Histo Flashcards
(475 cards)
1
Q
What is the typical chemotherapy regime used for non-resectable pancreatic cancer?
A
FOLFIRINOX
2
Q
What is the most likely abnormality that will be found on his echocardiogram to explain his permanent atrial fibrillation and poor success at cardioversion?
A
Dilated left atrium
NOTE: Being in AF means you’re more likely to stay in AF. This is often due to atrial dilatation.
May develop heart failure.
3
Q
Classification of AF
A
Permanent AF - Easiest. Always in AF despite optimal rhythm control (DCCV or antiarrhythmics)
Persistent AF - Remains in AF >7 days but not tried maximal rhythm control yet
Paroxysmal AF - Intermittent AF, lasts <7 days.
AF is also either primary AF (patient has no reversible cause of AF other than e.g. structural heart disease) or secondary AF (patient is in AF because they have a severe infection or have binged alcohol)
4
Q
What further imaging is indicated for a confirmed transient ischaemic attack of the anterior circulation when neurological symptoms have resolved?
A
Carotid Ultrasound
5
Q
Best investigation for pancreatic cancer
A
Appropriate first line investigation is CT
6
Q
Neuroendocrine tumours
A
Insulinomas - Whipple’s triad of symptoms
Gastrinoma - Zollinger-Ellison syndrome + gastric ulceration
7
Q
For patients with a confirmed anterior circulation TIA, next appropriate management?
A
imaging of the carotids (USS Carotid Dopplers) to consider them for a carotid endarterectomy
8
Q
Which class of lupus nephritis on biopsy may show complete sclerosis of nearly all glomeruli?
A
Class VI
9
Q
What is the most common type of breast cancer in the UK?
A
Invasive ductal carcinoma
10
Q
A nephrologist is investigating an elderly gentleman with nephrotic syndrome.
A renal biopsy revealed normal histology when viewed under a light microscopy. There were no immune complexes detected in the biopsy either. There was no amyloid deposition.
Urinary Bence Jones Protein and serum electrophoresis were normal.
The patient responded well to steroids and their renal function is normal.
What is the most likely primary cause of the nephrotic syndrome?
A
Minimal change disease, as no depositon
11
Q
What cancer is associated with the presence of “oat shaped cells” on biopsy?
A
small cell lung cancer
12
Q
A 23 year old man visits their GP with a positive pregnancy test, which he did for a joke. A repeat pregnancy test in the surgery is also positive.
He denies any sexual activity in the last year.
What is the possible underlying diagnosis?
A
Testicular cancer
13
Q
A 83 year old man is started on bicalutamide for treatment of his metastatic prostate cancer.
What is the method of action of bicalutamide?
A
Androgen antagonist
14
Q
Head trauma causing loss of consciousness followed by a lucid interval before the patient deteriorates is a classical history of what cerebral pathology?
A
Extradural haemorrhage
15
Q
What is the first line chemotherapy drug for treating prostate cancer in the UK?
A
Docetaxel
16
Q
A 18 year old woman was stabbed in the groin at a party. Arterial blood flow was observed from the wound on scene. Haemostasis was achieved by bystanders.
She was stabilised on scene and transferred to hospital by air ambulance.
She lost an estimated 6 units of blood, however the air ambulance transfused one unit on scene and bolused two litres of 0.9% sodium chloride.
You perform an A-E assessment in the emergency department 30 minutes later. She is unconscious but tachypneic. You note the presence of a new, soft, systolic murmur.
Given the history, what type of murmur is this likely to be?
A
Flow murmur - Innocent
17
Q
What condition is the presence of waxy casts in urine associated with?
A
Chronic Kidney disease
18
Q
Other than zinc, what is the first line pharmacological treatment for Wilson’s disease?
A
Trientine
19
Q
What is the name given to areas of regenerating mucosa which project into the lumen of the bowel, which may be visualised during a colonoscopy of a patient with ulcerative colitis?
A
pseudopolyp
20
Q
A 55 year old gentleman with newly diagnosed bipolar disorder is seen by a psychiatrist. An ECG is performed as part of the workup for starting lithium, a mood stabiliser.
His past medical history includes an anterior STEMI 4 months ago.
