high yield Flashcards

Question

thickened basement membrane with spike and dome appearance due to electron dense deposits in the subepithelial layer

Answer 1

membranous glomerulonephritis

Answer 2

nephrotic syndrome

Answer 3

squamous cell carcinoma

Answer 4

-AD -2 types (most comonly PKD1, other PKD2) - mutation in polycystin -liver cysts + berry anaeurysms (SAH) -depends on how many cysts (in each age group)

Answer 5

focal neurological deficit of presumed vascular origin that lasts >24hrs (stroke) or that resolves within 24hrs (TIA)

Answer 6

-ischaemic (80%) - RF: atheroscleosis -haemorrhagic (20%) - RF: HTN

Answer 7

ischaemia = lack of oxygen supply to tissue infarction = tissue death due to lack of o2 supply

Answer 8

liquefactive necrosis

Answer 9

straw-coloured fluid (otorrhea, rhinorrhea), battle sign

Answer 10

shear tensile forces tearing axona apart in midline structures eg. corpus callosum, rotral brainstem, septum pellucidum most common cause of traumatic coma

Answer 11

-collisions between brain and skull -coup: impact of brain on skull -countercoup: injury to the opposite side of brain

Answer 12

-ruptured berry aneurysms -bifurcation of internal carotid, posterior communicating arteries -hyperattenuation around circle of willis (star sign) -LP at 12 hours to see xanthrocromia

Answer 13

-rupture of middle menigneal artery (fracture of pterion) -"lemon" shape

Answer 14

-rupture of bridging veins -alcoholics, elderly, anti-coagulants -"banana" "crescent shape"

Answer 15

Amnesia apraxia aphasia agnosia anomia

Answer 16

alz > vascular > lewy > FTD

Answer 17

-accumulation of B-amyloid plaques around neurons interferes with neurone communication. hyperphosphorylation of tau forms neurofibrillary tangles -amyloid plaques & tau tangles -medial temporal lobes & hippocampus (but global atrophy) -BRAAK staging

Answer 18

mini strokes, step-wise deterioration

Answer 19

parkinsons, fluctuating course, visual hallucinations of little people an animals

Answer 20

younger patients, strong FH, personality changes & disinhibition -pick bodies (hyperphosphorylated TAU)

Answer 21

-depletio of dopamingeric neurons projecting from basal ganglia to substantial nigra (nigrostriatal pathway). alpha synuclein mutation --> lewy bodies that deposit in nigrostriatal pathway -lewy bodies

Answer 22

-PD + autonomic dysfunction - alpha synucleinopathy - glial cytoplasmic inclusions

Answer 23

-vertigal gaze dysnfunction -tauopathy

Answer 24

-alien limb phenomenon -tauopathy

Answer 25

-subfalcine -transtenorial/uncal -tonsillar (compresses brainstem, risk if high ICP and LP)

Answer 26

excess accumulation of fluid in the brain parenchyma 1) Vasogenic – disruption of the blood-brain-barrier permeability 2) Cytotoxic – secondary to cellular injury (e.g. ischaemic or hypoxic)

Answer 27

1) Communicating – reduced absorption of CSF into sinus veins e.g. in meningitis the meninges can become fibrous and this reduces absorption. 2) Non-communicating – obstruction in outflow of CSF e.g. in neonates, the lateral ventricles obstruct the cerebral aqueduct causing build-up of CSF in the lateral ventricles 3)normal pressure hydrocephalus (type of communicating hydrocephalus but normal CSF pressure): *urinary incontinence, cognitive impairment, gait apraxia (‘wet, wacky, wobbly’), Treated with a ventriculoperitoneal shunt (drains excess CSF into abdo)

Answer 28

secondary tumours (metastasis) - most commonly lung. very poor prognosis

Answer 29

1) intra-axial: glial, neurones, neuroendocrine cells (normally malignant) 2) extra-axial: cranium, soft tissue, meninges, nerves (normally benign)

Answer 30

1) supratentorial: -Focal neurological deficit -Seizures -Personality changes 2) infratentorial -Ataxia -Long tract signs – spasticity, hyperreflexia -Cranial nerve palsies

Answer 31

-Grade 1 – benign -Grade 2 – > 5 years survival -Grade 3 – 1-5 years survival -Grade 4 – < 1 year survival NO staging

Answer 32

-astrocytoma -kids (0-20) -BRAF -grade 1 -"hairy cells" "rosenthal fibres" "slow mitotic divisions"

Answer 33

-astrocytoma -20-40 -IDH -grade 2-3 -"low-moderate cellularity" "Low mitotic activity" "No vascular proliferation"

Answer 34

MOST COMMON AGGRESSIVE PRIMARY BRAIN TUMOUR IN ADULTS -astrocytoma -50+ -IDH wildtype -grade 4 - "high cellularit" "high mitotic activity" " vascular proliferation/necrosis)

Answer 35

-meningeal -increases with age -NF2 -psammoma bodies -grading determined by mitotic activity

Answer 36

-embryonal -2nd most common brain tumour in children

Answer 37

"fried egg appearance"

Answer 38

"ventricular tumour" "hydrocephalus)

Answer 39

* acute inflammation * corticosteroid use

Answer 40

chronic inflammation

Answer 41

* keratin production * intracellular bridges

Answer 42

* from glandular epithelium * form glands that secrete mucin

Answer 43

congo red stain (apple green birifrengence)

Answer 44

* prussian blue * Perl's stain

Answer 45

cytokeratin

Answer 46

* ziehl-neelson stain (red against blue background): acid fast bacilli * rhodamine-auramine stain (bright yellow)

Answer 47

Gomori's methanamine silver stain (flying saucer shaped cysts)

Answer 48

modified kimyoun stain

Answer 49

india ink stain (yeast cells surrounded by HALOs)

Answer 50

giemsa stain

Answer 51

Fite stain

Answer 52

* viral and idiopathic * diffuse concave ST elevation + PR depression * pleuritic chest pain (recent viral illness)

Answer 53

* chronic heart failure, inflammatory, infectious, malignant, autoimmune * Becks triad: 1) muffled heart sounds 2) raised JVP 3) hypotension

Answer 54

1. endothelial injury causes LDL to accumulate 2. LDL enters tunica intima and becomes trapped in sub-intimal space 3. LDL converted into modified & oxidised LDL 4. macrophages take this LDL up (via scavenger receptors), becoming foam cells 5. apoptosis of foam cells leads to inflammation & cholesterol core of plaque 6. Increase in adhesion molecules so more inflammatory cell infiltrate 7. vascular smooth muscle cells form fibrous cap (segregates thrombogenic core from lumen)

Answer 55

* abdominal aorta > thoracic aorta * leads to AAA

Answer 56

* origins (ostia) of major branches * turbulent flow: low/oscillartory shear stress = atherogeneic (laminar flow = protective)

Answer 57

angina due to coronary artery spasm rather than atherosclerosis (rare)

Answer 58

* coronary atherosclerosis * plaque rupture * platelet activation * thrombosis & vasospasm * myocardial necrosis seconary to ischaemia * COAGULATIVE NECROSIS

Answer 59

* <6 hrs: **normal** * 6-24hrs: loss of nuclei, homogenous cytoplasma, necrotic cell death * 1-4 d: polymorph infiltration --> macropahge infiltration (clears up debris) * 5-10 d: removal of debris * 1-2 wks: granulation tissue, angiogenenesis & myofibroblasts lay down collagen * weeks/months: strenghtening decellularising SCAR TISSUE

