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Year 5 Path Histopathology > Random Facts from past Papers > Flashcards

Random Facts from past Papers Flashcards

1
Q

What is the inheritance pattern for all Multiple Endocrine Neoplasia (MEN) subgroups?

A

All are autosomal domiant

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2
Q

What gene is affected in MEN 1?

A

MEN1 gene on chromomsome 11

Leads to altered expression of Mening (usually TSG)

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3
Q

What malignancies are associated with MEN1?

A

MEN 1= 3 Ps

  1. Parathyroid (parathyroid adenoma)
  2. Pancreas (endocrine pancreatic tumours e.g. insulinoma, gastrinoma)
  3. Pituitary adenoma (most commonly prolactin)
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4
Q

What gene is affected in MEN 2?

A

Altered expression of the RET proto-oncogene → elevated tyrosine kinase activity

MEN 2 has 2 subtypes. Both share 2 of the 3 neoplasms, but one is different (they also have different body habitus)

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5
Q

What malignancies is MEN 2a associated with?

A

MEN 2a =2P and one M

For all MEN 2

  • Medullary Thyroid carcinoma
  • Phaeochromocytoma

For Men 2a

  • above +
  • Primary hyperparathyroisim
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6
Q

What malignancies are associated with MEN2b?

A

MEN 2b = 2M and one P

For all MEN 2

  • Medullary Thyroid carcinoma
  • Phaeochromocytoma

For MEN2b

  • above +
  • Multiple neurinomas (+ marfanoid features)
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7
Q

What sub-types of thyroid cancers are there?

A
  1. Derived from Thyrocytes
  • Papillary
  • Follicular
  • Anaplasitc
  1. Derived from parafollicular C cells (calcitonin)
  • Medullary
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8
Q

What is the most common sub-type of thyroid cancer?

What is the typical epidemiology and prognosis?

A

Papillary thyroid cancer

usually in women 20-40, associated with irradiation

Overall has excellent prognosis

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9
Q

What are the histological charactreistics of papillary thyroid cancer?

A
  1. Psamoma bodies
  2. empty appearing nuclei with central clearing (orphan annie eyes)
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10
Q

Where does papillary thyroid cancer usually metastasise?

A

Usually Lymph nodes + lungs (often presents as painless cervical lymphadenopathy)

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11
Q

What type of thyroid cancer is assocaited with MEN2?

What cells is it derived from?

A

Medullary thyroid cancer (5% of all thyroid cancers)

–> Derived from parafollicular C cells

20% of people with medullary thyroid cancer have MEN2

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12
Q

What tumour markers can be used in the diagnosis of medullary thyroid cancers?

A
  1. CEA
  2. calcitonin
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13
Q

What is the histological appearance of medullary thyroid cancer?

What other features might hint you towards a medullary thyroid cancer in an SBA?

A

Sheets of dark cells
With amyloid depositions (arrows pointing to fibrous bands ) with high vascularity within tumour

  • Association with MEN2 (aka phaeos)
  • high calcitonin
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14
Q

What is follicular thyroid cancer?

What is the epiodemiology?
Where does it usually metastasise?
What is the histopathological appearnace?

A

2nd most common thyroid cancer (10-20%), usually in 40-60 years and metastasises early

Usually metastasises into **Blood ** first+

Histology

  • uniform cells forming small follicles and reminiscent of normal thyroid
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15
Q

What is the most agressive form of thyroid cancer?

What is the epidemiolgoy and histological appearance?

A

Anaplasic Thyroid cancer (only 1-2% of cases)

usually in elderly and prognosis <1 year

Histology: undifferentiated follicular, large pleomorphic giant cells, spindle cells

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16
Q

What is the most common type of pancreatic cancer?

What is the histological appearance

A

Ductal adenocarinoma (95%) with

  • altered ductal structures
  • cellular infiltration

Other subtypes (acinar adenocarcinoma, mucinous cystadenocarcinoma) are less common, but also exocrine

  • There are also pancreatic endocrine tumours
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17
Q

What antiviral medicaiton is used for treatment of CMV?

A

Ganciclovir

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18
Q

What antiviral medication can be used in the managment of RSV?