The ECG shows ST elevation in leads V2, V3, V4 and V5. He denies chest pain, breathlessness or any other symptoms.
What is the diagnosis?
A
Ventricular aneurysm
21
Q
What is persistent ST elevation post MI suggest? What are they at risk of?
A
Persistent ST elevation post myocardial infarction in the absence of chest pain or other ischaemic features is suggestive of the development of a ventricular aneurysm.
These patients are at high risk of ventricular free wall rupture and subsequent death. It is diagnosed through an echocardiogram or cardiac MRI.
22
Q
A 68-year-old woman presents to her GP with a non-tender, hard lump with irregular borders in her left breast. She denies any nipple discharge, weight loss or malaise.
She was in a car accident 6 months ago and sustained significant bruising to the chest wall.
She undergoes triple assessment. Ultrasound shows a solid mass with indistinct margins.
The biopsy report is lost however the system recorded that the specimen was benign.
What condition may explain the lump?
A
Fat necrosis
23
Q
What is the most common type of lung cancer in the UK?
A
Adenocarcinoma
24
Q
A 83 year old woman was admitted to hospital for a severe chest infection. At the time of admission, her CURB-65 was 4. Her blood pressure was 80/40
She was diagnosed as having an acute kidney injury.
What is the likely cause of the AKI?
A
ATN secondary to sepsis and hypoperfusion
25
What condition is characterised by microangiopathic haemolytic anaemia, thrombocytopenia and stroke-like symptoms in an adult?
Thrombotic Thrombocytopenic Purpura
26
What histopathological description is given to cells that have lost their intercellular connections between neighbouring cells?
An example could be the loss of desmosomal connections in pemphigus vulgaris.
Acantholysis
27
What monoclonal antibody therapy targets human epidermal growth factor receptor 2 and is used in the treatment of breast cancer?
Trastuzumab
28
poor prognostic marker in breast cancer
Presence of HER2 is a poor prognostic marker (but does allow for treatment with trastuzumab - a monoclonal antibody therapy)
29
good prognostic marker in breast cancer
Presence of oestrogen receptor or progesterone receptor is good as it predicts response to oestrogen deprivation therapy.
30
eczema of nipple then areola
Paget's disease of breast
31
oedema + pitting of breast
peau d'orange
32
What protein is defective in adult polycystic kidney disease?
Polycystin-1
33
What is the most common cause of a pulmonary embolus?
DVT
34
What is the most common histochemical stain used to visualise cells for light microscopy, such as that used for diagnosis of cancers?
Haematoxylin and eosin stain
35
A 55 year old woman presents to her GP with a number of painful fluid filled blisters in her mouth and on her body. They are relatively large, approximately 2-3cm on the body. She says they itch intermittently.
She feels well in herself and her type 1 diabetes is well controlled.
When you run your finger over the surface of one of the blisters on her arm, the roof of the blister easily comes away.
A biopsy reveals acantholytic cells, however the basal keratinocytes remain attached to the basement membrane.
What is the diagnosis?
Pemphigus vulgaris
NOTE: Pemphigus vulgaris presents with painful fluid filled blisters on the body and in the mouth, with acantholytic cells on biopsy. The roof of the blister easily comes away with light pressure.
36
The ECG leads II, III and aVF represent which region of the heart?
Inferior wall
37
What sign, which may be visible around the nails, is seen in Graves' disease and is due to periosteal bone growth in the nail bed?
Thyroid acropachy
38
An 84 year old Asian woman presented to the ED with chest pain of 10 hours duration, which began while watching television. The pain was 9/10 and did not radiate. She reported being under extreme stress since the death of her 50 year old son a week ago.
An ECG revealed ST elevation in V2 and V3. Chest X ray was normal. Troponin and electrolytes were normal. Percutaneous Coronary Intervention was unremarkable with no occlusions and no evidence of atherosclerotic disease.
An echocardiogram showed apical akinesis with an ejection fraction of 36%. There was hypertrophy of the interventricular septum.
What is the diagnosis?
