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Pathology Q Flashcards

1
Q

Nature of abscess

A

to discharge itself through the path of least resistance

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2
Q

Why does osmotic pressure increases inside pus?

A

Osmotic pressure increases with the number of molecules within the solution.
This increases in the pus as polymorphs/macrophages creates smaller molecules by breaking larger ones, leading to increase in osmotic pressure
This would continue until it discharges through a surface/space

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3
Q

Causes of acromegaly

A

Excessive production - eg functional pituitary adenoma

Ectopic production - Ca of Lung/pancreas/small bowel

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4
Q

Surgical importance of acromegaly

A 
Treatment of causative agent - TSS
Treatment of complications:
Prognatism - orthodontics
Osteoarthritis - arthroplasty
Increased colorectal ca - colonoscopy
Osteoporosis - fractures
Increased incidence of gallstones, hernia
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5
Q

Actinomycosis - presentation

A

mimic neoplastic changes
Can occurs at neck, thorax, abdomen
Can lead to fistula, abscess formation, fibrosis

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6
Q

Commonest actinomycosis pathogen and its appearance

A

actinomyces israelii
gram positive filamentous bacteria, resembles fungus
produces sulfur granules

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7
Q

When do they become a pathogen

A

immunosuppression - HIV, DM, Chemo, steroids

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8
Q

Layers of adrenal cortex

A

zona glomerulosa - aldosterone
zona fasciculata - cortisol
zone reticularis - sex hormone
medulla - adrenaline/noradrenaline

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9
Q

Causes of adrenocortical insufficiency

A

iatrogenic - sudden stop oral steroids
infective - TB, waterhouse-frederichsen syndrome
endocrine - hypopituitarism
Deposition - metastasis, amyloidosis, haemochromatosis
autoimmune

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10
Q

Clinical features of Addison’s

A

lack of aldosterone - hypotension, hypernatremia and hypokalemia
lack of cortisol - lethargy, confusion, N&V
high ACTH - ski pigmentation (POMC increase)

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11
Q

HIV and neoplasia - common tummour?

A

Skin cancer - SCC, BCC
Lymphoma - non Hodgkin’s Lymphoma, B cell lymphoma
Kaposi Sarcoma (HHV8)
SCC of larynx and cervix

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12
Q

HIV related acute abdomen

A

infective process
CMV enteritis/pancreatitis
TB
oncology - Mucosa associate lymphoid tissue lymphoma

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13
Q

Alcohol - effect to body

A 
CNS depression, head injury, trauma
CVS - AF
stomach - ulcer, gastritis
pancreas - acute, chronic, cancer
liver - ALD
Larynx - SCC, inflammation
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14
Q

Pathophysiology of alcohol related liver disease

A

Fatty infiltration
Inflammatory phase - mallory body (damaged filaments)
fibrotic band formation - cirrhosis
HCC

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15
Q

how is alcohol metabolised?

A

Microsomal ethanol oxidising system
Alcohol dehydrogenase
Catabolic reaction
Aldehyde - Carbonic acid

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16
Q

Disease cause by amoeba

A

GI - dysentery, abscess formation, inflammatory polyps, amoeboma
skin - ulceration
CNS - abscess

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17
Q

Different type of amyloid

A

AA amyloid - Chronic inflammation, macrophages releases interleukins which stimulate secretion of amyloid A (acute phase protein)
AL amyloid - primary amyloid, precursor immunoglobulin light chains, present in Myeloma
ABeta amyloid - Alzheimer’s dementia

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18
Q

disease related to AA amyloid

A

Infective - TB, syphilis
Autoimmune - RhA/IBD
Neoplastic - Hodgkin’s
Congenital - Familial mediterranean fever

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19
Q

In which tissue are amyloid deposited?

A

AL - heart (cardiomyopathy), neuropathy, neuphropathy

AA - kidney (GN, arteries), Liver, Spleen

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20
Q

Where would you biopsy for diagnosis of amyloidosis?