A

Ribavirn

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19
Q

50 year old female presents to the ENT clinic following a recent admission of hypercalcaemia. Primary hyperparathyroidism secondary to adenoma is suspected.

What investigation is most useful in determining location and functional status of the adenomas?

A

Technetium 99 scan

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20
Q

What are the traunsfusion threshold for platelet transfusions?

A

<10 : Leukaemias
<20 : Sepsis
<50 : Surgery (prevent bleeding in surgery, might be higher depending on site)
<75: if big RBC transfusion to balance

NO transfusion if activel bledding or any cunsumption diorders (e.g. TTP; DIC; HIT)

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21
Q

What Breast cancer is also known as No specific type?

A

Invasice ductal carcinoma (NST) –> most common breast cancer

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22
Q

What breast cancer is associated with E cadherin loss?

A

Lobular carcinoma

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23
Q

Which common condition can be treated with drugs that target TNF, IL-17 and Il-12/23?

A

Psoriasis

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24
Q

What viral diseases do you use Ribavirin against?

A

RSV

Hepatitis C

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25
Q

What medication is used to treat Herpes infections (HSV, CMV, EBV) in immunocompromised patients or in patients with CMV infection pre-transplant?

A

Foscarnet

Foscarnet is principally used for the treatment of ganciclovir-resistant cytomegalovirus (CMV) infections in patients with the acquired immunodeficiency syndrome (AIDS) or in transplant recipients.

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26
Q

What antiviral treatment must be administered with probenecid?

A

Cidofovir

–> off-label use of probenecid (usually gout medication) to limit nephrotoxic effects of cidofovir

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27
Q

What is an important differential to Multtiple myeloma when you see overproduction of IgM?

A

Waldenstrom’s macroglobulinaemia

A type of non-Hodgekin lymphoma leading to monoconal overproduction of IgM

Often presents due to hyperviscocoity (IgM overproduction) + fatigue

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28
Q

What is the most common cause of hypercalcaemia in the community?

A

hyperparathyroidism –> primary? (parathyroid adenoma)

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29
Q

Venetoclax is a BCL2 inhibitor used in CLL. What cellular process does it affect?

A

Apoptosis

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30
Q

What is the most common cause of contrictive pericarditis in developing countries?

A

??????

TB?

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31
Q

Wha is the most common cause of nephrotic syndrome in aduls that is glomerular pathology?

A

Focal segmental glomerularnephritis

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32
Q

What is the most common cause of portal vein thrombosis?

A

Hypercoaguability –> Polycythemia vera

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33
Q

What is the microscopic appearnace of the pathogen causing hamoptysis in eldery patients and alcoholics?

A

-ve rod, enterobacter

Klebsiella

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34
Q

What is the commonest cause of myocarditis?

A

Viral: expecially coxacie B

Most commonly implicated: coxsackie B1-B5 (picornavirus), parvovirus B19, human herpesvirus 6 (HHV-6), adenovirus, HCV, HIV

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35
Q

Which virus characteristically causes encephalitis involving the temporal lobes?

A

Herpes simplex virus

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36
Q

Recall the Zones of the adrenal and in which zones

  1. Glococorticoids
  2. Mineralcorticoids
  3. Androgens
  4. Epineohrine are produced
A

Has Medulla (inside) and Cortex (outside)

Medulla = Cetecholamines (Epinephrine)

Then from inside out:

  1. Zone reticularis (androgens)
  2. Zona fasciculata: glucocorticoids (cortisone)
  3. Zone glomerulosa: Aldosterone (Mineralcorticoids)
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37
Q

What condition occurs in both MEN1 and MEN2a?

A

Hyperparathyroidism

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38
Q

What active enzyme in sarcoidosis patients causes hypercalcaemia

A

1-alpha hydroxylase

ctivated pulmonary alveolar macrophages → ↑ 1-alpha hydroxylase expression and activity → ↑ 1,25-dihydroxyvitamin D (calcitriol) → hypervitaminosis D → hyperphosphatemia, hypercalcemia, and, possibly, renal failure [6]

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39
Q

Deficiency of which plasma protein occurs in patients with liver disease and a movement disorder?

A

ceruloplasmin

–> Wilson’s disease

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40
Q

Doctors should measure the level/activity of which enzyme before prescribing azathioprine?