Takotsubo's cardiomyopathy
39
What type of bladder cancer is associated with chronic cystitis?
sqaumous cell carcinoma
40
A 20-year-old man with cystic fibrosis presents to his GP with a chronic productive cough, that has been getting worse over the last two years. He is known to be colonised with pseudomonas aeruginosa.
His BMI is 18.5. Temperature in the surgery was 36.8c.
Examination revealed coarse crackles at the bases which shifted upon coughing.
Chest x ray was reported as showing tram-track opacities.
What is the diagnosis?
Bronchiectasis
41
CXR - tram track opacities
CT - signet ring sign
Bronchiectasis
42
Degeneration of neurons in the substantia nigra is implicated in the pathogenesis of what synucleinopathy?
Idiopathic Parkinson's disease
43
What condition is the presence of epithelial casts in urine associated with?
Acute tubular necrosis
44
What is the most appropriate treatment for non-small cell lung cancer that is present in both lungs?
Palliative care
45
What paraneoplastic syndromes are small cell lung cancers associated with?
Associated with SIADH (15% of patients), Cushing's syndrome (5%), Lambert-Eaton Myasthenic syndrome (3%) and acromegaly
46
Kimmelstiel WIlson Nodules
Diabetes Nephropathy
47
Most common renal cancer
Renal cell carcinoma
48
Most common CNS tumour
Glioblastoma multiforme
49
Sarcoid histological finding
non-caseating epithelioid cell granuloma
50
PKD inheritance
AD
51
What cells are found in granulomas?
Activated epitheloid amcrophages
52
What disease are eosinophils involved in?
Parasitic infections and Hodgkin's disease
53
Histological features of squamous cell carcinomas
keratin production, intercellular bridges, do NOT form glands
54
Histological features of adenocarcinomas
form glandular epithelium AND mucin glands that can SECRETE substances
55
Histological features of transitional cell carcinomas
stretchy epithelium
56
Histochemical and immunohistology stain
Histochemical stain – result from the chemical reaction between stain and the tissue
Immunohistology stain – antibodies against a specific antigen
57
Most common cancer in men
Prostate
58
Most common cancer overall
Breast
59
Most deadly cancer in men and women
Lung
60
What type of necrosis occurs in MIs? Why?
Coagulative (dry) occurs in MI’s blockage of blood vessel to heart muscle gets a wedge of infarction that is dry, doesn’t liquify just dies
61
What type of necrosis occurs in strokes? Why?
Liquefactive (wet) occurs in strokes brain is high fat organ similar process to coagulative as stroke is like an MI of brain but as lipid rich organ liquefactive. Can also occur in organs involving proteolytic enzymes
62
What type of necrosis is usually due to pseudomonas?
Gangrenous
63
What type of necrosis occurs due to TB?
Caseous granuloma (cordoned off, inflamed tissue) has cell death inside (“cheese-like”) seen in TB, non-caseating sarcoidosis
64
What type of necrosis occurs in acute pancreatitis?
Saponification fat necrosis binds with calcium to form soap crystals within dead tissue ACUTE PANCREATITIS
65
What type of necrosis occurs in AID, vasculitis or malignant hypertension?
Fibrinoid cell death within a vessel due to inflammation in AID or vasculitis, malignant hypertension fibrin leaks out of cell and deposits out of the cell fibrin deposition around vessel wall
66
Epithelial anatomy and what happens in BArrets
Epithelial anatomy:
- PROXIMAL 2/3RD SQUAMOUS EPITHELIUM WHITE
- DISTAL 1/3RD COLUMNAR EPITHELIUM PINK
- JOINED BY THE SQUAMOUS COLUMNAR JUNCTION Z LINE
Barret’s After chronic GORD can get metaplasia in the oesophagus from squamous epithelial to columnar which have goblet cells upward movement of the SCJ
67
Difference between gastric and intestinal metaplasia
- GASTRIC METAPLASIA WITHOUT GOBLET CELLS
- INTESTINAL TYPE METAPLASIA WITH GOBLET CELLS
68
Most common oesophogael cancer in developed world? RFs? Anatomical location?
- ADENOCARCINOMA (MOST COMMON OESOPHAGAEL CANCER IN DEVELOPED WORLD)
o RFS: BARRETS, SMOKING, OBESITY
LOCATED IN DISTAL 1/3RD OF OESOPHAGUS due to GORD
69
Most common oesophogael cancer in developing world? RFs? Anatomical location?