Answer 60

* secondary to LVF * nutmeg liver

Answer 61

* autosomal dominant * βMHC (β-myosin) gene or Topronin T (less common) * thick-walled, heavy & hyper-contracting heart * histology: myocyte disarray

Answer 62

* group A streptococcus (pyogenes) * mitral. less commonly aortic * antigen mimicry: antibodies against streptococcal antigen cross-react with myocardial antigens * beady vegetations (verrucae), aschoff bodies (granulomas) + anitschkov myocytes (regenerating) * benzylpenicillin

Answer 63

* Jones criteria * Major (CASES) 1) carditis 2) arthritis 3) syndenhams chorea 4) erythema marginatum 5) subcutaneous nodules * Minor 1) fever 2) high inflammatory markers 3) migratory arthralgia 4) PR prolgonation 5) previous RF 6) malaise 7) Tachycardia * group A strep + 2 major * 1 major + 2 minor

Answer 64

* small warty vegeations on line of closure (verrucae) * large irregular masses extendiing to chordae * small bland vegetations formed of thrombi (DIC/hypercoag) * small warty vegetations (sterile + platelet rich) - assoc with SLE

Answer 65

mitral > aortic > tricuspid > pulmonary

Answer 66

* dilataion of airways * goblet cell hyperplasia * hypertrophy of mucuous glands

Answer 67

* permanent fibrotic dilatation of bronchi

Answer 68

* smooth muscle hyperplasia * goblet cell hypertrophy * curschmann spirals (shed epithelium) * Charcot-Leyden crystals (eosinophil infiltration)

Answer 69

loss of alveolar parenchyma distal to terminal brochiole

Answer 70

* post-infectious most commonly. others: obstruction, CF, primary ciliary dyskinesia, asthma, abnormal host defect * recurrent infection/inflammation leads to bronchial wall oedema & excess mucus with inflammatory cells --> bronchial wall damage (more prone to infection + inflammation) * Xray: tram-track sign * CT: signet ring sign

Answer 71

* autosomal recessive * CFTR gene (delta F508 deletion) * pseudomonas aureginosa --> bronchiectasis

Answer 72

* fine end-inspiratory crackles * reduced FEV1 and FVR but ratio >70% * fibrosing, granulomatous, eosinophilic, smoking-related

Answer 73

* usual interstitial pneumonia * honeycomb change (begins at periphy) - usually sub-pleural * lower lobe | may have clubbing

Answer 74

* inhaling mineral dusts (coal-miners) * upper lobes

Answer 75

* pleural plaques (benign, fibrosis). malignant lesions (adenocarcinoma > mesothelioma) * lower lobe

Answer 76

* immune-mediated - against organic antigens causing widespread alvoelar inflammation * polypoid plugs of loose connective tissue with granuloma formation * farmers lung, pigeon fanciers, humidifiers lung, malt workers lung, cheese washers lung

Answer 77

1) consolidation 2) red hepatisation (neutrophilis) 3) grey hepatisatio (fibrosis) 4) resolution | typically strep.pneumoniae - rust coloured sputum

Answer 78

small cell + squamous = central + smoking

Answer 79

squamous > adenocarcinoma > small cell > large cell

Answer 80

* strongest smoking correlation * p53/c-myc mutations * central (proximal bronchi) * keratin + intracellular bridges * hypercalcaemia (PTHrP secretion)

Answer 81

* women, non-smokers * peripheral * gland formation / mucin production * EGFR mutations

Answer 82

* smoking * p53 + RB1 * central * oat cells (small, non-differentiated * SIADH, ectopic ACTH (chsings), Lambert-eaton syndrome | metastasise early - highly malignant

Answer 83

* large cells + large nuclei + prominent nucloli (no gland/mucin)

Answer 84

EGFR (adenocarcinoma)

Answer 85

* parietal/visceral pleura * plerual thickening on CT | bronchoenic carcinoma is still the most common lung cancer with asbestos

Answer 86

* mean pulmonary arterial pressure > 25mmHg at rest * classes 1) pulmonary arterial hypertension 2) due to left heart disease 3) due to lung dissease 4) due to clots 5) unclear multifactorial mechanisms

Answer 87

* left heart failure * acute: intra-alveolar fluid. chronic: IRON-LADEN macrophages * batwing, kerley B lines, fluid in horizontal fissure

Answer 88

* adults: infection, aspiration, trauma, pancreatitis * hylaine membrane disease (nRDS) * explaned, firm, plum-coloured, airless lungs * CXR: white out of all lung fields

Answer 89

* squamous stratified epithelium * separated from columnar epithelium of stomach via Z line (squamo-columnar junction) | NO GOBLET CELLS

Answer 90

reflux oesophagitis = GORD

Answer 91

* metaplasia of squamous mucosa to columnar epithelium due to chronic GORD * complication: adenocarcinoma * prescence of goblet cells (intestinal metaplasia)

Answer 92

* barrett's, smoking, obesity, radiation, M>F, white * distal 1/3 * most common type in UK/US (developed)

Answer 93

* alcohol & smoking, achalasia, nitrosamines, HPV * afro-carribean, men * most common in developing countries * upper 2/3 of oesophagus * progressive dysphagia (solids then fluids)

Answer 94

malignant bone tumour

Answer 95

benign bone tumour

Answer 96

* osteosarcoma * chondrosarcoma * ewing's sarcoma * giant cell tumour (borderline malignant)

Answer 97

* children (very rare) * knee * malignant mesenchymal cells, **ALP positive** * **"Codman's triangle"** (elevated periosteum), **"sunburst appearance"**

Answer 98

* >40 yrs * pelvis + axial skeleton * malignant **chondrocytes** * lytic lesion with **fluffy calcification**

Answer 99

* <20 yrs, highly malignant * pelvis + long bones * **small round blue cells, CD99+** * **onion skinning** * **t (11;22)**

Answer 100

* 20-40yrs, **F>M** * knee-epiphysis * **soap bubble appearance**, **giant multi-nucleate osteoclasts** * lytic lucent lesions up to articular surface

Answer 101

ewings sarcoma

Answer 102

chondrosarcoma

Answer 103

* osteoid osteoma * osteoma * enchondroma * osteochondroma * fibrous dysplasia

Answer 104

* adolescents M>F * tibia, femur * **night pain releived by aspirin** * normal bone, arises from osteoblasts * **"central nidus with sclerotic rim", "Bulls-eye"**

Answer 105

* middle age * **head & neck** * **bony outgrowths** attached to normal bone. part of **gardners syndrome**: GI polyps + multiple osteomas + epidermoid cysts * normal bone

Answer 106

* middle age * hands * benign cartilage tumours * normal cartilage * **cotton wool calcification, popcorn calcification, O ring sign** | enchondroma = ends = hands

Answer 107

* adolescent - **most common benign tumour** * metaphysis of long bones * cartilage capped **"mushroom" bony growth** * well defined bony protuberance from bone

Answer 108

* middle age, F>M * bone replaced by fibrous tissue * **McCune Albright syndrome:** polyostotic dysplasia + cafe au lait spots + precocious puberty * **chinese letters** (misshapen bone trabeculae) * **"soap bubble osteolysis"** **"shepherds crook deformity"**

Answer 109

osteochondroma

Answer 110

* **decreased bone mass** * low impact features: NOF, vertebrae, wrists (colles) * normal biochemistry * loss of cancellous bone