A

Rectal biopsy

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21
Q

Localised deposit of amyloid

A 
Thyroid - medullary ca - calcitonin
pancreatic islet in DM
urinary tract 
laryngeal
pituitary gland
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22
Q

Commonest anaerobic organism in the body

A

Bacteriodes

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23
Q

How can anaerobic organism can be classified

A

Facultative anaerobes

Obligatory anaerobes

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24
Q

Example of anaerobes

A

Clostridia spp

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25
Diseases that are caused by anaerobes
Gas gangrene Tetanus pseudomembranous colitis botulism
26
Classification of aneurysm?
Definition - True vs False Shape - saccular, fusiform Aertiology - atherosclerotic, inflammatory, infective Congenital - Berry aneurysm
27
Complication of aneurysm
Thrombosis Distal embolism Rupture Mass effect
28
Example of physiological apoptosis
Uterine wall Degeneration of thymus Embryological changes
29
Example of pathological apoptosis
Duct obstruction | Damaged cells from virus/irradiation
30
How is apoptosis regulated
support p53, c-myc | inhibit BCL-2
31
Causes of appendicitis
Idiopathic Intraluminal - FB Transmural - infection, inflammation, ischaemia, hamartoma, neoplasia Extraluminal - salpingitis, endometriosis, autoimmune
32
disease caused by asbestos
ILD - pneumoconiosis | Malignancy - mesothilioma, bronchial ca
33
Occupation related to asbestosis
builders | shipworkers
34
Type of asbestosis
Chrysotile - white asbestos, long woolly fibres Crocidolite - blue asbestos, short fibres Amosite - brown abestos, long brittle fibres
35
Causes of ascites
Exudate - malignancy (peritoneal disease), infection (TB, perinitis), inflammation (pancreatitis) Transudate - liver cirrhosis, cardiac cirrhosis, renal failure, Meig's disease, hypoalbuminaemia
36
Test for ascites
Protein Amylase Cytology MC/S
37
Theory behind atheroma formation
inbibition - accumulation of lipid by lipoprotein encrustation - thrombus formation proliferation - smooth muscle cells are stimulated
38
Complication of atheroma
``` Thrombosis Distal embolism Rupture of plaque Stenosis of circulation Aneurysm formation ```
39
Causes of atrophy
Physiological - thymus, endometrial tissue Embryological - ductus arteriosus, thyroglossal duct pathological - ischaemia, idiopathic, iatrogenic
40
How can autoimmune disease be divided
Systemic | Organ dependent
41
Examples of systemic autoimmune disease
Rheumatoid arthritis - RhF Systemic lupus erytheromatus - Anti DNA PBC - anti mitochondria
42
Examples of organ specific autoimmune disease
Hashimoto's thyroiditis - TPO grave's disease - TSH R Idiopathic thrombocytopaenic purpura - plt myasthenia gravis - endomysial antigen
43
Aortic stenosis - aetiology
Age related calcification Rheumatic fever Infective Bicuspid aortic valve
44
Pathogenesis of calcific disease of aortic valve
lipid accumulation inflammation calcification
45
Clinical signs of aortic stenosis
Pericordial sign - ESM radiating to carotids, LV heaves, quiet S2 Peripheral signs - slow rising pulse, narrow pulse pressure, signs of endocarditis, LVF
46
main general visceral afferent to appendix
lesser splanchnic nerve
47
Score for appendicitis
Alvarado | AIR score
48
Causes of Transudate ascites
Hypoalbuminaemia vs Portal HTN Portal HTN - cirrhosis, cardiomyopathy, budd chiari, thoracic duct obstruction Hypoalbuminaemia - liver failure, nephrotic syndrome, protein losing enteropathy, renal failure
49
Fibroadenoma
Benign breast lump common <30 mobile, rubbery, well defined Proliferation of epithelium and stromal tissue of duct lobule - biphasic in nature
50
Phylloides tumour
Bisphasic tumour larger than fibroadenoma, 4-50s grow rapidly
51
Breast cyst
Distended involuted lobules that develop in perimenopausal females Painful smooth discrete lumps
52
Different types of mastalgia
true vs chest wall pain | True - cyclical vs non cyclical