A

TPMT

Thiopurine methyltransferas

enzmyme needed in metabolism of azathioprine. If congenital deficiency of TPMT –> built up of toxic metabolit of azathioprine leading to severe BM failure

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41
Q

What gene is defected in X-linked severe combined immune deficiency?
What does it result in?

A

mutations in the gene encoding the common gamma chain → defective IL-2R gamma chain receptor linked to JAK3 (most common SCID mutation)

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42
Q

Mutation of CD40 ligand is associated with which form of primary immunodeficiency?

A

Hyper-IgM syndrome

A group of syndromes characterized by impaired interaction between Th cells and B cells that results in a B cell class-switching defect

CD40 ligand deficiency is most common form

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43
Q

Which class of antibiotics has concentration dependent killing (i.e. the goal of therapy is to maximise peak > MIC)

A

Aminoglycosides

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44
Q

What is the treatment of samonella typhi?

A

Cefotaxime (or ceftriaxone)

azithromycin may be an alternative in mild or moderate disease caused by multiple-antibacterial-resistant organisms.

Alternative if micro-organism sensitive, ciprofloxacin

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45
Q

What antifungalis used in the treatment of cryptococcal meningitis + invasive fungal infection?

A

Amphotericin B

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46
Q

What type of necrosis is seen after an acute Myocaridal infarction?

A

The pathological hallmark of acute MI is coagulative necrosis of the myocardiu

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47
Q

What is the most common glia cell in the CNS?

A

Astrocyte

48
Q

What is the inheritance pattern of haemochromatosis?

A

Autosomal recessive (with incomplete penetrance)

(Wilson’s disease is also autosomal recessive)

49
Q

Explain the pathophysiology and how a mutation in MEFV gene leads to diase?

A

Causes familial mediterranean fever

–> Failure to regulate cryopyrin driven activation of neutrophils

50
Q

What drug regime is usually started post-transplant?

A
  1. Signal transduction blockade, usually a CNI (calcineurin) inhibitor: Tacrolimus or Cyclosporin; sometimes mTOR inhibitor (Rapamycin) –> inhibits activation of T cells
  2. Antiproliferative agent: MMF or Azathioprine (T-cell antiproliferative)
  3. Corticosteroids
51
Q

What is the most common form of prion disease?

A

Sporadic –> Either somatic PRNP mutation OR spontaneous conversion of PrPc to PRPSC and subsequent seeding

52
Q

What is the most common parasitic infectio, often resides in the duodenuman and can cause malabsorbtion?

A

Gardiasis: infection with Giardia lamblia

Giardia live in two states: as active trophozoites in the human body and as infectious cysts surviving in various environments. Following the ingestion of the cyst, individuals may experience abdominal cramps and frothy, greasy diarrhea. Diagnosis of giardiasis involves analyzing stool for microscopic confirmation of cysts or trophozoites, and possibly immunoassays to detect antigens. Treatment is indicated in nonpregnant symptomatic individuals and usually consists of tinidazole.

Diagnsis is usually made with visualisation of cysts in stool sample

53
Q

What are the 5 most common cancers on women?

A
  1. Breast
  2. Lung
  3. Bowel
  4. Uterus
  5. Malignant Melanoma
54
Q

What arer the 5 most common cancers in men?

A
  1. Prostate
  2. Lung
  3. Bowel
  4. Head and Neck
  5. Kidney
55
Q

What are the 5 leading causees of cancer mortality in men?

A
  1. Lung
  2. Prostate
  3. Bowel
  4. Oesophagus
  5. Pancreas
56
Q

What are the 5 leading causes of cancer deaths in Females?

A
  1. Lung
  2. Breast
  3. Bowel
  4. Unknown primary
  5. Pancreas
  6. Ovary
57
Q

What are the routine vaccinations offered in pregnancy ?

A

Influenza

Pertussis

COVID

58
Q

What viruses are routinely screened for in pregnancy?

A

HIV, syphilis, hep B,

59
Q

What antifungal is used for invasive fungal infections and cryptococcal meningitis?

A

Amphotericin B

60
Q

What organism causes athelete’s foot?

How do you call it based in the location?