Answer 111

* **decreased bone mineralisation** * bone pain, tenderness, proximal muscle weakness * **"looser's zones"** (pseudofractures), splaying of metaphysis * excess unmineralised bone (osteoid) * low calcium, low phosphate, high ALP

Answer 112

* bone changes of osteitis fibrosa cystica * hypercalcaemia features (moans, stones, bones, groans) * **"brown tumours"** (collection of multinucleate giant cells. **"salt & pepper skull"**, **"subperiosteal bone resorption in phalanges"** * osteitis fibrosa cystica (brown tumour)

Answer 113

* mixed lytic & sclerotic lesions: osteolytic --> mixed --> osteosclerotic * bone pain, fractures, **sensori-neural & conductive deafness**, skull changes, heart failure * >50, M, caucasian * **mixed lytic & sclerotic lesions**. "cotton wool", "picture frame" "ivory vertebrae" * **huge osteoclasts** with >100 nuclei, **mosaic pattern** of lamellar bone * isolated high ALP

Answer 114

* all skeletal changes assoc with CKD: * osteitis fibrosa cystica (2ndary PTH) * osteomalacia * osteosclerosis * osteoporosis * adynamic bone disease | histology, x-ray features depend on subtype

Answer 115

* polyarticular arthritis * tophi deposits in ear lobes, fingers, and elbows * urate kindey stones * tophus is pathognomonic

Answer 116

* rat bite erosions * monosodium urate

Answer 117

* idiopathic * electrolytes: hyperPTH, hypophosphataemia, hypomagnesemia * metabolic: DM, hypothyroid, wilsons, haemochromatosis

Answer 118

* knee & shoulder * white lines of chondrocalcinosis

Answer 119

* early: subperiosteal new bone formation * 10 days after: lytic bone destruction

Answer 120

* S.aureus (vertebrae, jaw - dental abscess, toe - diabetic ulcer) * haemophilus influenzae, GBS * salmonella * TB * syphillis

Answer 121

* heberdens nodes (DIP) * bouchard nodes (PIP) * squaring at base of thumb | bouch my peen

Answer 122

LOSS * loss of joint space * osteophytes * subchondral sclerosis * subchondral cysts

Answer 123

* radial deviation of wrist * ulnar deviation of fingers * swan neck: hyperextension of PIP & felxion of DIP * boutonierre: flexion of FIP, hyperextension of DIP * z-shaped thumb * synovial swelling

Answer 124

swan neck deformity (RA) | swans help people

Answer 125

boutonniere deformity (RA)

Answer 126

* thickening of synovial membrnae * hyperplasia of surface synoviocytes * intense inflammatory infiltrate * fibrin deposition & necrosis

Answer 127

renal collecting ducts

Answer 128

calcium oxalate

Answer 129

* too much calcium absorption in gut * renal issues: impaired calcium reabsorption from PCT * anti-freeze consumption

Answer 130

staghorn calculi (large and painful)

Answer 131

urease producing organisms (alkalinise urine) and precipitate magnesium phosphate salts eg. proteus mirabilis

Answer 132

hyperuricaemia (gout / rapid cell turnover eg. TLS)

Answer 133

* pelvic-ureteric junction * pelvic brim * vesico-ureteric junction

Answer 134

* papillary adenoma * oncocytoma * angiomyolipoma

Answer 135

* renal epithelium tumour with papillary architecture * bland epithelial cells growing in papillary or tubopapillary pattern - well circumscribed | <15mm

Answer 136

* oncocytic renal epithelial neoplasm * macroscopic: **majogany brown** * microscopic: sheets of oncolytic cells with pink cytoplasm forming **nests of cells**

Answer 137

* **mesenchymal** tumour: composed of fat, blood vessels & muscle * fat spaces, thick blood vessels & spinde cells

Answer 138

* renal cell carcinoma * nephroblastoma (wilms tumour) * transitional cell carcinoma

Answer 139

renal cell carcinoma

Answer 140

* smoking, HTN, obsity, long-term dialysis, Von hippel lindau syndrome

Answer 141

* High EPO & high Hb * triad of renal mass + painless haematuria + loin pain

Answer 142

clear cell

Answer 143

* clear cell * papillary * chromophobe

Answer 144

* **golden yellow** with haemorrhagic areas * nests of epithelium with **clear cytoplasm**

Answer 145

* **fragile, friable brown tumour** * papillary/tubopapillary growth pattern * >15mm

Answer 146

* **well circumscribed, solid brown tumour** * sheets of large cells with distinct cell borders

Answer 147

* children * 2nd most common childhood malignancy * abdominal mass with high BP

Answer 148

* small round blue cells (undifferentiated) with an epithelial combonent

Answer 149

* smoking / dyes

Answer 150

* non-invasive papillary urothelial carcinoma * invasive urothelial carcinoma

Answer 151

* frond-like growths projecting from bladder wall * papillart fronds lined by uroepithekial | can be low or high grade (high can progress to invasive)

Answer 152

* invasive behaviour * grows as solid masses, fixed to tissue

Answer 153

* polycythameia * hypercalcaemia * HTN * cushings * amyloidosis

Answer 154

* dihydrotestosterone - mediated hyperplasia of prostatic stromal & epithelial cells - forming large nodules * nodules compress urethra leading to outflow obstruction

Answer 155

* difficulty urinating, retention, frequency, nocturia, dribbling

Answer 156

* nodule formation, prostatic epithelial ducts + duct spaces

Answer 157

* TURP * 5-a reductase inhibitors (finasteride) * alpha blockers (tamsulosin)

Answer 158

hypotension

Answer 159

adenocarcinoma

Answer 160

* arises from precursor lesion: PIN (prostatic intraepithelial neoplasia) * arises in peripheral zone of gland with firm neoplastic tissue * local spread to bladder, haematogenous spread to bone

Answer 161

age, afro-carribean, FH, hormonal factors

Answer 162

gleason score | based on degree of differentiation & glandular patterns

Answer 163

add the 2 most common grades | result out of 10

Answer 164

germ cell tumour

Answer 165

* seminoma

Answer 166

* cryptorchidism * testicular dysgenesis * klinefelters * testicular feminisation

Answer 167

intratubular germ cell neoplasia

Answer 168

* most common type * peak age 30 * radiosenstivie

Answer 169

* at any age (infancy onwards) * malignant when in post-pubertal male * chemo-sensitive * markers: AFP, hCG, LDH | (mr gonzalez one)

Answer 170

resembles embryonic tissue

Answer 171

painless lump

Answer 172

* leydig cell tumour (from stroma) * sertoli cell tumour (from sex cord) * poor prognosis

Answer 173

* orchidectomy +/- LN dissection * grade I and above - BEP (bleomycin, eoposide and cisplatin)

Answer 174

good, even with mets (90% 5-year survival)

Answer 175

* transitional cell

Answer 176

* shistosomiasis * smoking

Answer 177

* smoking (most important) * aniline dyes (textile industry) * rubber manufacture * cyclophosphamide

Answer 178

* rare * arises from extensive intestinal metaplasia or urachal remnant

Answer 179

* hepatic lobule is structural unit: hexagonal * at the centre is hepatic vein (central vein) * corners formed by portal tracts: portal triad - bile ducts, hepatic artery & portal vein

Answer 180

* portal vein (out to in) * hepatic artery (out to in) * bile duct (in to out) | blood flows towards centre, bile flows away

Answer 181

portal triad | zone 3 closest to central vein

Answer 182

* viral hepatitis * recieves more oxygen (periportal hepatocytes)