53
Mastalgia
Physiological - menstrual cycle | breast enlargement, pain, nodularity
54
Breast abscess
lactational vs non lactional lactational = breast feeding, Staph, Strep Managed with ABx vs drainage
55
peri ductal mastitis
non lactational mastitis in smoker | active inflammation around non dilated sub areolar duct
56
Mondor's disease
Sudden onset of pain, with tenderness of a subcutaenous cord of tissue sclerosing thrombophlebitis of subcutaneous vein
57
Gynaecomastia
``` enlargement of male breast physiological vs pathological Neonates, puberty & old age pathological Liver failure, renal failure, testicular tumour, adrenal tumour, thyrotoxicosis, lung Ca, Klinefelter's Drug related ```
58
Nipple discharge
``` unilateral vs bilateral? colour? - blood stain = tripple assessment spontaneous vs expressing Hx of breast disease Lumps? ```
59
Causes of nipple discharge
``` Physiological Duct ectasia - perimenopausal, shortening of dilatation of subareolar ducts Intraductal papilloma epithelial hyperplasia galactorrhoea - bilateral milk gestanional nipple discharge ```
60
bone tumours
1ry vs 2ry benign vs malignant swelling/mass vs bone pain vs pathological # vs night sweats
61
Benign bone tumour
``` non ossifying fibroma simple bone cyst osteochondroma - most common giant cell tumour enchondroma fibrous dysplasia ```
62
Malignant bone tumour
Multiple myeloma - most common Osteosarcoma Ewing's sarcoma - onion skin, 5-20yrs old Chorndrosarcoma Metastatic - breast, lung, kidney, thyroid
63
Bone tumour investigation
``` Biochemistry - PTH, calcium, ALP Bone XR, MRI CT scan Whole body Tc bone scan Bone biopsy ```
64
Management of bony tumour
``` Conservative Mass effect Primary - in specific centre Secondary - IM nailing Biopsy - LIMB SALVAGE LINE ```
65
Surgical management of bone tumour
Intralesional resection marginal resection - extends to reactive zone wide local excision - plane did not breach reactive zone radical resection - boney + myofascial compartment
66
Limb salvage surgery - principles
if tumour removed with adequate tissu emargin, must allow reasonable degree of movement and funcationality Bone, nerve, blood vessels and soft tissu envelope are key components for a viable limb
67
Colorectal cancer - risk factor
FAP/HNPCC Age UC
68
Duke classification
``` A - limited to mucosa B1 - extending into muscularis propria but not penetrating through B2 - penetrating muscularis propria C1 - B1 with nodal involvement C2 - B2 with nodal involvement D - distal metastatic disease ```
69
Layers of GIT
Mucosa - epithelium, lamina propria, muscularis mucosa submucosa Muscularis propria Adventitia, serosa
70
Adenoma-carcinoma sequence
mutation of epithelium to hyperproliferation, adenoma then carcinoma mutation to APC gene then KRas and DCC, PP3
71
Hepatomegaly causes
``` physiological infective metabolic - acromegaly, alcohol infiltrate - amyloid vascular - RHF, Budd Chiari ```
72
thyroid cancer risk
age <60 radiation exposure family history genetic - gardner, MEN
73
Thyroid cancer
Papillary 85% Follicular Medullary Anaplastic
74
Hyperparathyroidism
1ry - adenoma, hyperplasia 2ry - low calcium 3ry - autonomous hyperplastic gland, high calcium
75
hypoparathyroidism
post thyroidectomy idiopathic radioactive iodine Rx for grave's
76
Hyperaldosteronism
1ry - elevated aldosterone, LOW renin; adenoma, hyperplasia | 2ry - elevated aldosterone, HIGH renin; Renal vascular disease, liver cirrhosis
77
Cholangiocarcinoma
adenocarcinoma of biliary tree caused by PSC, CLD, HIV; (liver flukes) CEA, Ca19.9
78
Wound infection
Patient factor - malnutrition, immunocompromised, malignancy, diabetes, obesity, smoking, hypothermia, chemorad Condition specific - preexisting infection, surgical site
79
Necrotising fasciitis
severe soft tissue infection with rapid p@rogressive inflammation and necrosis infection of deeper layers of skin and subcutaneous tissue - spread across fascial plane SEPSIS Erythema, pain +++, oedema/swelling/vesicles - thrombosis - tissue ischaemia - necrosis - cyanosis - epidermolysis - dermal gangrene 1) polymicrobial - staph, pseudomona, coliforms, bacterioride 2) monomicrobial - Group A strep or C perfringens