A

Fungal infection, most commonly with T. rubrum, Trichophyton interdigitale

Tinea pedis = foot
Tinea manuum = hands

61
Q

What pathogen causes hypopigmentation of the affected area?

A

Usually Malassezia globosa/furfur causugin Tinea vesiculor

62
Q

What are the two scoring systems used for
1. stageing
2. grading

of prostate cancer?

A
  1. Stageing: TNM
  2. Grading: Gleason score
63
Q

What is the expected electrolytte imbalance in congenital andrenal hyperplaia?

A

No production of aldosterrone –> Low NA+ + high K+

64
Q

What pathogen is Leishmaniasis caused by? How is it transmitted?

A

Leishmania donovani (protozoan)

lots of different types –> transmitted by Sandflies

65
Q

What is the clinical presentation of cutaenous leishmaniasis?

What is the treatment?

A

solitary or multiple reddish macules/papules around the sandfly bite that quickly increase in size and develop central ulceration

If uncomplicated: usually local treatment (incl. thermotherapy)

66
Q

What is the clinical presentation of visceral leishmaniasis?

What is the treatment?

A

Management: Amphotericin B

Presentation
* many are asymptomatic, but otherwise present with
* Kala - azar =”blackfever”
* Flue like symptoms, feverr spikes, lymphadenopathy, hepatosplenomegaly, pancytopemia

67
Q

What is the treatment for human tapeworms in adults?

A

Praziquantel

Human tapeworms are part of the cestodes and can be asymputomatic in many cases, but might present with GI symtptoms, inclduing N&V, abdominaal lpain, weight loss

68
Q

35) A 39 year old male farmer from Southern Africa has been exposed to mouldy grain during his working life. He has worsening abdominal pain and jaundice. There is a large mass in the right lobe of his liver. Biopsy of the mass reveals hepatocellular carcinoma. What extrinsic agent is likely to have played a role in the development of this tumour?

A

Alflatoxin

(mould produced by aspergillus flavus and associated with increased risk in hepatocellular carcinoma)

69
Q

What is the management of Familial Mediterranean Fever?

A

Colchicine 500ug bd - binds to tubulin in neutrophils and disrupts neutrophil functions
including migration and chemokine secretion
* Anakinra (Interleukin 1 receptor antagonist)
* Etanercept (TNF alpha inhibitor)

70
Q

What primary immunodeficiency is associated with

  • normal B cell numbers
  • nomal CD8+ T cells + NK cells
  • reduction in CD4+ T-cells
  • reduction in IgA and IgG antibodies?
A

Bare lymohocyte syndrome II

Defect in one of the regulatory proteins involved in Class II gene expression * Regulatory factor X or Class II transactivator
→Absent expression of MHC Class II molecules →Profound deficiency of CD4+ cells

71
Q

What type of hearing loss can Paget’s disease cause?

A

Both nerve and conductive!

Conductive: due to ossicleinvolvement
Sensorineural: Compress 8th nerve

If pagets of the skull could have either

72
Q

Which enzyme increases after an acutet Myocardial infarction?

A

Mainly 4 enzymes

  1. Troponin (quickest)
    2. AST –> typical after cardiac event
  2. CK (MB) –> cardiac form of creatinine kinase
  3. LDH

Potassium can increase slightly but usually decreases due to adrenaline

73
Q

What liver enzyme is usually highest in a patient with viral hepatitis?

A

Both transaminases high, but usually
**ALT **> AST

74
Q

Which transaminse is usually higher in patients with jaundice caused by chronic alcohol hepaitis?

A

Usually AST> ALT

75
Q

What two tumourmarkers / biochemical investigations can be done in the diagnosis of prostate carcinoma?

A
  1. Acid phosphatase
  2. Now usually replaced by PSA (prostate specific antigen) measurements
76
Q

What happens to the the levels of Vitamin D in primary hyperparathyroidism?

A

decreases –> due to increased activation by 1-alpha- hydroxylase –> used up

77
Q

What marker of renal function increases rapidly in patients with dehydration?

What marker of renal function increases more in patients with chronic renal failure?