Answer 183

* metabolic toxins & hypoxia (ischaemia) * perivenular hepatocytes * has the most enzymes & is furthest from oxygen supply

Answer 184

* glyclosis * glycogen storage * glucose syntehsis * amino acid syntehsis * fatty acid synthesis * lipoprotein etabolism * drug metabolism

Answer 185

* all circulating proteins (except gamma globulins) - albumin, fibrinogen, coagulation factors

Answer 186

* glycgoen * vitamin A, D, B12 (a lot) & a little vit K, folate, iron, copper

Answer 187

* activates vitamin D (25-hydroxylase) * conjugation/excretion of steroid hormones * peptide hormone metabolism (insulin, GH, PTH)

Answer 188

bile synthesis (600-1000ml daily)

Answer 189

* phagocytosis by kuppfer cells

Answer 190

* hepatocytes with microvilli * stellate cells in space of disse (space between hepatocytes and sinusoid)

Answer 191

* loss of microvilli * activated stellate cells become myofibroblasts and lay down collagen in space of disse (fibrosis) * myofibroblasts contrast and constrict sinusoits (+ increase vascular resistance) * undamaged hepatocytes regenerate in nodules

Answer 192

* hepatitis A & E * drugs

Answer 193

spotty necrosis

Answer 194

* viral (hep B & C) * genetic: PBS/PSC, wilsons, haemochromatosis

Answer 195

* grade: severity of inflammation * state: severity of fibrosis | liver is part of GI (grade = inflammation)

Answer 196

1. portal infalmmation 2. interface hepatitis (piecemeal necrosis) 3. lobular inflammation 4. bridge formed from portal vein to central vein

Answer 197

cannot see border between portal tract & parenchyma

Answer 198

* intrahepatic shunting (blood bypasses hepatocytes and reduces liver function) * loss of liver detox (and thus ammonia build up)

Answer 199

* DIFFUSE abnormality in liver architecture (interferes with blood flow & function)

Answer 200

* hepatocyte necrosis * fibrosis * **nodules of regenerating hepatocytes** * disturbance of vascular architecture

Answer 201

* fibrotic bridges form between portal triad & central vein (intrahepatic shunting) * extrahepatic shunting (due to portal hypertension) --> eg. varices (oesophageal, anorectal, caput madusae)

Answer 202

* hepatic encephalopathy (build up of ammonia)

Answer 203

* bleeding * hypogonadism * osteodystrophy * ascites

Answer 204

* oesophageal varices * anorectal varices * caput medusae

Answer 205

1. alcoholic liver disease 2. non-alcoholic fatty liver disease (NAFLD) 3. chronic viral hepatitis (B +/- D, & C) 4. autoimmune hepatitis 5. PBC, PSC 6. genetic: haemachromatosis, wilsons, alpha-1 antitrypsin, galactosaemia, glycogen storage diseases 7. drugs - methotexate

Answer 206

* alcoholic * NAFLD * chronic viral hepatitis

Answer 207

* size of regenerating nodules (micronodular or macronodular)

Answer 208

nodules <3mm

Answer 209

**alcoholic hepatitis**, biliary tract disease

Answer 210

* viral hepatitis * wilsons disease * alpha-1 antitrypsin deficiency

Answer 211

modified child's pugh score

Answer 212

* albumin (lower = worse) * bilirubin (higher = worse * prothrombin time (higher = worse) * ascites * encephalopathy

Answer 213

* albumin: 1 (>35), 2 (28-35), 3 (↓28) * bilirubin: 1 (↓34), 2 (34-50), 3 (↑50) * PT: 1 (↓4), 2 (4-6), 3 (↑6) * ascites: 1 (none), 2 (mild), 3 (moderate/severe) * encephalopathy: 1 (none), 2 (mild), 3 (marked) | albumin: 35, 28 bilirubin: 34, 50 PT: 4, 6

Answer 214

* <7: A (45% 5-year survival) * 7-9: B (20% 5-year survival) * 10+: C (<20% 5 year survival)

Answer 215

* large, pale, yellow, greasy liver * accumulation of fat droplets in hepatocytes (statetosis), fibrosis in late stage

Answer 216

fully reversible if alcohol avoided

Answer 217

* large, fibrotic liver * **hepatocyte ballooning**, **mallory denk bodies** (clumped cytoskeleton) | can be seen acutely after night of heavy drinking

Answer 218

* yellow, tan, fatty, big. transforms into shrunken, non-fatty and brown * **micronodular cirrhosis**

Answer 219

alcoholic hepatitis

Answer 220

NAFLD | obesity, hyperlipidaemia, metabolic syndrome, DM

Answer 221

* **simple steatosis**: fatty infiltration, relatively benign * **non-alcoholic steatohepatitis (NASH)**: statosis + hepatosis (can progress to cirhhosis)

Answer 222

* women - young & post-menopausal * HLA-DR3

Answer 223

plasma cells

Answer 224

* Type 1: ANA, **anti-smooth muscle antibody**, anti-actin, anti-soluble liver antigen * Type 2: **anti-LMK (anti-liver-kidney-microsomal)**

Answer 225

* steroids (good response) * until transplant | but disease returns in up to 40%

Answer 226

* autoimmune destruction of small/medium sized **INTRAHEPATIC bile ducts** causing cholestasis and **slow** development of cirrhosis * females: 10:1 - 40-50 years

Answer 227

* high ALP, high cholesterol, high IgM, high bilirubin (late) * **anti-mitochondrial antibodies**

Answer 228

no bile duct dilation

Answer 229

* bile duct loss with granulomas

Answer 230

* pruritus, fatigue, abdominal discomfort

Answer 231

ursodeoxycholic acid

Answer 232

* inflammation &** fibrosis of EXTRAHEPATIC & INTRAHEPATIC bile ducts **leading to **stricutre formation and dilatation** of preserved segments * M>F

Answer 233

* IBD (mostly **UC**) * increased ALP, several auto-Ig mainly **p-ANCA**

Answer 234

* US: bile duct **dilatation ** * ERCP: strictures look like **necklace beads** * histology: **onion skinning fibrosis**

Answer 235

cholangiocarcinoma

Answer 236

autosomal recessive

Answer 237

* mutated **HFE gene** (6p21.3) * causes increased iron gut absorption (deposits in tissues/organs)

Answer 238

iron deposits in liver - prussian blue

Answer 239

* skin bronzing * diabetes * hepatomegaly (micronodular cirrhosis)

Answer 240

* high ferritin and iron * low TIBC * transferrin saturation >45%

Answer 241

* venesection * desferrioxamine | RF for HCC

Answer 242

autosomal recessive

Answer 243

* ATP7B (chr13) * endoes copper transporting ATPase - decreased biliary copper excretion & deposits in liver, CNS & iris

Answer 244

* stains with rhodanine * mallory bodies & fibrosis

Answer 245

* liver disease * neuro disease ( psychosis, dementia, parkinsonism (basal ganglia) * kayser fleischer rings (copper deposit in descemet's membrane in cornea)

Answer 246

lifelong penicillamine (copper chelator) | neuro damage is permanent, may need liver transplant

Answer 247

autosomal dominant | all the others are recessive !!