80
C Diff - pseudomembranous colitis | pathogenesis
Produces toxin taht helps colonise the gut this causes inflammation of the bowel, leading to grey white exudate that is thin and adherent on to the bowel wall the membrane is composed of necrotic epithelium, debris, fibrins, bacteria and neutrophils
81
Helicobacter pylori
Gram negative microaerophilic bacterium uses flagella to swim away from acidic lumen to adhere to more neurtal epithelial lining of stomach produce urease and converts to ammonia, which neutralise gastric acid increases risk of gastric adenoCa and Gastric MALT lymphoma (total of 1-2%)
82
How does it cause ulcer/gastritis
produces protease and phospholipase with ammonia leads to inflammation Damaged protective mucosal layer - unable to protect itself from stomach
83
How is it diagnosed
using CLO test (campylobacter like organism) | Looks at urease production - changing urea into ammonia - changes pH
84
Urease breath test
Drink radiolabelled urea | Collect carbon dioxide with labelled C
85
Gastric acid producrtion
Cephalic phase and gastric phase G cells in stomach is stimulated to produce gastrin gastrin stimulate enterochromaffin like cells to produce histamine histamine and gastrin both causes parietal cells to secrete acid
86
Barrett's oesophagus
Metaplasia of distal oesophagus, stratified squamous to columnar epithelium
87
Gastric adenocarcinoma
Lauren classification - intestinal vs diffuse
88
Heart transplant
Cardiomyopathy NYHA class 4, ejection fraction <14, deteriorating cardiac function in last year No active malignancy, HIV, EtOH/ smoking
89
Donor criteria for heart
normal ECG, <55 Brainstem death, ABO compatibility Free of HIV, hepatitis, infection
90
Type 1 hypersensitivity reaction
B cells, T helper cells and mast cells Initial exposure to the antigen leads the sensitisation of T and B cell IgE binds to mast cells - leading to degranulation and release of histamine
91
Graft versus host disease
donor t cells recognise and react against host HLA antigen
92
Steroids side effect
Central obesity, Muscle wasting in limbs thin skin, brusing, buffalo hump, hirsuitism HTN, fluid retention Psychosis, AVN, DM
93
Ciclosporin
Nephrotoxicity hirsuitism glucose intolerance
94
Tacrolimus
Nephrotoxicity | neurotoxicity
95
mycophenolate
anaemia N&V diarrhoea
96
hypercalcaemia symptoms
Bone - bone pain Stones - renal stone Moans and groan - abdo pain, constipation, pancreatitis thrones - polyuria psychiatric overtone - psychosis, depression
97
Parathyroid gland
Chief cells and oxyphil cell superior - 4th pharyngeal pouch inferior - 3rd pharyngeal pouch, thus can be in mediastinum
98
Ideal closed space for infection
``` poor perfusion hypoxia hypercapnia acidosis narrow outlet ```
99
Surgical infection spread
``` blood stream lymphatic fat planes abscess through fascial and subcutaneous planes ```
100
Stages of acute inflammation
``` vasodilation increased vascular permeability migration of white cells through vessel wall phagocytosis resolution or chronic inflammation ```
101
Chemical mediators of acute inflammation
``` histamine/serotonin bradykinin complement cascade coagulation cascade leukotriene and prostaglandin cytokines - IL, TNF ```
102
Complement cascade
component of innate immune system cascade of protein that results in formation of membrane attack complex Classical - antigen - antibody complex Alternate - contact with microorganism
103
Possible outcome of acute inflammation
``` Resolution Process to chronic inflammation Abscess formation Death Organisation and repair ```
104
Extraintestinal manifestation of IBD
Eye - conjunctivitis, uveitis, episcleritis Liver/biliary tree - cirhossis, PSC, cholangiocarcinoma Renal tract - stones joint - arthropathy, Ank Spond, Sacroiliitis Finger clubbing, erythema nodosum, pyoderma gangrenosum, aphthous ulcers