- SQUAMOUS CELL CARCINOMA MOST COMMON IN DEVELOPING WORLD
o RFS: SMOKING, ALCOHOL
LOCATED IN THE MIDDLE 1/3RD OF OESOPHAGUS (upper 2/3rds)
NOTE: THINK S' --> squamous occurs due to smoking, superiorly
70
What GI condition can pernicious anaemia cause? What can this lead to?
can cause AI gastritis, can also cause atrophy leading to malabsorption
71
What bacteria can cause chronic gastritis?
H.Pylori in antrum
72
Difference ebtween gastritis and ulcer
ULCERS BREACH THROUGH MUSCULARIS MUCOSA INTO SUBMUCOSA
73
Most common cause of gastric ulcer
H.pylori
74
Most vulnerable area in GI tract to H.pylori, why?
DUODENUM IS MOST VULNERABLE TO H. PYLORI AS INCREASED ACID PRODUCTION LEAKS INTO DUODENUM CAUSING GASTRIC METAPLASIA (WITHOUT GOBLET CELLS)
NB: Intestinal type metaplasia with goblet cell
75
What cancers can H.pylori lead to?
Adenocarcinoma via metaplasia
Gastric MALToma
76
What are duodenal ulcers caused by?
H.PYLORI
GIARDIA LAMBLIA MOST IMPORTANT
77
What is Whipple's disease caused by? How does it present? What does this lead to?
CAUSED BY TROPHERYMA WHIPPELII CAUSED DUODENAL ULCERS AND GASTRITIS
Leads to malabsorption in the small intestine
78
Atrophic gastritis is caused by
Pernicious anaemia
79
Most common cause of stomach cancer
adenocarcinoma
80
Histopathological sign of gastric adenocarcinoma
Signet ring cells
81
What type of cell is gastric MALToma mediated by?
B cells as it is a lymphoma, presents in the stomach
82
Difference in type of cells between acute and chronic inflam
acute - neutrophils
chronic - lymphocytes
83
What are 100% of duodenal ulcers due to?
H.pylori
84
What cancer can occur in the small intestine? What is it due to?
Enteropathy associated T cell lymphoma (EATL), due to untreated coeliac leading to INCREASED EPITHELIAL LYMPHOCYTES
85
How does gastric MALToma differ from EATL?
Gastric MALToma occurs in stomach and is due to B cells, caused by H.Pylori
EATL occurs in small intestine and is due to T cells, caused by untreateed coeliac
86
Type of tropical enteropathy that causes malabsorpiton and jejunitis
Tropical sprue
87
Histological findings of coeliac
Crypt hyperplasia, villous atrophy and increased epithelial lymphocytes
88
First test to do before checking for antibodies in coeliac, why?
Serum IgA levels
Coeliac antibodies are IgA
89
Where to do biopsy in coeliac? Why?
Terminal duodenum as no brunners glands
90
Antibodies in coeliacl
If IgA normal: ANTI- TISSUE TRANSGUTAMINASE AND ANTI-ENDOMYSIAL
If IgA deficient: IgG anti-gliadin
91
Histological findings of crohns
- SKIP LESIONS WITH COBBLESTONE MUCOSA
- TRANSMURAL INFLAMMATION
- NON-CASEATING GRANULOMAS
92
How does smoking differ in crohn's and UC?
Smoking makes crohn's much worse, makes UC ebtter
93
Most common type of IBD
US
94
Histological finding of UC
- INFLAMMATION CONFINED TO MUCOSA
- SHALLOW ULCERS
95
Complications of UC
- Toxic megacolon
- Adenocarcinoma
96
What extra-intestinal disease is UC associated with?
PSC
97
Areas of regenerating mucosa in UC that project into lumen of th e bowel
Pseudopolyps
98
Treatment of C.Diff
Oral vanco
99
What causes diverticular disease? What does it lead to?
