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MRCS pathology > Pathology Q > Flashcards

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
Q

Diseases that are caused by anaerobes

A

Gas gangrene
Tetanus
pseudomembranous colitis
botulism

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26
Q

Classification of aneurysm?

A

Definition - True vs False
Shape - saccular, fusiform
Aertiology - atherosclerotic, inflammatory, infective
Congenital - Berry aneurysm

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27
Q

Complication of aneurysm

A

Thrombosis
Distal embolism
Rupture
Mass effect

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28
Q

Example of physiological apoptosis

A

Uterine wall
Degeneration of thymus
Embryological changes

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29
Q

Example of pathological apoptosis

A

Duct obstruction

Damaged cells from virus/irradiation

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30
Q

How is apoptosis regulated

A

support p53, c-myc

inhibit BCL-2

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31
Q

Causes of appendicitis

A

Idiopathic
Intraluminal - FB
Transmural - infection, inflammation, ischaemia, hamartoma, neoplasia
Extraluminal - salpingitis, endometriosis, autoimmune

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32
Q

disease caused by asbestos

A

ILD - pneumoconiosis

Malignancy - mesothilioma, bronchial ca

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33
Q

Occupation related to asbestosis

A

builders

shipworkers

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34
Q

Type of asbestosis

A

Chrysotile - white asbestos, long woolly fibres
Crocidolite - blue asbestos, short fibres
Amosite - brown abestos, long brittle fibres

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35
Q

Causes of ascites

A

Exudate - malignancy (peritoneal disease), infection (TB, perinitis), inflammation (pancreatitis)
Transudate - liver cirrhosis, cardiac cirrhosis, renal failure, Meig’s disease, hypoalbuminaemia

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36
Q

Test for ascites

A

Protein
Amylase
Cytology
MC/S

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37
Q

Theory behind atheroma formation

A

inbibition - accumulation of lipid by lipoprotein
encrustation - thrombus formation
proliferation - smooth muscle cells are stimulated

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38
Q

Complication of atheroma

A 
Thrombosis
Distal embolism
Rupture of plaque
Stenosis of circulation
Aneurysm formation
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39
Q

Causes of atrophy

A

Physiological - thymus, endometrial tissue
Embryological - ductus arteriosus, thyroglossal duct

pathological - ischaemia, idiopathic, iatrogenic

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40
Q

How can autoimmune disease be divided

A

Systemic

Organ dependent

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41
Q

Examples of systemic autoimmune disease

A

Rheumatoid arthritis - RhF
Systemic lupus erytheromatus - Anti DNA
PBC - anti mitochondria

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42
Q

Examples of organ specific autoimmune disease

A

Hashimoto’s thyroiditis - TPO
grave’s disease - TSH R
Idiopathic thrombocytopaenic purpura - plt
myasthenia gravis - endomysial antigen

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43
Q

Aortic stenosis - aetiology

A

Age related calcification
Rheumatic fever
Infective
Bicuspid aortic valve

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44
Q

Pathogenesis of calcific disease of aortic valve

A

lipid accumulation
inflammation
calcification

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45
Q

Clinical signs of aortic stenosis

A

Pericordial sign - ESM radiating to carotids, LV heaves, quiet S2
Peripheral signs - slow rising pulse, narrow pulse pressure, signs of endocarditis, LVF

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46
Q

main general visceral afferent to appendix

A

lesser splanchnic nerve

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47
Q

Score for appendicitis

A

Alvarado

AIR score

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48
Q

Causes of Transudate ascites

A

Hypoalbuminaemia vs Portal HTN
Portal HTN - cirrhosis, cardiomyopathy, budd chiari, thoracic duct obstruction
Hypoalbuminaemia - liver failure, nephrotic syndrome, protein losing enteropathy, renal failure

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49
Q

Fibroadenoma

A

Benign breast lump common <30
mobile, rubbery, well defined
Proliferation of epithelium and stromal tissue of duct lobule - biphasic in nature

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50
Q

Phylloides tumour

A

Bisphasic tumour
larger than fibroadenoma, 4-50s
grow rapidly

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51
Q

Breast cyst

A

Distended involuted lobules that develop in perimenopausal females
Painful smooth discrete lumps

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52
Q

Different types of mastalgia

A

true vs chest wall pain

True - cyclical vs non cyclical

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53
Q

Mastalgia

A

Physiological - menstrual cycle

breast enlargement, pain, nodularity

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54
Q

Breast abscess

A

lactational vs non lactional
lactational = breast feeding, Staph, Strep
Managed with ABx vs drainage