Answer 248

* failure to secrete A1AT in blood - accumulates in hepatocytes causing hepatitis * lack of A1AT in lungs causes emphysema

Answer 249

**intracytoplasmic globules** of A1AT staining for **PAS (periodic acid Schiff)**

Answer 250

* kids: neonatal jaundice * adults: emphysema & chronic liver disease

Answer 251

* low serum A1AT * absent a-globulin band on electrophoresis

Answer 252

* hepatic adenoma * haemangioma

Answer 253

* **OCP** * resection if symptomatic, >5cm or no shrinkage once stopped OCP

Answer 254

haemangioma | no treatment

Answer 255

secondary tumour (met from GI, breast or bronchus) | usually multiple

Answer 256

* hepatocelular carcinoma * cholangiocarcinoma * haemangiosarcoma * hepatoblastoma * secondary tumour

Answer 257

* chronic liver disease * viral hepatitis * alcoholic cirrhosis * haemochromatosis * NAFLD * **aflatoxin-B1 (in grains)** * androgenic steroids

Answer 258

6 monthly USS in cirrhotic patients

Answer 259

AFP (alpha-fetoprotein)

Answer 260

adenocarcinomas arising from bile ducts | intra or extra hepatic

Answer 261

gallstones

Answer 262

* **PSC** !! * parasitic liver disease * chronic liver disease * congential liver abnormalities * lynch syndrome type 2

Answer 263

* cancer of vascular epithelium * highly invasive

Answer 264

* from immature liver precursor cells * occurs in kids / infants - presents with abdo mass

Answer 265

* secondary tumours * hepatocellular * cholangiocarcinoma * haemangiosarcoma * hepatoblastoma

Answer 266

lined by gastric mucosa, columnar epithelium (mucin secreting) & glands | NO GOBLET CELLS

Answer 267

HCL & intrinsic factor

Answer 268

pepsinogen

Answer 269

* acute = neutrophils * chronic = lymphocytes & plasma cells

Answer 270

MALT lymphoma

Answer 271

gastric ulcer

Answer 272

duodenal ulcer

Answer 273

ulcer | otherwise an erosion

Answer 274

punched out lesion with rolled margins

Answer 275

adenocarcinoma

Answer 276

* intestinal * diffuse

Answer 277

* well differentiated * golbet cells present following intestinal metaplasia

Answer 278

poorly differentiated, no gland formation

Answer 279

* signet ring cell carcinoma * linitis plastica

Answer 280

* left supraclavicular node (Virchows node) * umbilicus (Sister Mary Joseph nodule)

Answer 281

duodeal ulcer

Answer 282

* japan, china * eat fermented, pickled, smoked foods

Answer 283

irish women

Answer 284

dermatitis herpetiformis (itchy rash on extensor)

Answer 285

hyposplenism | recomend penumococcal vaccine

Answer 286

tropical sprue

Answer 287

* IgA anti-tissue trasglutaminase (TTG) * IgA anti-endomysial antibody (EMA) * anti-gliadin (poor marker of disease control)

Answer 288

anti-gliadin antibodies

Answer 289

distal duodenal biopsy (while on gluten diet for at least 6 wks before)

Answer 290

* villous atrophy * crypt hyperplasia * increased intraepithelial lymphocytes | normal villous: crypt ratio = 2:1

Answer 291

enteropathy-associated T cell lymphoma (EATL) | 10% risk

Answer 292

group of tumours of **enterochrommafin origin** - produce **5-HT (serotonin)**

Answer 293

commonly small bowel other: lung, ovaries, testes

Answer 294

* bronchoconstriction * flushing * diarrhoea

Answer 295

* life threatening vasodilation * hypotension * tachycardia * bronchoconstriction * hyperglycaemia

Answer 296

24hr urinary 5-HIAA

Answer 297

ocretotide (somatostatin analogue)

Answer 298

double bubble sign

Answer 299

sigmoid volvulus

Answer 300

* **watershed areas**: eg. splenic flexure & rectosigmoid * areas most distal to arteries

Answer 301

crohns | improves sx in UC

Answer 302

* whole GI tract * transmural * terminal ileum most common * skip lesions * cobblestone mucosa * non-caseaeting granulomas * fistula * 1st lesion: aphthous ulcer * deep rosethorn ulcers * can join to form serpentine ulcers

Answer 303

* rectum most common * backwash ileitis (when it affects small intestine) * superfirical lesions confined to mucosa * crypt abscesses * pseudopolyps (islands of regereating mucosa)

Answer 304

angular stomatitis (iron deficiency)

Answer 305

anterior uveitis

Answer 306

* erythema nodosum * erythema multiforme * pyoderma gangrenosum * digital clubbing

Answer 307

migratory assymetrical polyarthropathy of large joints

Answer 308

toxic megacolon

Answer 309

adenocarcinoma

Answer 310

corticosteroids

Answer 311

5-ASA +/- steroids

Answer 312

* 1st line: azathioprine, mercaptopurine * 2nd line: methotrexate

Answer 313

* 1st line: 5-ASA * 2nd line: azathioprine

Answer 314

* downs syndrome * no meconium >48hrs * rectal biopsy * resection of affected bowel & ano-rectal pull through

Answer 315

hypertrophied nerve fibres, no ganglia

Answer 316

pseudomembranous colitis

Answer 317

diverticulosis

Answer 318

diverticulitis

Answer 319

architecture * tubular * tubulovillous * villous

Answer 320

* worst prognosis * hypoproteinaemic hypokalameia (leak a lot of protein & potassium) | VILLAINOUS = bad prognosis

Answer 321

most important = **large size** other: * degree of dysplasia * increased villous component

Answer 322

* normal colon * first mutation in 1st **APC **gene --> at risk * 2nd mutation to remaining APC gene --> adenoma * progresses to carcinoma after activation of **KRAS, LOF mutations of p53**

Answer 323

* hamartomatous polyp * hyperplastic polyp * inflammatory polyp

Answer 324

juvenile polyposis (autosomal dominant)

Answer 325

peutz-jeugers syndrome

Answer 326

autosomal dominant **LKB1**

Answer 327

IBD (pseudopolyps)

Answer 328

colorectal cancer

Answer 329

adenocarciomas

Answer 330

carcinoembryonic antigen (CEA)

Answer 331

Duke's staging (to determine treatment)

Answer 332

* A = confined to mucosa (5yr >95%) * B1: extending into muscularis propria * B2: transmural invasion * C1: into muscularis propria + LN met * C2: transmural invasion + LN met * D = distant met (5yr <10%)

Answer 333

abdominoperineal resection

Answer 334

anterior resection

Answer 335

sigmoid colectomy

Answer 336

left hemicolectomy

Answer 337

right hemicolectomy

Answer 338

extended right hemicolectomy

Answer 339

autosomal dominant

Answer 340

APC tumour suppressor gene (C5q1)

Answer 341

>100 adenomatous polyps - all will progress to adenocaricnoma if left untreated | prophylactic colectomy

Answer 342

subtype of FAP with +++ skull osteomas + dental caries

Answer 343

autosomal dominant

Answer 344

in DNA miscmatch repair genes

Answer 345

* colorectal * endometrial * ovarian * gastric * small bowel | usually in right colon, very few polyps

Answer 346

HNPCC / lynch

Answer 347

S cells of duodenum | causees release of gastric acid

Answer 348

I cells of duodenum | causes release of digestive enzyme

Answer 349

digestive enzymes - amylases, proteases, lipases into ducts

Answer 350

somatostatin

Answer 351

pancreatic polypeptide

Answer 352

islets of langerhans

Answer 353

glasgow scale 3 and above

Answer 354

serum lipase

Answer 355

pseudocyst

Answer 356

coagulative necrosis

Answer 357

obstructive causes

Answer 358

ischaemic causes

Answer 359

combo of obstructive & ischaemic causes

Answer 360

due to fat necrosis (enzmes react with fat causing precipitation fo calcium soaps)