Low fibre diet causing high intraluminal pressure which causes outpouchings at weak points in the bowel walls (weak outpouchings are known as TAENIA COLI)
100
weak outpouchi9ngs in diverticular disease AKA
taenia coli
101
Where do most outpouchings occur in diverticular disease?
sigmoid
102
Difference in presentaiton of volvulus between children and elderly
NB: IN CHILDREN VOLVULUS AFFECTS SMALL BOWL, IN ELDERLY SIGMOID COLON
103
Most common cause of colitisd by infection
- VIRAL:
o CMV
SEEN IN IMMUNOSUPPRESSED
OFTEN IBD AS TREATMENT IS IMMUNOSUPPRESSED
- BACTERIAL
o SALMONELLA
- PROTOZOA
o ENTAMOEBA HISTOLYTICA
- FUNGAL
o CANDIDA
104
Most common type of colorectal cancer, most common location?
MAJORITY OF COLORECTAL CANCERS ARE ADENOCARCINOMAS MOST IN RECTUM
105
Area most affected by ischaemic colitis
ACUTE MESENTERIC ISCHAEMIC OCCURS IN WATERSHED ZONES SPLENIC FLEXURE AND RECTOSIGMOID
106
Tumour marker of colorectal cancer
Carcinoembryonic antigen (CEA)
107
Where are enterochromaffin cells msot commonly found? What do they lead to?
ENTEROCHROMAFFIN CELLS MOST COMMONLY FOUND IN THE BOWEL, lead to carcinoid tumours
NOTE: therefore most commonly carcinoid tumours develop from the bowel
108
Carcinoid syndrome triad
- BRONCHOCONSTRICTION
- FLUSHING
- DIARRHOEA
109
What is carcinoid syndrome caused by ?
BY EXCESS OF SERETONION (5-HYDROXYTRYPTAMINE (5-HT))
110
Diagnostic test for carcinid syndrome
24 HOUR URINE 5-HYDROXYINDOLEACETIC ACID (5-HIAA)
111
Treatment of carcinoid sydnrome
OCTREOTIDE SOMATOSTATIN ANALOGUE
112
Polyp factors that demonstrate a high likelihood of transformation to cancer include:
- Size of polyps
- Quantity of polyps
- Proportion of villous component (villous more so than tubular)
o TUBULAR
o TUBULOVILLOUS
o VILLOUS MOST LIKELY TO BECOME CANCER
- Dysplasia
113
Villous or tubular, which ore likely to lead to colorectal cancer?
villous
114
Inheritance of familial adenomatous polyposis? Where is mutation? Presents with?
- AUTOSOMAL DOMINANT
- APC TUMOUR GENE (on chromosome 5q21)
- HUNDREDS TO THOUSANDS OF POLYPS
115
Gardner syndrome
FAP WITH EXTRA-INTESTINAL MANIFESTIONS WHICH INCLUDE OSTEOMAS AND DESMOID TUMOURS (BENIGN BONE TUMOURS)
116
Turcot syndrome
FAP WITH BRAIN TUMOURS
117
Most commonc cause of hereditary colorectal cancer
Hereditary nonpolyposis colorectal cancer (HNPCC), AKA lynch syndrome
118
Inheritance of Lynch syndrome? Where is mutation? Presents with?
- AUTOSOMAL DOMINANT
- VERY FEW POLYPS HIGHER CHANCE OF PROGRESSION TO CANCERS
- DNA REPAIR GENES ERROS
119
Differences between FAP and HNPCC
- BOTH AUTOSOMAL DOMINANT
- FAP
o HUNDREDS TO THOUSANDS OF POLYPS
o RECTOSIGMOID TUMOURS
- HNPCC
o HANDFUL OF POLYPS
o PROXIMAL TO SPLENIC FLEXURE
120
What other cancers are Lynch ssyndfrome associated with?
ENDOMETRIAL (next most common after colorectal)
Ovarian
small bowel
gastric
121
Portal triad consists of
Portal vein (posterolateral)
Hepatic artery (medial)
Bile ducts (lateral)
122
Zones of liver
- Zone 1 closest to portal triad (periportal triad) most oxygenated
o ZONE AFFECTED FIRST BY TOXIC SUBSTANCES AND VIRAL HEPATITIS
- Zone 2 mid zone
- Zone 3 perivenular hepatocytes (most mature and metabolically active)
o MOST SUSCPETIBLE ZONE TO ISCHAEMIC AS NEAREST TO THE HEPATIC VEIN WHICH IS LEAST OXYGENATED
123
Which zone in liver is affected first by toxic substances and viral hepatitis?
