Seminar 5 Oral Exam Flashcards
Syndrome: Chronic Glomerulonephritis
Description: Symmetrically small kidneys with thin granular cortex and increased peripelvic fat.
Aetiology: hereditary, immunological, hypertension and diabetes (as they lead to scarring of the glomeruli).
Diagnostic criteria: develops slowly over years (no symptoms in the early stages). Hematuria, oedema, high BP, proteinuria (foamy appearence) and nocturia.
Outcomes: kidney failure.
Syndrome: Hashimoto’s Thyroiditis
Description: Extensive lymphocytic infiltrate with germinal center formation. Lymphocytes are predominantly T cells and plasma cells (polyclonal). Atrophic follicles with abundant Hürthle cells / oncocytes but no / reduced colloid. Fibrosis may be increased but does not extend beyond capsule. May see giant cells. Epithelium may have enlarged or overlapping nuclei with partial nuclear clearing, large squamous nests, hyperplastic follicles, ductal metaplasia. Squamous metaplasia of follicular epithelium can be confused with solid cell nests. Occasionally is nodular. Initial lesion is focal, then oxyphilic metaplasia of follicular cells and nodularity; later little thyroid parenchyma is present.
Aetiology: autoimmune (possibly stimulated by bacteria or genetic flaws).
Diagnostic criteria: More common in Caucasians, Black people and Japanese people. Most common in middle aged women. Anti-TSH, antithyroglobulin and antithyroid peroxidase are all present in bloods. Symptoms include unexplained weight gain, joint pain, muscle weakness, bloated face, brittle nails, dry skin and hair loss.
Syndrome: Alcoholic Liver Cirrhosis
Description: liver is yellow and greasy. It is also easily fractured. In later stages the liver becomes red with bile stained areas. There are visible nodules and fibrosis.
Aetiology: Chronic alcoholism leading to scarring (cirrhosis) of the liver.
Diagnostic criteria: patient may experience jaundice, portal hypertesnion, itching (pruritus). History of alcohol abuse. Anaemia, high blood ammonia, high blood sugar, leukocytosis, biopsy, AST 2 x higher than ALT, low magnesium, potasssium and sodium.
Outcomes: patients experience decompensated cirrhosis - this includes ascites, encephalopathy, bleeding varices and jaundice. Those with severe scirrhosis may require a liver transplant.
Syndrome: Alcoholic Liver Cirrhosis
Description: early form (steatosis). Macrovesicular steatosis - with large lipid drop that displace nucleus to periphery. Appears first in perivenular region and spreading if drinking persists or disappears with abstinence. Alcoholic cirrhosis appears classically micronodular with steatosis. Steatosis and ballooned hepatocytes may burn out in advanced fibrosis or cirrhosis.
Aetiology: Chronic alcoholism leading to scarring (cirrhosis) of the liver.
Diagnostic criteria: patient may experience jaundice, portal hypertesnion, itching (pruritus). History of alcohol abuse. Anaemia, high blood ammonia, high blood sugar, leukocytosis, biopsy, AST 2 x higher than ALT, low magnesium, potasssium and sodium.
Outcomes: patients experience decompensated cirrhosis - this includes ascites, encephalopathy, bleeding varices and jaundice. Those with severe scirrhosis may require a liver transplant.
Syndrome: Non-atypical Endometrial Hyperplasia
Description: glands are closely packed. The stroma is present between the galndular basement membrane (though diminshed ration of 3:1). Their is variation in the gland size with cystic dilatation or irregualr luminal contours. Cytologically it is reminiscent of normal proliferative endothelium but with pseudostratisfied, mitotically active and elongated columnar cells. Cells are enlarge but with smooth nuclear contours but no distinct nucleoli. It is common for there to be metaplastic chances (eosinophilic, papillary syncytial, squamous morular, mucinous and ciliated).
Aetiology: common in post menopausal women as progesterone is no longer produced.
