm?
Abnormal mass of tissue in which growth is uncoordinated, exceeds that of normal tissue and persists after cessation of a stimulus
what is used to screen for recurrence in Colorectal cancer?
CT scan
CEA
an exudate typically has a protein count of what?
> 30g/l
What fluid is associated with maligancy in ascites?
Exudate
what can be tested in ascitic fluid?
Protein Glucose Lactate Cytology (for malignant cells) microbiology (organism) Cultures (and sensitivities)
what type of bacteria are clostridia?
Gram positive
Spore forming
anaerobic
what are the risk factors for symptomatic C diff infection?
Elderly H2/PPI use Immunosupression Prev C.diff infection perioperative Abx use comorbidities
how is C diff diagnosed?
Acute diarrhoea (>2 ep in 24 hrs) stool culture c diff toxins A +B Pseudomembranes on colonoscopy
how is C diff treated?
metronidazole +/- vancomycin
Monoclonal antibody/faecal transplant
what is toxic megacolon?
Acute Colonic distention characterised by dilated colon, abdominal distention +/- fever, abdominal pain and shock
what is the most common type of breast cancer?
Invasive ductal carcinoma
how is HER2 receptor status determined?
IHC = immunohistochemistry FISH = fluorescence in situ hybridization
what is Herceptin?
Trastuzumab = monoclonal antibody against HER2 receptor
a lesion occupying what percentage of the femoral shaft is recommended for prophylactic IM femoral nailing?
> 50%
along what lines should bone biopsy be performed?
Limb salvage lines
what is a marginal resection when referring to bone cancer?
Surgical dissection extends into reactive zone
what is a radical resection when referring to bone cancer?
Resection of bony and myofascial compartments containing tumour
what is a wide local excision when referring to bone cancer?
if plane of dissection does not breach reactive zone
what are the 4 key components of a viable limb?
Bone
Nerves
Blood Vessels
Adequate soft tissue coverage
what are the 2 gold standard investigations for a patient with visible haematuria?
Flexible cystoscopy + biopsy CT urogram (visualize kidneys + ureters)
what is the lymphatic drainage of the bladder?
External iliac
Internal iliac
Common iliac
Sacral
what adjuvant treatments are used to reduce recurrence rate in bladder cancer?
intravesical chemotherapy (mitomycin C) BCG immunotherapy
what type of epithelium lines the biliary tree?
Columnar epithelium
what type of cancer is cholangiocarcinoma?
Adenocarcinoma of biliary ducts (most commonly extra hepatic)
what are the risk factors for developing cholangiocarcinoma in the western world?
Primary sclerosing cholangitis
Chronic liver disease (alcohol, HBV, HCV)
HIV
Congenital liver disease
what is a klatskin tumour?
Cholangiocarcinoma originating at junction of L and R hepatic ducts
which part of the biliary system is affected in primary biliary cirrhosis?
Interlobular bile ducts
which tumour markers may be raised in cholangiocarcinoma?
CEA, CA19-9
what is a fibroadenoma?
Proliferation og epithelium and stromal tissue of duct lobules (biphasic)
what are the histological features of a phyllodes tumour?
achitectural frond formation stromal cytological atypia stromal mitotic activity irregular gland dilatation morphoic hetrogenecity
what is a breast cyst?
Fluid filled, distended, involuted lobules in peri menopausal women
what is true mastalgia?
Exaggerated response of breast tissue to hormones during the menstrual cycle (causes breast pain, enlargement and nodularity)
which drug can be used in the treatment of true mastalgia?
Danazol - anti gonadotrophin agent
what is periductal mastitis ?
Mastitis in non lactational young female smokers, characterised by inflammation of subareolar ducts
sclerosing thrombophlebitis of superficial veins of the breast and chest well - describes what condition?
Mondors disease
which type of testicular tumour is associated with gynaeocomastia?
Leydig cell tumour
which genetic syndrome is associated with lack of testosterone and gynaecomasia?
Klinfelters syndrome
what is the definition of ascites?
Accumulation of fluid in the peritoneal cavity
a transudate has a protein count of what?
<25g/L
an exudate has a protein count of what?
> 25g/L
what are the 4 main causes of exudates (ascites)?
4 Ps Peritonitis - bacterial/TB Post-irradiation Peritoneal mets Pancreatitis
what is obturator sign in acute appendicitis?
Pain on flexion and internal rotation of R hip due to appendix irritating obturator internus
through which main visceral afferent nerve does the initial pain of appendicitis travel?
Lesser sphlanchnic nerve (T10)
what scoring systems are used in diagnosing appendicitis?
Alvarado score (also called Mantrels) Appendicitis inflammatory response score (AIR)
calcific aortic disease is characterised by which 3 main features?
Lipid accumulation
inflammation
Calcification
what are the 3 main symptoms of aortic stenosis?
Syncope
Angina
Dyspnoea
what are the ECG findings in LVH?
High voltage QRS
Left axis deviation
Left ventricular strain - T wave inversion in lateral leads
what is aortic sclerosis?
Calcific aortic valve disease without significant gradient across valve
what is aortic dissection?
Forceful separation of layers of aortic wall due to tear in the initima
what is amyloidosis?
disease where abnormal fibrillar protein known as amyloid is deposited in extracellular tissue
Proteins are deposited in beta pleated sheet structure