- Zone 1 closest to portal triad (periportal triad) most oxygenated
o ZONE AFFECTED FIRST BY TOXIC SUBSTANCES AND VIRAL HEPATITIS
124
Which zone in liver is most suspceptible zone to ischaemic? why?
- Zone 3 perivenular hepatocytes (most mature and metabolically active)
o MOST SUSCPETIBLE ZONE TO ISCHAEMIA AND METABOLIC TOXINS AS NEAREST TO THE HEPATIC VEIN WHICH IS LEAST OXYGENATED
125
liver macropahge
Kuppfer cell
126
What test determines the proportion of conjugated vs unconjuated bilirubin? How does it work?
- VAN DER BERGH
o DIRECT REACTION MEASURES CONJUGATED
o INDIRECT MEASURES UNCONJUGATED
127
What is itching in liver disease caused by? What type of liver disease causes it?
ITCHING IN LIVER DISEASE IS CAUSED BY UROBILINOGEN AND STERCOBILINOGEN
IN POST-HEPATIC LIVER DISEASE
128
Findings in portal hypertension
- DISTENDED VEINS
- ASCITES
- SPLENOMEGALY MOST COMMON FINDING DUE TO EXTRAHEPATIC SHUNTING
129
Most common finding in portal hypertension
Portal hypertension causes splenomegaly, NOT hepatomegaly hepatomegaly may be seen as a result of hepatitis NOT portal HTN
130
Histology of acute hepatitis
spotty necrosis concentrated around the portal triad
NB: small foci of inflammation and necrosis with inflammatory infiltrates
131
What viruses can cause acute hepatitis?
HEPATITIS A AND E MORE LIKELY TO CAUSE ACUTE HEPATITIS
132
What viruses CANNOT cause chronic hepatitis?
Hep A and E
133
Which viruses cause chronic hepatitis/
- VIRAL (B,C,D)
134
Histopathology of chronic hepatitis
- INTERFACE HEPATITIS PIECEMEAL NECROSIS CAN’T SEE BORDER BETWEEN PORTAL TRACT AND PARENCHYMA DUE TO INFLAM
- BRIDGING FIBROSIS FROM PORTAL VEIN TO CENTRAL VEIN THIS IS A CRITICAL STAGE IN HEPATITIS TO CIRRHOSIS INTERFACE
135
Summary table of types Hep B antigens
136
Causes of micronodular cirrhosis
- MICRONODULAR <3MM
o CAUSES
ALCOHOLIC HEPATITIS
137
How is cirrhosis classified ?
size of regenerating nodules
- MICRONODULAR <3MM
- MACRONODULAR >3MM
138
What is A1AT deficiency? What can it caues? Histopathological features?
A1AT DEFICIENCY
* Caused by a failure to secrete it
* CAN CAUSE HEPATITS AND PNEUMONITIS (COPD)
* PERIPORTAL RED HYALINE GLOBULES USING PERIODIC ACID SCHIFF STAIN
139
Most common benign liver lesion
hemangioma
140
Association of hepatic adeoma
OCP
141
Pathophys of cirrhosis, difference between intra and extrahepatic shunting
INTRAHEPATIC SHUNTING WHEN BLOOD GOES THROUGH LIVER BUT DOES NOT CONTACT HEPATOCYTES NOT FILTERED
EXTRAHEPATIC SHUNTING WHEN BLOOD BACKLOGS INTO SITES OF PORTOSYTEMIC ANASTOMSES caused by portal HTN
142
Histology of alcoholic hepatitis
- HEPATOCYTE BALLOONING AND NECROSIS
- MALLORY DENK BODIES (FILAMENTS OF COLLAGEN) STAIN BLUE - TRICHOME
- PERICELLULAR FIBROSIS
NOTE: Mainly seen in zone 3
143
Histology of hepatic steatosis
fat droplets in hepatocytes
REVERSIBLE
144
Histology of alcoholic cirrhosis
micronodular cirrhosis
145
Histtology of NAFLD/NASH, what is it similar to?