A

Urea increases more rapidly than Creatinine in dehydration

in chronic renal failure –> increase in Creatinine

78
Q

What are the best markers of glucose control
1. Over the last 3 months?
2. Over the last 3 weeks?

A
  1. HBA1c
  2. Fructosamine
79
Q

What is Lesch - Nyhan syndrome?
What other clinical conditon is associated with it?

Inheritance pattern?
What enzyme is mutated?

A
  1. Lesh - Nyhan = inherited genetic disorder characterized by impaired purine salvage pathway, resulting in an overproduction of uric
    acid (due to defect in HGPTR)

–> Clinical presentaiton of gout! (+ self-harming behaviour + failure to thrive)

It is X-linked recessive

80
Q

What is Leptospirosis? How does it present?

A

zoonotic disease caused by gram-negative Leptospira bacteria

Direct transmission to humans occurs when broken skin and mucous membranes come into contact with the urine of infected animals such as rodents –> oftenwater

  1. Early phase:
    * mild witth nonspecific symptoms (e.g., fever, headache, and myalgia)
    * 90% resolvespontaneouly within 7 days

But 10% progress to

  • severe form (icterohemorrhagic leptospirosis, or Weil disease)
  • triad of jaundice, bleeding manifestations, and acute kidney injury
81
Q

What organ is this?

A

Thyroid

82
Q

What organ is this?

A

Liver

83
Q

What organ is this?

A

Kidney

84
Q

What organ is this?

A

Breast

85
Q

what organ is this?

A

Adrenal

86
Q

What tissue is this?

A

Lymph node with germinal centre

  1. Germinal centre =centeroblasts and centerocytes
  2. The periphery/ darker mantle zone = mature B cells
87
Q

How couly you biochemically differentiate between Diabetes insipidus and psychogenic polydipsia?

A

Usually Serum Sodium/ plasma osmolality

in DI= high
in psychogenic polydipsia = low

88
Q

What drugs prevent end-stage renal failure in diabetic patients?

A
  1. ACEi (reduced renal perfusion pressure and result in reduced microalbuminuria)
  2. SGLT2 inhibiotrs
89
Q

post initial treatment this strain of malaria requires primaquine 30mg to eradicate liver parasites

A

plamodium vivax

90
Q

this test is determined to determine the species of malria parasite

A

Thin film

91
Q

A patient was admitted afer a fall. Investigations showed a leukocytosis with increased bilirubin levels. Albumin, folate and 12 were found tto be low. Wha tis he most likely diagnosis?

A

alcoholic liver disease

92
Q

What vitamin deficiency causes pellagra?

A

Vitamin B3

Pellagra presents with Dermatitis, Diarrhea, and Dementia

–> usually due to Heavy drinking or malnuttrition

93
Q

What virus is associated with the development of nasopharyngeal carcinoma?

A

EBV

94
Q

122) Which of the following is found in haemolytic jaundice
a) Bilirubin is normal
b) AST is raised
c) CK is raised
d) The stools are pale
e) There is increased urobilinogen in urine

A

Increase in urobilinogen
–> as a marker of increased haemolysis

Typical biochemical findings in hemolysis include ↓ haptoglobin, ↑ LDH concentration, ↑ indirect bilirubin concentration, peripheral blood smear abnormalities (e.g., ↑ reticulocytes, schistocytes, spherocytes, polychromasia), and urinalysis abnormalities (e.g., hemoglobinuria, hemosiderinuria, and urobilinogen).

95
Q

What drugs can be used in the treatment of Hepatitis B?

A
  1. Nucleotide reverse transcriptase inhibitors (NtRTIs), e.g., tenofovir
  2. Nucleoside reverse transcriptase inhibitors (NRTIs), e.g., entecavir (ETV
  3. Pegylated interferon alfa (PEG-IFN-α) –> usually not done anymoredue to side-effects
96
Q

What is the different between sporadic and variant prion disease?

How is each of them diagnosed?

A

Sporadic = Creitzfeld- Jacob disease, usually diagnosed with CSF analysis and increase in 14-3-3, s100 and Tau protein, no known cause

Variant = due to ingestion of prion protein, diagnosed with tonsillar biopsy (100% sensitive + specific)

97
Q

What cauases UTIs in young women?