105
Sentinel node biopsy
1st node in lymph chain to receive lymphatic drainage from a tumour by injecting radio isotope or blue dye into subdermal layer around areolar region - identified using geiger counter Solution- TC99 human colloid albumin
106
Ductal carcinoma in situ
most common type of non invasive breast cancer asymptomatic microcalcification proliferation of malignant epithelial cells bound by BM of the duct
107
Invasive ductal carcinoma
70% of all breast ca breast lump + nipple discharge/retraction + skin tethering or retraction histolohgy - batches of malignat cells infiltrate into the stromal tissue
108
Lobular CIS
on biopsy not visible on MMG asymptomatic
109
Invasive lobular carcinoma
10-15% of invasive carcinoma diffuse lesion, bilateral Difficult to detect on MMG
110
Paget's disease of breast
1-2% of breast Ca erythematous, scaly rash around nipple looks like eczema
111
Surgical management of breast cancer
Breast vs Axilla Breast - WLE vs Mastectomy WLE - removal of 2-10mm of around tumour down to pectoral fascia + Titanium clip for radiotherapy Axilla - ANC vs SNB
112
Axillary nodal levels
Related to Pectoralis Minor 1 - inferolateral 2 - posterior 3- superomedial
113
indication for mastectomy
1) multifocal 2) high tumour to breast tissue ratio 3) recurrence following WLE 4) male 5) patient choice 6) BRCA1/2
114
Complication of mastectomy
immediate - haemorrhage early - haematoma, skin flap necrosis, wound dehiscence, numbness over scar, seroma, nerve famage Late - tumour recurrence
115
Breast reconstruction
``` breast mound implant implant + autologous - lat dorsi flap autologous - flap alone Nipple areolar complex nipple reconstruction - via graft or flap areolar - tattooing ```
116
Breast flap
latissimus dorsi TRAM - transverse rectus abdominus DIEP - deep inferior epigastric perforator vessels SGAP/IGAP - superior/inferior gluteal artery perforator
117
Hormonal therapy in Breast
ER status tamoxifen in premenopausal aromatase inhibitor in post menopausal - anastrazole, lestrazole
118
Herceptin
Monocolonal antibody - trastuzumab | HER2 receptor - transmembrane epidermal growth factor
119
Poor Prognostic factor for breast disease
``` positive margin young age high grade tumour large tumour lymphvascular invasion no radiotherapy ER negative HER-2 positive ```
120
Types of naevus
``` Melanocytic Congenital Juntional Interdermal Compound Blue Becker'S 0 pigmented hairy Vascular - porti wine stain, slamon patch, strawberry (capillary haemangioma) Epidermal - warty Connective tissue - shagreen patch in tuberous sclerosis ```
121
Main types of melanoma
``` Superficial spreading nodular acral lentiginous subungual Lentigo maligna (amelanotic, ocular, desmoplastic) ```
122
Risk factor
``` Family Hx Xeroderma pigmentosum albinism giant congenital pigment naevus Skin type Sun exposure Number of naevi Immunosuppression ```
123
CHaracteristic of melanoma
``` Asymmetry Irregular border grading of colour larger diameter evolving features ```
124
differential diagnosis to thyroglossal cyst
dermoid cyst lymph node thyroid nodule sebaceous cyst
125
Different type of necrosis
``` coagulative - loss of blood supply liquefactive - brain caseous - TB fat necrosis - trauma gangrenous - wet, dry, gaseous ```
126
How can neoplasms be classified according to cell type
``` epithelial - papilloma, adenoma, carcinoma mesenchymal - fibroma, lipoma, sarcoma lymphoma Pleormorphic adenoma, fibroadenoma Teratoma ```
127
Physiological hyperplasia
breast tissue during puberty | thyroid during pregnancy
128
Pathological hyperplasia
BPH | Adrenals in Cushings, other glands as well
129
Physiological hypertrophy
Muscle | uterus pregnancy
130
Pathological hypertrophy
Ventricular Hypertrophy | thyroid in graves
131
Example of hamartoma
Lipoma Haemangioma Peutz Jegher
132
Example of metaplasia
Barrett's oesophagus | transformation zone of cervix
133
Scores for pancreatitis