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55
Q

peri ductal mastitis

A

non lactational mastitis in smoker

active inflammation around non dilated sub areolar duct

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56
Q

Mondor’s disease

A

Sudden onset of pain, with tenderness of a subcutaenous cord of tissue
sclerosing thrombophlebitis of subcutaneous vein

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57
Q

Gynaecomastia

A 
enlargement of male breast
physiological vs pathological
Neonates, puberty &amp; old age
pathological
Liver failure, renal failure, testicular tumour, adrenal tumour, thyrotoxicosis, lung Ca, Klinefelter's
Drug related
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58
Q

Nipple discharge

A 
unilateral vs bilateral?
colour? - blood stain = tripple assessment
spontaneous vs expressing
Hx of breast disease
Lumps?
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59
Q

Causes of nipple discharge

A 
Physiological
Duct ectasia - perimenopausal, shortening of dilatation of subareolar ducts
Intraductal papilloma 
epithelial hyperplasia 
galactorrhoea - bilateral milk
gestanional nipple discharge
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60
Q

bone tumours

A

1ry vs 2ry
benign vs malignant
swelling/mass vs bone pain vs pathological # vs night sweats

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61
Q

Benign bone tumour

A 
non ossifying fibroma 
simple bone cyst
osteochondroma - most common 
giant cell tumour
enchondroma 
fibrous dysplasia
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62
Q

Malignant bone tumour

A

Multiple myeloma - most common
Osteosarcoma
Ewing’s sarcoma - onion skin, 5-20yrs old
Chorndrosarcoma
Metastatic - breast, lung, kidney, thyroid

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63
Q

Bone tumour investigation

A 
Biochemistry - PTH, calcium, ALP
Bone XR, MRI
CT scan
Whole body Tc bone scan
Bone biopsy
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64
Q

Management of bony tumour

A 
Conservative
Mass effect
Primary - in specific centre
Secondary - IM nailing
Biopsy - LIMB SALVAGE LINE
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65
Q

Surgical management of bone tumour

A

Intralesional resection
marginal resection - extends to reactive zone
wide local excision - plane did not breach reactive zone
radical resection - boney + myofascial compartment

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66
Q

Limb salvage surgery - principles

A

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

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67
Q

Colorectal cancer - risk factor

A

FAP/HNPCC
Age
UC

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68
Q

Duke classification

A 
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
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69
Q

Layers of GIT

A

Mucosa - epithelium, lamina propria, muscularis mucosa
submucosa
Muscularis propria
Adventitia, serosa

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70
Q

Adenoma-carcinoma sequence

A

mutation of epithelium to hyperproliferation, adenoma then carcinoma
mutation to APC gene then KRas and DCC, PP3

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71
Q

Hepatomegaly causes

A 
physiological
infective
metabolic - acromegaly, alcohol
infiltrate - amyloid
vascular - RHF, Budd Chiari
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72
Q

thyroid cancer risk

A

age <60
radiation exposure
family history
genetic - gardner, MEN

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73
Q

Thyroid cancer

A

Papillary 85%
Follicular
Medullary
Anaplastic

74
Q

Hyperparathyroidism

A

1ry - adenoma, hyperplasia
2ry - low calcium
3ry - autonomous hyperplastic gland, high calcium

75
Q

hypoparathyroidism

A

post thyroidectomy
idiopathic
radioactive iodine Rx for grave’s

76
Q

Hyperaldosteronism

A

1ry - elevated aldosterone, LOW renin; adenoma, hyperplasia

2ry - elevated aldosterone, HIGH renin; Renal vascular disease, liver cirrhosis

77
Q

Cholangiocarcinoma

A

adenocarcinoma of biliary tree
caused by PSC, CLD, HIV; (liver flukes)
CEA, Ca19.9

78
Q

Wound infection

A

Patient factor - malnutrition, immunocompromised, malignancy, diabetes, obesity, smoking, hypothermia, chemorad
Condition specific - preexisting infection, surgical site

79
Q

Necrotising fasciitis

A

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
Q

C Diff - pseudomembranous colitis

pathogenesis

A

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
Q

Helicobacter pylori

A

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
Q

How does it cause ulcer/gastritis

A

produces protease and phospholipase with ammonia leads to inflammation
Damaged protective mucosal layer - unable to protect itself from stomach

83
Q

How is it diagnosed

A

using CLO test (campylobacter like organism)