Answer 361

alcoholism

Answer 362

IgG4 disease

Answer 363

malabsorption and secondary DM

Answer 364

fibrosis and loss of exocrine parenchyma with calficiation

Answer 365

* pseudocysts * diabetes * pancreatic cancer

Answer 366

ductal adenocarcinoma

Answer 367

head of pancreas

Answer 368

painless jaundice + painless enlargement of gallbladder (courvoisiers sign)

Answer 369

trousseaus syndrome

Answer 370

Ca19-9 (>70)

Answer 371

Palliative (5-FU)

Answer 372

whipples procedure

Answer 373

body or tail of pancreas

Answer 374

cells arranged in nests or trabeculae with granular cytoplasm

Answer 375

functional or non-functional

Answer 376

* insulinoma * gastrinoma * VIPoma * glucagonoma

Answer 377

Whipple's triad * hypoglycaemia, neurogylcopenic sx, prompt relief when given glucose)

Answer 378

Zollinger-Ellison syndrome | leads to recurrent ulceration

Answer 379

necrolytic migrating erythema

Answer 380

chromogranin

Answer 381

* parathyroid hyperplasia/adenoma * pancreatic endocrine tumour * pituitary adeoma

Answer 382

* parathyroid adenoma/hyperplasia * medullary thyroid cancer * phaeochromocytoma

Answer 383

* phaeochromocytoma * medullary thyroid * acoustic neuroma * +++ marfanoid habitus

Answer 384

neoplastic epithelial cells with eosinophilic granular cytoplasm. positive immunoreactivitiy for lipase, trypsin & chymotrypsin | BAD prognosis, + for enzymes, eosinophils

Answer 385

FORTY, FERTILE, FAT, FEMALES * increasing age * Females * OCP * disorders of bile matabolism

Answer 386

gallstones in gall bladder

Answer 387

acute inflammation of gallbladder

Answer 388

murphy's sign + (pain on palpation of RUQ on inspiration)

Answer 389

cystic duct

Answer 390

porcelain gallbladder (calcification & fibrosis)

Answer 391

Charcot's triad (fever, RUQ pain, jaundice)

Answer 392

adenocarcinoma

Answer 393

follicular

Answer 394

non-rupture of dominant follicle

Answer 395

early pregnancy

Answer 396

corpus luteum doesnt break down, and instead filled with blood/fluid | may present with intraperitoneal bleed

Answer 397

* nulliparity * early menarche * obesity * HRT * BRCA1/2

Answer 398

epithelial

Answer 399

serous cystadeoma

Answer 400

* serous cystadenoma * mucinous cystadenoma | 1st and 2nd most common benign ovarian tumours

Answer 401

columnar epithelium, **psamomma bodies**

Answer 402

mucin secreting cells

Answer 403

pseudomyxoma peritonei

Answer 404

mucinous cystadenoma

Answer 405

* endometrioid * clear cell

Answer 406

tubular glands | endometriosis is RF

Answer 407

clear cells, clear cytoplasm, hobnail appearance | also assoc with endometriosis

Answer 408

* dysgerminoma * teratoma

Answer 409

* testicular seminoma * radiotherapy sensitive

Answer 410

dysgerminoma

Answer 411

benign in adults, malignant in kids

Answer 412

* usually cystic * contains mature tissues (skin, hair, teeth)

Answer 413

* solid * malignant * contains immature, embryonal tissues * secretes AFP

Answer 414

choriocarcinoma

Answer 415

* fibroma * granulosa-theca * sertoli-leydig

Answer 416

* no hormone production * associated with Meig's syndrome ( fibroma + ascites + R sided pleural effusion)

Answer 417

* produces **E2** (oestrogen) * histology: **call-exner bodies**

Answer 418

krukenberg tumour | from gastric/coloic cancer (signet cells)

Answer 419

mucin prodicing **signet ring cells**

Answer 420

* 1: only in ovaries * 2: spread to pelvis * 3: spread to abdomen (inc. regional LN) * 4: met ouside abdominal cavity

Answer 421

RMI = U X M X Ca-125 | US finding x menopausal status x ca-125

Answer 422

chlamydia & gonorrhea

Answer 423

TB and shistostomiasis

Answer 424

* S.aureus * Streptococcfus * C.perfringens * Coiliforms

Answer 425

"violin string" peri-hepatic adhesions

Answer 426

1. retrograde menstrual flow of endometrial cells 2. metaplastic transformation of coelomic epithelial cells 3. vascular/lymphatic dissemination of endometrial cells

Answer 427

red-blue to brown vesicles - "powder burns"

Answer 428

blood filled "chocolate cysts"

Answer 429

endometrial glands & stroma

Answer 430

"bulky uterus" "globular uterus" "subendothelial linear striations"

Answer 431

* malignant transformation * red degeneration in pregnancy

Answer 432

fibroid (leiomyoma)

Answer 433

intramural

Answer 434

sharply circumscribed, discrete, round, firm, grey-white tumour

Answer 435

bundles of smooth muscle cells

Answer 436

* endometrioid (80%) * non-endometrioid (20%)

Answer 437

* secretory * endometrioid * mucinous

Answer 438

endometrioid

Answer 439

endometrioid (E2 excess)

Answer 440

* papillary * sesous * clear cell

Answer 441

PTEN mutation p53 HER-2 amplifications

Answer 442

* stage 1: only in uterus * 2: spread to cervix * 3: to pelvic area * 4: met to rectum/bladder/distal organs

Answer 443

* outer cervix covered by squamous epithelium * endocervical cancal by columnar glandular epithelium * squamocolumnar junction separates them

Answer 444

transformation zone

Answer 445

high rate of cell turnover

Answer 446

HPV 16 & 18

Answer 447

1: dysplasia confined to deepest 1/3 of epithelium 2: lower 2/3 3: full thickness, but basement membrane intact

Answer 448

cervical galndular intraepithelial neoplasia * less common * requires excision of entire endocervix

Answer 449

cervical cancer

Answer 450

adenocarcinoma -rest are squamous cell

Answer 451

invasion through basement membrane

Answer 452

* HPV encodes E6 and E7 proteins * E6 inactivated p53 leading to proliferation * E7 inactivated retinoblastoma (Rb) gene --> proliferation | HPV proteins inactivate tumour suppressor genes

Answer 453

* 0= CIN * 1 = only cervix * 2 = spread to upper 1/3rd vagina * 3 = spread to pelvic side wall or/and lower 1/3 vagina * 4 = met beyong pelvic to bladder/bowel

Answer 454

squamous epithelium

Answer 455

* usual type * differentiated type

Answer 456

* HPV 16/18, smoking, immunosuppresion * warty, basaloid, mixed | younger women

Answer 457

* lichen sclerosus * keratinised squamous epithelium | more likely to progress to cancer

Answer 458

* mainly squamous cell * clear cell adenocarcinoma - teenagers, associated with diethylstilbestrol * primary vaginal carcinoma - older women usual squamous carcinoma

Answer 459

1) clinical examination 2) Imaging: USS or mammography (cut-off 35) 3) cytology & histology

Answer 460

* fine needle aspirate * C1 (inadequate), C2 (benign), C3 (atypia) C4 (suspicious of malignancy) C5 (malignant)

Answer 461

* core biopsy * B1 (normal), B2 (benign) B3 (uncertain) B4 (suspicious) B5 (malignant) B5a (DCIS), B5b (invasive carcinoma)