modified glasgow score - severity and involvement of HDU ranson criteria - mortality balthzar - CT scoring apache II - ITU mortality
134
Modified glasgow score
``` PaO2 <8kPa Age >55 Neutrophil >15 Calcium <2.00 Renal - urea >16 Enzyme - LDH>600 or AST>200 Albumin <32 Sugar >10 ```
135
Complication of acute pancreatitis
Early Shock, ARDS, DIC, MODS, hypocalcaemia Late Pseudocyst, Necrosis, abscess, Haemorrhage, thrombosis
136
What causes bilateral parotid swelling
Local - Mumps, Sjogren, Neoplasia Systemic - Sarcoid, TB, EtOH XS Drugs - OCP, thiouracil, isoprenaline
137
Unilateral parotid swelling
Duct obstruction - calculus, compression Neoplasia Infective - mumps, parotiditis
138
Salivary calculus
``` Submandibular >>> Parotid More mucous content, alkaline Single large vs multiple stones Formed by Calcium phosphate and hydroxyapatite, flow is slow and intermittent stasis 80% radioopaque ```
139
Parotid gland tumour
85% benign - pleomorphic adenoma vs Warthin's | 15% malignant - mucoepidermoid carcinoma, adenoid cystic carcinoma
140
Complication of parotidectomy
7th nerve palsy Frey's syndrome Salivary fistula Greater auricular nerve damage
141
Indication for OGD with dyspepsia
``` Age >55 Weight loss N&V Familial Hx Progressive dysphagia Anaemia/Chronic GI bleed ```
142
Complication of PUD
Bleeding - gastroduodenal artery perforation Gastric outflow obstruction Malignant transformation
143
how are polyps classified
non neoplastic - metaplastic, harmatoma, inflammatory | neoplastic - tubular, tubulo villous, villous
144
Complication of polyps
``` Malignant transformation ulceration bleeding infection intussusception protein/potassium loss ```
145
FAP management
``` clinical assessment Councelling Regular endoscopy - flexible sigmoidoscopy yearly from 10-12 yrs Colectomy - 6monthly endoscopy Medication - celecoxib, sulindac ```
146
Symptoms of BPH
Filling - frequency, urgency, nocturia | Voiding - poor stream, hesitancy, terminal dribbling
147
Assessment of BPH
``` Full Hx & examination International prostate symptom score Urine dip PSA TRUS voiding chart uroflowmetry ```
148
Complication of diverticulum
``` Infection Perforation Bleeding May contain ectopic tissue Fistula stricture Malignant potential ```
149
Risk factor to prostate cancer
``` Age Obesity Diet Family Hx Ethnicity ```
150
Management of Prostate Ca
``` MDT approach Watchful wait/surveillance Radiotherapy vs brachytherapy Hormonal - LHRH (goserelin) vs Anti androgen (flutamide) Orchidectomy TURP Chemotherapy Radical prostatectomy ```
151
Complication of TURP
``` Bleeding, UTI, urinary retention Retrograde ejaculation urinary incontinence urethral stricture erectile dysfunction TURP syndrome ```
152
Complication of renal stone
``` Passage ongoing colic obstruction - hydroureter and hydronephrosis infection haematuria SCC ```
153
Renal calculi causes
``` Abnormal anatomy proteus infection - struvite Urate Cysteinuria dehydration/stasis ```
154
Renal calculi - composition
Calcium oxalate Struvite Uric acid Cysteine/pyruvate
155
Difference between smooth vs skeletal muscles
Smooth muscle involuntary Calcium binding is calmodulin vs troponin lacks t-tuules has prolonged contraction and greater stretch has haphazard fibre arrangement
156
Complication of haemodialysis
Dysequilibrium syndrome | Sudden change in osmolality - cerebral oedema and seizures
157
Organ donation in UK - Act?
Human tissue act 2004
158
Contraindication to transplant
Malignant disease, remission within 5yrs HIV without stable CD4 count IHD - risk of death 5yrs Graft loss in 1 yr 50% - 90% survive difficult to comply to immunosuppressant - mental health, Class A drug users Persistent viral infection or chronic bacterial infection
159
Stages of organ recovery
Warm ischaemia - starts when donor circulation stops and ends when perfusion solution is flowing Cold ischaemia - starts when perfusion solution is flowing and ends when kidney is transplanted
160
Immunosuppression for transplant surgery