Looks at urease production - changing urea into ammonia - changes pH

84
Q

Urease breath test

A

Drink radiolabelled urea

Collect carbon dioxide with labelled C

85
Q

Gastric acid producrtion

A

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
Q

Barrett’s oesophagus

A

Metaplasia of distal oesophagus, stratified squamous to columnar epithelium

87
Q

Gastric adenocarcinoma

A

Lauren classification - intestinal vs diffuse

88
Q

Heart transplant

A

Cardiomyopathy
NYHA class 4, ejection fraction <14, deteriorating cardiac function in last year
No active malignancy, HIV, EtOH/ smoking

89
Q

Donor criteria for heart

A

normal ECG, <55
Brainstem death, ABO compatibility
Free of HIV, hepatitis, infection

90
Q

Type 1 hypersensitivity reaction

A

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
Q

Graft versus host disease

A

donor t cells recognise and react against host HLA antigen

92
Q

Steroids side effect

A

Central obesity, Muscle wasting in limbs
thin skin, brusing, buffalo hump, hirsuitism
HTN, fluid retention
Psychosis, AVN, DM

93
Q

Ciclosporin

A

Nephrotoxicity
hirsuitism
glucose intolerance

94
Q

Tacrolimus

A

Nephrotoxicity

neurotoxicity

95
Q

mycophenolate

A

anaemia
N&V
diarrhoea

96
Q

hypercalcaemia symptoms

A

Bone - bone pain
Stones - renal stone
Moans and groan - abdo pain, constipation, pancreatitis
thrones - polyuria
psychiatric overtone - psychosis, depression

97
Q

Parathyroid gland

A

Chief cells and oxyphil cell
superior - 4th pharyngeal pouch
inferior - 3rd pharyngeal pouch, thus can be in mediastinum

98
Q

Ideal closed space for infection

A 
poor perfusion
hypoxia
hypercapnia
acidosis
narrow outlet
99
Q

Surgical infection spread

A 
blood stream
lymphatic
fat planes
abscess
through fascial and subcutaneous planes
100
Q

Stages of acute inflammation

A 
vasodilation
increased vascular permeability
migration of white cells through vessel wall
phagocytosis
resolution or chronic inflammation
101
Q

Chemical mediators of acute inflammation

A 
histamine/serotonin
bradykinin
complement cascade
coagulation cascade
leukotriene and prostaglandin
cytokines - IL, TNF
102
Q

Complement cascade

A

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
Q

Possible outcome of acute inflammation

A 
Resolution
Process to chronic inflammation
Abscess formation
Death
Organisation and repair
104
Q

Extraintestinal manifestation of IBD

A

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
Q

Sentinel node biopsy

A

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
Q

Ductal carcinoma in situ

A

most common type of non invasive breast cancer
asymptomatic
microcalcification
proliferation of malignant epithelial cells bound by BM of the duct

107
Q

Invasive ductal carcinoma

A

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
Q

Lobular CIS

A

on biopsy
not visible on MMG
asymptomatic

109
Q

Invasive lobular carcinoma

A

10-15% of invasive carcinoma
diffuse lesion, bilateral
Difficult to detect on MMG

110
Q

Paget’s disease of breast

A

1-2% of breast Ca
erythematous, scaly rash around nipple
looks like eczema

111
Q

Surgical management of breast cancer

A

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
Q

Axillary nodal levels

A

Related to Pectoralis Minor
1 - inferolateral
2 - posterior
3- superomedial

113
Q

indication for mastectomy

A

1) multifocal
2) high tumour to breast tissue ratio
3) recurrence following WLE
4) male
5) patient choice
6) BRCA1/2

114
Q

Complication of mastectomy

A

immediate - haemorrhage
early - haematoma, skin flap necrosis, wound dehiscence, numbness over scar, seroma, nerve famage
Late - tumour recurrence

115
Q

Breast reconstruction

A 
breast mound 
implant
implant + autologous - lat dorsi flap
autologous - flap alone
Nipple areolar complex
nipple reconstruction - via graft or flap
areolar - tattooing
116
Q

Breast flap

A

latissimus dorsi
TRAM - transverse rectus abdominus
DIEP - deep inferior epigastric perforator vessels
SGAP/IGAP - superior/inferior gluteal artery perforator

117
Q

Hormonal therapy in Breast

A

ER status
tamoxifen in premenopausal
aromatase inhibitor in post menopausal - anastrazole, lestrazole

118
Q

Herceptin

A

Monocolonal antibody - trastuzumab

HER2 receptor - transmembrane epidermal growth factor

119
Q

Poor Prognostic factor for breast disease

A 
positive margin
young age
high grade tumour
large tumour
lymphvascular invasion
no radiotherapy
ER negative
HER-2 positive
120
Q