Answer 462

histopathology

Answer 463

ductal-lobular system lined by inner glandular epithelium

Answer 464

Staph aureus

Answer 465

abundance of neutrophils

Answer 466

keratinising squamous metaplasia blocks lactiferous ducts (smoking association)

Answer 467

inflammatory reaction to damaged adipose tissue (usually obese)

Answer 468

painless breast mass / skin thickening

Answer 469

empty fat spaces, histiocytes & giant cells | giant cells cos fat

Answer 470

fibroadenoma

Answer 471

benign neoplasm of a lobule arising from fibro (stromal) and glandular (adenomal) epithelium

Answer 472

painless, mobile "breast mouse" firm smooth mass

Answer 473

braching sheets of epithelium, bare bipolar nuclei & stroma

Answer 474

painless transillumimable lump in peri-menopausal women that is mobile and correlates with menstraul cycle

Answer 475

dilatation of milk ducts due to blockage

Answer 476

thick yellow-green-white nipple discharge

Answer 477

if ducts get infected can lead to inflammatory symtpoms and abscess formation

Answer 478

nipple discharge - proteinacious material and macrophages

Answer 479

duct dilatation, proteinacious material and periductal inflammation

Answer 480

* benign papillary tumour from duct system * peripheral papilloma = small terminal ductules (clinically silent) * central papilloma = larger lactiferous ducts (nipple discharge)

Answer 481

sub-areolar mass +/- bloody nipple discharge

Answer 482

**papillary mass** with dilated duct lined by epithelium

Answer 483

benign slceroing lesion - central scarring surrounded by proliferating glandular tissue (stellate pattern)

Answer 484

stellate mass

Answer 485

central, fibrous, stellate area

Answer 486

arises from interlobular stroma (like fibroadenoma) with increased cellularity/mitoses

Answer 487

* low grade or high grade * most benign but can be agressive so excised

Answer 488

phyllodes tumour

Answer 489

**branching**/**leaf** like fronts/**artichocke** appearance

Answer 490

lumpy breasts changes according to mentstrual cycle

Answer 491

**dilated large ducts** that may become **calcified**

Answer 492

* usual epithelial hyperplasia * flat epithelial atypia (atypical ductal carcinoma) * in situ lobular neoplasia | intraductal epithelial proliferations with risk of invasive disease

Answer 493

* growth of glandular tissue & epithelial cells forming **fronds** * 1-2%

Answer 494

* multiple layers of epithelial cells & lumens more **regular & round** with **punched out areas** * 4x risk

Answer 495

* solid proliferation of **aplastic cells** with little space where you can still see lumens * 7-12x cancer risk

Answer 496

47-73 y/o every 3 years for mammography

Answer 497

ductal carcinoma in situ (DCIS)

Answer 498

* invasive ductal carcinoma * invasive lobular carcinoma * pagets disease of nipple (eczematous)

Answer 499

* always incidentally * no microcalcifications or stromal reactions

Answer 500

E-cadherin

Answer 501

microcalficiation

Answer 502

ducts filled with **atypical epithelial cells**

Answer 503

Big, pleiomorphic cells

Answer 504

cells aligned in single file chains / strands

Answer 505

well-formed tubules

Answer 506

cells produce extracellular mucin

Answer 507

* nuclear polymorphism * tubule formation * mitotic activity

Answer 508

* grade 1: well differentiated <5 * grade 2: moderately 6-7 * grade 3: poorly differentiated 8-9

Answer 509

ER/PR + | predicts good response to tamoxifen

Answer 510

status of axillary LN

Answer 511

tamoxifen | low grade

Answer 512

herceptin | high grade

Answer 513

basal cell carcinoma

Answer 514

mixed agonist/antagonist of estrogen

Answer 515

monoclonal antibody to HER2

Answer 516

* toxic to myocardium * moitor LVEF

Answer 517

sheets of markedly atypical cells with lymphocytic infiltrate - stains + for CK5/6/14 | BRCA association

Answer 518

basal-like carcinoma

Answer 519

* (stratum) corneum * lucidum * granulosum * spinosum * basale | Come lets get some beers

Answer 520

hyperkeratosis

Answer 521

parakeratosis

Answer 522

acanthosis

Answer 523

acantholysis

Answer 524

spongiosis

Answer 525

lentiginous

Answer 526

psoriasiform

Answer 527

* dry itchy rashes * often history of atopy

Answer 528

1) inside out theroy: immune system --> IgE sensitisation --> skin barrier dysfunction 2) outside in theory: defective skin barrier --> allergen exposure --> IgE sensitisation

Answer 529

* atopic dermatitis * contact dermatitis * seborrheic dermatitis

Answer 530

* fluid collection in dermis (**spongiosis**) * **eosinophil infiltrate** in dermis * **dilated thermal capillaries**

Answer 531

* acanthosis * crusting, scaling

Answer 532

* infants: face scalp, extesnor * older: flexural areas

Answer 533

IgE-mediated

Answer 534

* erythema, swelling itching * commonly ear lobes and neck (jewellery), wrist (watch), feet (shoes)

Answer 535

type IV HSN rxn

Answer 536

inflammatory reaction to yeast malasseiza furfur

Answer 537

* infants: cradle cap & nappy sites (large yellow scales) * adults: erythema, fine scaling, mildly pruritic (face, eyebrow, ear)

Answer 538

erythematous, well demarcated scaly plaques

Answer 539

**Type IV T cell HSN rxn** in epidermis causes further T cell recuitment and release of pro-inflammatory TNF-a & IFN-γ leading to **keratinocyte hyperproliferation** & epidermal thickening

Answer 540

* **Parakeratosis** * neutrophilia * **test tubes in a rack** apperance (clubbing of rete ridges) * **munro's microabscesses**

Answer 541

* chronic plaque * flexudral * guttate * ertyhrodermic/pustular * koebner phenomenon

Answer 542

chronic plaque psoriasis

Answer 543

extensor surfaces

Answer 544

groin, natal cleft, sub-mammary area

Answer 545

"rain drop" plaques often in children on trunk - 2 kws post-group A strep infection

Answer 546

* emergency * severe disease + systemic sx

Answer 547

plaques forming at/along sites of trauma

Answer 548

pin-point bleeding (**Auspitz' sign**)

Answer 549

* Pitting * onycholysis * subungual hyperkeratosis

Answer 550

* DIP * **Arthritis mutilans (telescoping)** * Spondylopathy * Symmetrical polyarthritis

Answer 551

* Pruritic * pruple * polyglonal * papules * plaques | 5 Ps

Answer 552

wickham's striae

Answer 553

usually inner survfaces of wrists + oral mucous membrane

Answer 554

T cells attack BM

Answer 555

hyperkeratosis with **saw-toothing of rete ridges** &** civette bodies **(dead cells releasing nucleus)

Answer 556

annular target lesions commonly on extensor surface of hands & feet

Answer 557

* HSV * mycoplasma

Answer 558

SNAPP * sulphonamides * NSAIDs * Allopurinol * Penicllin * Phenytoin

Answer 559

erythema multiforme --> steven johnsons syndrome --> toxic epidermal necrolysis

Answer 560

lichenoid inflammation

Answer 561

* sheets of skin detatment (<10% body surface vs >30% in TEN)

Answer 562

**Nikolsky's sign positive** - rubbing skin results in pealing of outer layer (separation of demis) | mucosal invovlement prominent

Answer 563

sulphonamide abx, anti-convulsants

Answer 564

* coeliac diseaase * **IgA** binds to basement membrane causing **subepidermal bulla**