At time of surgery Steroids Anti CD25 (basiliximab), AntiCD3 (antithymocyte), anticd52 (alemtuzumab) Maintenance therapy Calcineucin inhibitor - tacrolimus or cyclosporin Purine - azathioprine Steroids
161
Stages of organ rejection
Hyperacute - within minutes, from recipient antibody - complement activation, clumping of RBC and platelets leading to interstitial haemorrhage Acute - up to 100days, T cell mediated, lymphocytic infiltration, arteritis and tubulitis Steroids Chronic - months to years, humoral system, graft fibrosis and atrophy
162
Clinical features of renal rejection
``` Pain Swelling Fever Reduced Urine output rising creatinine fluid retention ```
163
Complication of renal transplant
``` Delayed 1ry funtion - AKI Vascular - leak, thrombosis, stenosis urological - leak, ureteric stricture infection lymphocele ```
164
Undescended testicle
``` Risk of Testicular cancer 40x infertility 70% in inguinal canal Risk factor - low birth weight, FHx, hormonal abnormality. raised IAP (gastroschisis) may descend spontaneously in 6 months ```
165
Testicular cancer - types
Germcell vs non germ cell Germ cell - seminoma vs non seminoma non seminoma - teratoma, embryonal, choriocarcinoma, yolk sac, mixed germ cell
166
Tumour markers for teratoma
beta HCG CEA AFP
167
Tumour markers for seminoma
placental ALP | beta HCG
168
Follow up seminoma
Regular review in clinic for 10 years Beta HCG, LDH CT AP 6 monthly for 5 years
169
Follow up non seminoma
regular review Beta HCG, LDH, AFP CTAP 6monthly
170
cytological features of malignancy
``` increase mitotic sigures abnormal mitosis pleomorphism increased nuclear: cytoplasmic ratio hyperchromatism ```
171
histological feature of malignancy
``` loss of normal tissue architecture invasion through basement membrane Neovascularisation necrosis haemorrhage ```
172
function of spleen
immune response - presents antigen to lymphocyte and filtrate encapsulated organism circulatory filtration - get rid of old or damaged RBC storage of platelet haemopoiesis - until birth iron reutilisation
173
grading to splenic injury
1 - capsular tear <1cm 2 - capsular tear <3cm not involving the trabecular vessel 3- capsular tear >3cm involving trabecular vessel 4 - laceration involving segmental of hilar vessels, producing major devascularisation 5 - shattered spleen, hilar vascular injury which devascularise the spleen
174
Indication for splenectomy
Trauma - continuous bleeding, unstable patient Hypersplenism - anaemia Splenic malignancy - lymphoma As part of radical resection - colon, stomach, pancreas
175
Complication of splenectomy
immediate - bleeding early - gastric stasis/necrosis, subphrenic abscess, pancreatitis Late - pancreatic fistula, thrombocytosis, overwhelming post splenectomy infection
176
Splenectomy blood film
Increased platelet count Increased size of platelet Howell Jolly bodies
177
Causes of splenomegaly
Infective - EBV, CMV, HIV, malaria, TB Haematological - haemolytic anaemia, myeloproliferative disease, SCD, thalassaemia, leukaemia, lymphoma Systemic - Sarcoid, amyloid, Rheumatoid arthritis Portal hypertension
178
Gastric secretion
Parietal cell - HCl and intrinsic factor Chief - pepsinogen G cell - gastrin Mucous - mucous Secretion is stimulated by gastrin, histamine and vagal stimulation (hypercalcaemia as well) Inhibited by secretin, cholecystokinin and somatostatin
179
Management of low grade gastric MALT lymphoma
H Pylori eradication - regression in 75%
180
Most common benign thyroid tumour
Follicular adenoma | Similar to Follicular thyroid carcinoma in FNAC
181
Stages of wound healing
Coagulation Acute Inflammation Formation of granulation tissue (endothelial, fibroblast, macrophages Angiogenesis Epithelialisation, fibroplasia, wound contraction (myofibroblast) Maturation Remodelling
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Difference between hypertrophic and keloid scar
hypertrophic - confined to wound margin | keloid extends beyond wound margin

MRCS pathology (2 decks)

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