ON HISTOLOGY: SIMILAR TO ALCOHOL HEPATITIS
- HEPATOCYTE BALLOONING AND NECROSIS
- MALLORY DENK BODIES (FILAMENTS OF COLLAGEN) STAIN BLUE - TRICHOME
146
What is the most common cause of chronic liver disease in the west?
NAFLD/NASH
147
Who is PBC more common in? Blood findings? Abs? US? Histology?
More common in females
Blood findings:
- RAISED ALP
- RAISED CHOLESEROL
GET RAISED ANTI-MITOCHONDRIAL ANTIBODIES IN PBC
ON ULTRASOUND, NO BILE DUCT DILATATION IS SEEN
ON HISTOLOGY, SEE BILE DUCT LOSS WITH GRANULOMAS
148
Who is PSC more common in? Blood findings? Abs? US? On ERCP? Histology?
More common in males
Inflam and obliterative fibrosis of BOTH intrahepatic and extrahepatic ducts
MAIN ASSOCIATION IS WITH UC
Blood findings:
- HIGH ALP
GET RAISED P-ANCA IN PSC
ON ULTRASOUND, SEE BILE DUCT DILATATION (DON’T GET THIS IN PBC)
ON ERCP BEADING OF BILE DUCTS ‘BEAD ON STRINGS’
ON HISTOLOGY ONION SKINNING FIBROSIS ONCENTRIC FIBROSIS
149
Main association of PSC
UC
150
PSC is a major risk factor for
cholangiocarcinoma
151
Types of AIH and their respective antibodies
- TYPE 1 ANTI-SMA, ANA
- TYPE 2 ANTI-LKM (LIVER, KIDNEY, MICROSOMAL)
152
Inheritance of haemochromatosis? Gene affected? Stain used?
AUTOSOMAL RECESSIVE
HFE GENE ON CHROMOSOME 6 AFFECTED
STAIN USED IS PRUSSIAN BLUE
153
Complications of haemochromatosis
haemochromatosis (HaemoChromatosis Can Cause Deposits Anywhere)
o Hypogonadism
o Cancer (hepatocellular)
o Cirrhosis
o Cardiomyopathy
o Diabetes mellitus
o Arthropathy
154
Inheritance of WIlsons? Gene affected? Blood finding? Stain done? Management?
AUTOSOMAL RECESSIVE
THE ATP7B GENE ON CHROMOSOME 13 IS AFFECTED
SEE LOW CAERUPLASMIN AND COPPER ON BLOODS
RHODANINE IS THE STAIN DONE FOR COPPER
NB: Treated with Zinc and Trientine (copper chelating agent)
155
Presentation of wilsons
Liver cirrhosis that presents in kids
Neuro signs
Kaiser Fleischer rings
156
Most common liver malignancy
Secondary mets from GI TRACT, BREAST OR LUNG
157
Tumour marker of hepatocellular carcinoma
AFP
158
causes of hepatic granulomas
PBC, drugs, TB, sarcoid
159
Most common tyype of gallstone
Cholesterol - radiolucent
Different from pigment stones which are radioopaque
160
Histology of chronic cholecystitis
- DIVERTICULA OUTPOUCHING FROM GALLBLADDER – ROKITANSKY-ASCHKOFF SINUSES
161
Most common cause of chronic cholecystitis and gallbladder cancer
gallstones
162
Most common type of gallbladder cancer
adenocarcinomas
163
RFs for gallsotones
Fair, fat, femal,e fertile, forty
164
Most common cause of acute pancreatitis, second most common/
Gallstones, Ethanol
165
Causes of acute pancreatitis
THINK: I GET SMASHED
- IDIOPATHIC
- GALLSTONES - MOST COMMON
- ETHANOL – 2ND MOST COMMON
- TRAUMA
- STEROIDS
- MUMPS
- AID
- SCORPION STING
- HYPERCALCAEMIA
- HYPERLIPIDEMIA
- ERCP
- DRUGS THIAZIDES
166
Pathogenesis of acute pancreatitis
Positive feedback of enzyme activation causing acinar necrosis causing further enzyme release and activation
Damage ranges from stromal oedema to haemorrhagic necrosis
Lipase release + pancreas tissue necrosis = saponification
167
Complications of acute pancreatitsi
- Pseudocyst
- Abscess
- Shock
- Chronic pancreatitis
168
Most common cause of chronic pancreatitis
Alcohol
169
Genetic conditions that can cause chronic pancreatitsi
Haemochromatosis
CF
170
Histology of chronic pancreatitsi
- PARENCHYMAL FIBROSIS WITH LOSS OF PARENCHYMA
- DUCT STRICTURE WITH CALCIFIED STONES
- LOSE ACINAR CELLS FIRST
171
What antibodies seen in AI pancreatitis
IGG4 POSITIVE PLASMA CELLS
172
Histology of pancreatic carcinomas
- Adenocarcinomas with mucin producing glands set in desmoplastic stroma
- Gritty and grey macroscopically
173
Most common type of pancreatic cancer
Ductal adenocarcinoma
174
Most common secretory pancreatic tumour
insulinomat
175
most common site of pancreatic adenocarcinoma
Head of the pancreas
176
What is trousseau syndrome? What is it seen in?