Diagnostic criteria: thickened endometrial stripe on pelvic / transvaginal ultrasound. Endometrial biopsy. Hysterectomy with endometrial curettage. The patient may have experienced abnormal or dysfunctional uterine bleeding. It is rare for the patient to be asymptomatic.
Outcomes: leads to uterine / endometrial cancer.
Syndrome: Pheochromocytoma
Description: well circumscribed and unencapsulated. Solid white to red-brown hemorrhagic cut surface. The mean diameter is between 4 - 6.5cm. If malignant will be between 7 and 9cm.
Aetiology: 3 clusters of mutation: 1) induce hypoxic response, 2) increased MAP kinase and cell proliferation, 3) Wnt pathway alteration - all increase production of catecholamines.
Diagnostic criteria: tumours secrete catecholamines and are detected in the blood and urine via liquid chromotagraphy or mass spec. Chromogranin A secreted by chromaffin cells in serum. Using CT and MRI if metastatic. There is rim enhancement with sharp necrotic borders.
Outcomes: effects of increased adrenaline and noradrenaline. These include hypertensive crisis and heart failure.
Syndrome: Phlegmonous Appendicitis
Description: hemorrhagic / necrotic appearence with fibrinopurulent coating. Serosa in congested. Evident rupture. Ulcerated and hyperemic mucosa. Lumen contains puss and blood. Fecalith may be present.
Aetiology: luminal obstruction by fecalith, lyphoid hyperplasia, fecal debris, true calculus or tumour. This leads to increased intraluminal pressure and impairs venous outflow with mucosal damage. Bacterial infection spreads into the wall with mural necrosis and formation of abscess’.
Diagnostic criteria: mucosal or luminal neutrophils within the wall of the appendix. Associated with granulocytosis, increased sed rate and C - reactive protein. There is mural thickening and enhancement, appendiceal dilation, cecal thickening.
Outcomes: rupture, sepsis, death.
Syndrome: Phlegmonous Appendicitis
Description: neutrophilic infiltration in the walls (acute mucosal inflammation). Vessels may show thrombosis or contain lymphocytes, granulation tissue may be present. May see foamy histiocytes.
Aetiology: luminal obstruction by fecalith, lyphoid hyperplasia, fecal debris, true calculus or tumour. This leads to increased intraluminal pressure and impairs venous outflow with mucosal damage. Bacterial infection spreads into the wall with mural necrosis and formation of abscess’.
Diagnostic criteria: mucosal or luminal neutrophils within the wall of the appendix. Associated with granulocytosis, increased sed rate and C - reactive protein. There is mural thickening and enhancement, appendiceal dilation, cecal thickening.
Outcomes: rupture, sepsis, death.
Syndrome: Rapidly Progressive Glomerulonephritis
Description: crescents in glomeruli are proliferation or parietal epithelium of Bowman’s capsule with macrophages, neutrophils, lymphocytes, fibrin and collagen. Gloerular capillary collapse, atrophic tubules and interstitial inflammation.
Aetiology: depostion of fibrin, epithelial cell and inflamatory cells.
Diagnostic criteria: nephrotic syndrome (proteinuria, hypoalbuminaemia and hyperlipidemia) and is steroid resistant.
Outcomes: damages glomerular basement membrane of the Bowman’s capsule and then death with weeks if left untreated.
Syndrome: Uterine Leiomyoma
Description: shaprly circumscribed, round, firm, grayish white and whorled cut surface. Often shells out. Bulging and trabeculated cut surface. Usually within myometrium (intramural).
Aetiology: binding of xenoestrogens to oestrogen receptors in the myometrium. Somatic mutation in the X chromosme for initiation of myomas.
Diagnostic criteria: abnomral uterine bleeding and lower abdomen pressure. Interference of pregnancy and may block the ureters. It is oestrogen responsice so may regress after menopause.
Outcomes: negatively imapcts reproductive outcomes.