Answer 565

itchy vesicles on extensor surfaces of elbows

Answer 566

* subepidermal bullae * IgA deposits at tips of demal papillae

Answer 567

* **IgG & C3** complement bind to **hemidesmosomes of BM** * causes epidermis to lift off and fluid to accumulate in space * SUBepidermal bullae

Answer 568

* **large tense bullae** * do not rupture as easily

Answer 569

* **eosinophilia** * **linear deposition of IgG** along BM

Answer 570

* **IgG** binds to **desmoglein 1 & 3** between keratinocytes in SS causing acantholysis * INTRAepidermal bulla

Answer 571

* bullae **rupture easily** (flaccid bullae) leaving red raw surface * skin & **mucosal surfaces** * **Nikolsky's sign +ve**

Answer 572

* **intraepidermal bullae** * netlike pattern of **intercellular IgG deposits** * Acantholysis

Answer 573

IgG against desmoglein in epidermis causes detatchment of superficial keratinocytes

Answer 574

seborrheic keratosis

Answer 575

rough plaques, **waxy, stuck on apperance**

Answer 576

keratin horns in epidermis

Answer 577

* acitinic keratosis * keratoacanthoma * Bowens disease (SCC in situ)

Answer 578

rough sandpaper like texture lesions on sun-exposed areas

Answer 579

SPAIN * Solar elastosis * Parakeratosis * Atypical cells * Inflammation * Not full thickness

Answer 580

rapidly growing dome shaped nodule - may have necrotic crusted centre | grows every 2-3 wks and spontaneously clears

Answer 581

* flat, red, scaly patches on sun-exposed areas * can form horns on skin

Answer 582

intact BM but full thickness & atypia/dysplasia

Answer 583

Ulcerative, crusting, hyperkeratotic +/- rolled edges | can met and be locally invasive

Answer 584

atypia/dysplasia spreading through BM into dermis

Answer 585

"rodent" ulcer, well defined rolled edges, pearly surface often with telangiectasis | rarely met but locally destructive

Answer 586

mass of basal cells pushing down into dermis and palisading

Answer 587

melanocytic nevi (moles)

Answer 588

* junctional * compound * intradermal

Answer 589

atypical melaoncutes, initially growing horizontally in epidermis (**radial growth phas**e), then vertically into dermis (**vertical growth phase**) producing **buckshot appearance** (pagetoid cells)

Answer 590

breslow thickness (depth of lesion)

Answer 591

superficial spreading

Answer 592

* superficial spreading * nodular * lentigo maligna * acral lentiginous

Answer 593

irregualr morders with colour variation

Answer 594

sun-exposed areas, elderly white people, flat slowly growing black lesion

Answer 595

* palms, soles, subungual * more in asians & black

Answer 596

* Assymetry * Border * Colour * Diametes * Evolving

Answer 597

**salmon pink rash** apperas first (**herals patch)** followed by oval macules in **christmas tree distribution**

Answer 598

low C3 as well

Answer 599

* Females * Afro-carribean

Answer 600

2,3, SLE DR3 (mostly) + DR2

Answer 601

ANA, Anti-dsDNA, Anti-Sm (smith)

Answer 602

anti-histone

Answer 603

"wire loop" glomeruli

Answer 604

small-vessel angiopathy

Answer 605

'onion skin' lesions

Answer 606

libman sacks endocarditis

Answer 607

DR5 & DRw8

Answer 608

anti-centromere

Answer 609

anti-topoisomerase II (Scl-70)

Answer 610

* increasec ollagen in skin & organs * **"onion skin" thickening of arterioles**

Answer 611

inflammation within or around muscle fibres

Answer 612

* distal skin only (forearms) * CREST * calcinosis * raynauds * esophageal dysmotility * sclerodactyly * telangeictasisa

Answer 613

pulmonary HTN

Answer 614

* skin changes anywhere (distal + proximal) * Tendon friction + Raynauds * Widespread organ involvement

Answer 615

pulmonary fibrosis

Answer 616

muscle biopsy

Answer 617

Anti-Jo-1 (tRNA synthetase)

Answer 618

* CK, LDH, myoglobin * abnormal EMG

Answer 619

ovarian, pancreatic, NHL

Answer 620

NHL, lung, bladder

Answer 621

endomysial inflammatory infiltrate

Answer 622

"drop out" of capillaries & myofibre damage

Answer 623

proximal muscle weakness

Answer 624

* Heliotrope rash (over eyelids) * Gottrons papules * Systemic V rash * Mechanics hands

Answer 625

pulmonary fibrosis

Answer 626

* takayasu's arteritis * Temporal arteritis (GCA)

Answer 627

branches of aortic arch

Answer 628

* inflammatory phase: FLAWS * pulseless phase: **Pulseless**, claudication, cold hands | Japanese women

Answer 629

* scalp tenderness, headache, jaw claudication * polymyaglia rheumatica | age >50, high ESR

Answer 630

* ESR 1st * Definitive: temporal artery biopsy

Answer 631

granulomatous transmural inflammation + giant cells + skip lesions

Answer 632

* polyarteritis nodosa (PAN) * Buerger's diseaase

Answer 633

renal involvement (spares lungs)

Answer 634

microaneurysms (string of pearls / **rosary bead** appearance)

Answer 635

fibrinoid necrosis & neutrophil infiltration

Answer 636

heavy smoking, men <35

Answer 637

corkscrew apperaance

Answer 638

* GPA (wegeners) * eGPA (churg-strauss) * microscopic polyangitis * HSP (IgA vasculitis)

Answer 639

* URTI: **saddle nose**, sinusitis, epistaxis * LRTI: **pulmonary haemorrhage** * Kidney: **cresenteric glomerulonephritis**

Answer 640

asthma, allergic rhinitis, eosinophilia

Answer 641

pulmonary renal syndrome (pulmonary haemorrhage + rapidly progressive glomerulonephritis)

Answer 642

p-ANCA (but sometimees can be c-ANCA)

Answer 643

beta-pleated sheet resistant to enzyme degradation

Answer 644

Primary (AL)

Answer 645

* Ig light cahins * Multiple myeloma (bence jones proteins in urine and inceased BM plasma cells)

Answer 646

* serum amyloid A (acute phase protein) * due to chronic inflammation/infection * eg. autoimmune (RA), chronic infections (TB)

Answer 647

beta-2 microglobulin | assoc with carpal tunnel syndrome

Answer 648

familial mediterranean fever (AR)

Answer 649

nephrotic syndrome

Answer 650

* nephrotic syndrome * restrictive cardiomyopathy * heart failure * hepatosplenomegaly * macroglossia * carpal tunnel syndrome

Answer 651

* non-caseating granulomas * Schauman and asteroid bodies (inclusion of protein & calcium)

Answer 652

afro-carribeans

Answer 653

* bilateral hilar Lymphadenopathy * pulmonary infiltrates (fine nodular shadowing in mid zones)

Answer 654

* erythema nodosum * lupus pernio (red/purple lesion on nose) * skin nodules

Answer 655

* anterior uveitis * posterior uveitis * uveoparotid fever * keratoconjunctivitis * lacrimal gland enlargment

Answer 656

* anaemia * leukopenia * hypercalcaemia * hypercalciuria (stones)

Answer 657

* ACE * 1-alpha hydroxylase

Answer 658

restrictive

Answer 659

* high calcium * ectopic 1-alpha hydroxylase from activated macrophages

high yield Flashcards

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