A
  1. E.coli
  2. Staphylococcus saprophyticus
98
Q

A heavily pregnant (34+3) lady is newly diagnosed with HIV. Her viral load is 2,000 copies per mL of blood.

What medication should be given intrapartum to reduce the likelihood that her child will be infected by HIV?

A

Zidovudine

99
Q

What 3 fungal antigens can you test for and what fungus do they respond to?

A
100
Q

What pathogen causes athlete’s foot?

A

trycophyton ruburm

101
Q

Spot diagnsosis: discolourattion of superficial skin

A

Pityriasis versicolor

102
Q

What monoclonal antibody can be used in the ttreatment of crohn’s?

A

Vedulizumab (antit alpha 4 beta 7)

+ Natalizumab (anti alpha 4 beta 1)

103
Q

What are the different pathways that can be targeted in the treatment of Rheumatoid arhtirits?

A
  1. JAK1/3 inhibitor (inhibits production of inflammatory molecules)
  2. Anti- CTLA4 (reduces co-stimmulation of T-cells)
  3. Anti-CD20 (reduced antibody prouction)
  4. Anti - IL6 (reduced macrophage, lymphocyte, neutrophil activation)
  5. Anti TNF-alpha

+ Methotrexate
+

104
Q

What are the different pathways that can be targeted in the treatment of psoriasis/psoriatic arthritis?

A
  1. Calcineurin inhibitors (decreased T-cell activation)
  2. JAK 1/2 inhibitors ( inhibits production of inflammatory molecules)
  3. Anti - TNF alpha
  4. **Anti IL-12/23
  5. ANti-IL 17A**

+ Methotrexate

105
Q

What are the different targets that can be used in treatment of ankylsosing spondylitis?

A
  1. JAK1/3 inhibiotrs (reduce production of inflammatory molecules)
  2. anti-TNF alpha
  3. Anti TNF alpha/TNF beta
  4. ANti IL17
106
Q

What is the target of a potential monoclonal antibody that can be used in eosinophil-associated disease (asthma, eczema,)

A

IL4/5/13 blockade

107
Q

What parasite is capeable of auto-reinfection via penetration of the GI tract or perianal skin?

A

Strongyloides

108
Q

Name the drug used for patients with type 2 diabetes which inhibits the enzyme alpha glucosidase in the brush border membrane of the small bowel.

A

Arcabose

109
Q

Name a sulphonylurea

A

Gliclazide

110
Q

Name a DDP4 inhibittorr

A

Gliptins
Sitagliptin, Linagliptin

111
Q

Name a GLP-1 agonist

A

Incretin (GLP-1 analogue –> peptide increasing insulin secretion )

(-atide/- glutide)

112
Q

Recall he differentials for
1. Prolacinaemia <1000
2. Prolactinaemia 1000-5000
3. Prolactinaemia >5000

A
113
Q

Match the lipid lowering drugs with the mechanism of action

  1. Atrovastatin
  2. PCSK9 inhibitors
  3. Bile acid sequestrants
  4. Ezetimibe
  5. Niacin
  6. Fibrates

a. Inhibits the enzyme that causes internalisation of LDL receptors
b. Inhibits cholesterone absorbtion at the brush border of enterocytes
c. Activation of the peroxisome proliferator-activated receptor alpha (PPAR–α)
d. Bind bile acid in intestine –>reduced bile acid resorbtion
e. Competitive inhibition of HMG-CoA reductase
f. Inhibits lipolysis and fatty acid release in adipose tissue by blockading hormone-sensitive lipase

A

1- e
2- a
3 - d
4- b
5 - f
6- c

114
Q

What are some differentiating features between Myeloma kidney (cast nephropathy) and AL amyloiud renal damage?

A

Different pathopysiologieybut

  1. Myeloma kidney usually presents with
  • Ligh chain dominant proteinuria
  • AKI
  1. Amyloidosis
  • Albumnin dominant proteiuria
115
Q

Which agent is an Interleukin 6 (IL-6) inhibitor, indicated for treatment of severe COVID-19 infection with hypoxia?
Anakinra
Nafamostat
Palivizumab
Ruxalitinib
Tocilizumab

A

Tocilizumab

Year 5 Path Histopathology (19 decks)

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