Types of naevus

A 
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
Q

Main types of melanoma

A 
Superficial spreading
nodular
acral lentiginous
subungual
Lentigo maligna
(amelanotic, ocular, desmoplastic)
122
Q

Risk factor

A 
Family Hx
Xeroderma pigmentosum
albinism
giant congenital pigment naevus
Skin type
Sun exposure
Number of naevi
Immunosuppression
123
Q

CHaracteristic of melanoma

A 
Asymmetry
Irregular border
grading of colour
larger diameter
evolving features
124
Q

differential diagnosis to thyroglossal cyst

A

dermoid cyst
lymph node
thyroid nodule
sebaceous cyst

125
Q

Different type of necrosis

A 
coagulative - loss of blood supply
liquefactive - brain
caseous - TB
fat necrosis - trauma
gangrenous - wet, dry, gaseous
126
Q

How can neoplasms be classified according to cell type

A 
epithelial - papilloma, adenoma, carcinoma
mesenchymal - fibroma, lipoma, sarcoma
lymphoma
Pleormorphic adenoma, fibroadenoma
Teratoma
127
Q

Physiological hyperplasia

A

breast tissue during puberty

thyroid during pregnancy

128
Q

Pathological hyperplasia

A

BPH

Adrenals in Cushings, other glands as well

129
Q

Physiological hypertrophy

A

Muscle

uterus pregnancy

130
Q

Pathological hypertrophy

A

Ventricular Hypertrophy

thyroid in graves

131
Q

Example of hamartoma

A

Lipoma
Haemangioma
Peutz Jegher

132
Q

Example of metaplasia

A

Barrett’s oesophagus

transformation zone of cervix

133
Q

Scores for pancreatitis

A

modified glasgow score - severity and involvement of HDU
ranson criteria - mortality
balthzar - CT scoring
apache II - ITU mortality

134
Q

Modified glasgow score

A 
PaO2 <8kPa
Age >55
Neutrophil >15
Calcium <2.00
Renal - urea >16
Enzyme - LDH>600 or AST>200
Albumin <32
Sugar >10
135
Q

Complication of acute pancreatitis

A

Early
Shock, ARDS, DIC, MODS, hypocalcaemia

Late
Pseudocyst, Necrosis, abscess, Haemorrhage, thrombosis

136
Q

What causes bilateral parotid swelling

A

Local - Mumps, Sjogren, Neoplasia
Systemic - Sarcoid, TB, EtOH XS
Drugs - OCP, thiouracil, isoprenaline

137
Q

Unilateral parotid swelling

A

Duct obstruction - calculus, compression
Neoplasia
Infective - mumps, parotiditis

138
Q

Salivary calculus

A 
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
Q

Parotid gland tumour

A

85% benign - pleomorphic adenoma vs Warthin’s

15% malignant - mucoepidermoid carcinoma, adenoid cystic carcinoma

140
Q

Complication of parotidectomy

A

7th nerve palsy
Frey’s syndrome
Salivary fistula
Greater auricular nerve damage

141
Q

Indication for OGD with dyspepsia

A 
Age >55
Weight loss
N&amp;V
Familial Hx
Progressive dysphagia
Anaemia/Chronic GI bleed
142
Q

Complication of PUD

A

Bleeding - gastroduodenal artery
perforation
Gastric outflow obstruction
Malignant transformation

143
Q

how are polyps classified

A

non neoplastic - metaplastic, harmatoma, inflammatory

neoplastic - tubular, tubulo villous, villous

144
Q

Complication of polyps

A 
Malignant transformation
ulceration
bleeding
infection
intussusception
protein/potassium loss
145
Q

FAP management

A 
clinical assessment
Councelling
Regular endoscopy - flexible sigmoidoscopy yearly from 10-12 yrs
Colectomy - 6monthly endoscopy
Medication - celecoxib, sulindac
146
Q

Symptoms of BPH

A

Filling - frequency, urgency, nocturia

Voiding - poor stream, hesitancy, terminal dribbling

147
Q

Assessment of BPH

A 
Full Hx &amp; examination
International prostate symptom score
Urine dip
PSA
TRUS
voiding chart
uroflowmetry
148
Q

Complication of diverticulum

A 
Infection
Perforation
Bleeding
May contain ectopic tissue
Fistula
stricture
Malignant potential
149
Q

Risk factor to prostate cancer

A 
Age
Obesity
Diet
Family Hx
Ethnicity
150
Q

Management of Prostate Ca

A 
MDT approach
Watchful wait/surveillance
Radiotherapy vs brachytherapy
Hormonal - LHRH (goserelin) vs Anti androgen (flutamide)
Orchidectomy
TURP
Chemotherapy
Radical prostatectomy
151
Q

Complication of TURP

A 
Bleeding, UTI, urinary retention
Retrograde ejaculation
urinary incontinence
urethral stricture
erectile dysfunction
TURP syndrome
152
Q

Complication of renal stone

A 
Passage
ongoing colic
obstruction - hydroureter and hydronephrosis
infection
haematuria
SCC
153
Q

Renal calculi causes

A 
Abnormal anatomy
proteus infection - struvite
Urate
Cysteinuria
dehydration/stasis
154
Q

Renal calculi - composition

A

Calcium oxalate
Struvite
Uric acid
Cysteine/pyruvate

155
Q

Difference between smooth vs skeletal muscles

A

Smooth muscle involuntary
Calcium binding is calmodulin vs troponin
lacks t-tuules
has prolonged contraction and greater stretch
has haphazard fibre arrangement

156
Q

Complication of haemodialysis

A

Dysequilibrium syndrome

Sudden change in osmolality - cerebral oedema and seizures

157
Q

Organ donation in UK - Act?

A

Human tissue act 2004

158
Q

Contraindication to transplant

A

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
Q

Stages of organ recovery

A

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
Q

Immunosuppression for transplant surgery

A

At time of surgery
Steroids
Anti CD25 (basiliximab), AntiCD3 (antithymocyte), anticd52 (alemtuzumab)

Maintenance therapy
Calcineucin inhibitor - tacrolimus or cyclosporin
Purine - azathioprine
Steroids

161
Q

Stages of organ rejection

A

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
Q

Clinical features of renal rejection

A 
Pain
Swelling
Fever
Reduced Urine output
rising creatinine
fluid retention
163
Q

Complication of renal transplant

A 
Delayed 1ry funtion - AKI
Vascular - leak, thrombosis, stenosis
urological - leak, ureteric stricture
infection 
lymphocele
164
Q

Undescended testicle

A 
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
Q

Testicular cancer - types

A

Germcell vs non germ cell
Germ cell - seminoma vs non seminoma
non seminoma - teratoma, embryonal, choriocarcinoma, yolk sac, mixed germ cell

166
Q

Tumour markers for teratoma

A

beta HCG
CEA
AFP

167
Q

Tumour markers for seminoma

A

placental ALP

beta HCG

168
Q

Follow up seminoma

A

Regular review in clinic for 10 years
Beta HCG, LDH
CT AP 6 monthly for 5 years

169
Q

Follow up non seminoma

A

regular review
Beta HCG, LDH, AFP
CTAP 6monthly

170
Q

cytological features of malignancy

A 
increase mitotic sigures
abnormal mitosis
pleomorphism
increased nuclear: cytoplasmic ratio
hyperchromatism
171
Q

histological feature of malignancy

A 
loss of normal tissue architecture
invasion through basement membrane
Neovascularisation 
necrosis
haemorrhage
172
Q

function of spleen

A

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
Q

grading to splenic injury

A

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
Q

Indication for splenectomy

A

Trauma - continuous bleeding, unstable patient
Hypersplenism - anaemia
Splenic malignancy - lymphoma
As part of radical resection - colon, stomach, pancreas

175
Q

Complication of splenectomy

A

immediate - bleeding
early - gastric stasis/necrosis, subphrenic abscess, pancreatitis
Late - pancreatic fistula, thrombocytosis, overwhelming post splenectomy infection

176
Q

Splenectomy blood film

A

Increased platelet count
Increased size of platelet
Howell Jolly bodies

177
Q

Causes of splenomegaly

A

Infective - EBV, CMV, HIV, malaria, TB
Haematological - haemolytic anaemia, myeloproliferative disease, SCD, thalassaemia, leukaemia, lymphoma
Systemic - Sarcoid, amyloid, Rheumatoid arthritis
Portal hypertension

178
Q

Gastric secretion

A

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
Q

Management of low grade gastric MALT lymphoma

A

H Pylori eradication - regression in 75%

180
Q

Most common benign thyroid tumour

A

Follicular adenoma

Similar to Follicular thyroid carcinoma in FNAC

181
Q

Stages of wound healing

A

Coagulation
Acute Inflammation
Formation of granulation tissue (endothelial, fibroblast, macrophages
Angiogenesis
Epithelialisation, fibroplasia, wound contraction (myofibroblast)
Maturation
Remodelling

182
Q

Difference between hypertrophic and keloid scar

A

hypertrophic - confined to wound margin

keloid extends beyond wound margin

MRCS pathology (2 decks)

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