OFTEN GET TROUSSEAU SYNDROME IN PANCREATIC ADENOCARCINOMA SUPERFICIAL THROMBOPHLEBITIS EARLY SIGN ALSO SEEN IN GASTRIC AND LUNG
177
Where are neurodencorine tumours found?
FOUND IN TAIL OF PANCREAS, UNLIKE ADENOCARCINOMAS FOUND IN HEAD
178
How does insuloma present?
hypoglycaemic attacks
179
How does gastrinoma present?
WITH ZOLLINGER ELLISON SYNDROME HIGH ACID OUTPUT RECURRENT ULCERATION OF STOMACH TYPICALLY FOUND IN PANCREAS OR DUODENUM
180
Triad of Zollinger Ellison syndrome
(1) gastric acid hypersecretion, sustained by (2) fasting serum hypergastrinemia causing (3) peptic ulcer disease and diarrhea
181
How does VIPoma present?
DIARRHOEA VIP IS VASOACTIVE INTESTINAL PEPTIDE
182
How does glucagonoma present?
NECROLYTIC MIGRATING ERYTHEMA
183
Main stain for NE tumours? Alternatives?
MAIN STAIN FOR NE TUMOURS IS CHROMOGRANIN
CAN ALSO DO SYNAPTOPHYSIN. CD56 AND INDIVIDUAL HORMOMES (E.G. GASTRIN, INSULIN)
184
What are neurodenocrine tumours associated with?
MEN1
185
Triad of nephrotic syndrome
Peripheral oedema
proteinuria
low serum albumin
THINK: PPL
186
Important protein lost in nephrotic syndrome
Antithrombin III
187
What are all nephrotic syndromes treated with?
Steroids
188
Causes and histology of nephrotic syndrome
o MINIMAL CHANGE DISEASE
HISTOLOGY EFFACEMENT OF PODOCYTE FOOT PROCESSES
o FOCAL SEGMENTAL GLOMERULOSCLEROSIS (FSGS)
HISTOLOGY GLOMERULI WHICH ARE SCARRED
o MEMBRANOUS GLOMERULONEPHRITIS
HISTOLOGY SUBEPITHELIAL DEPOSITION OF IMMUN DEPOSITS
189
What is seen in the urine of nephrotic syndrome?
Fatty casts
190
Most common cause of nephropathy in kids, finding on electron microscopy? Management?
Minimal change disease, loss of foot processes, responds very well to steroids
191
Most common cause of nephropathy in adults
Membranous glomerulonpphropathy
192
Histology of FSGS
FOCAL + SEGMENTAL SCARRING
193
Histology of membranous glomerulonephropathy
. GET DIFFUSE BASEMENT MEMBRANE THICKNENING AND SPIKEY IMMUNE COMPLEXES ACROSS ALL OF BASEMENT MEMBRANE
194
What is membranous glomerulonephropathy associated with?
SLE and anti-phospholipase A2 ABs.
195
Most common cause of chronic renal failure
Diabetes, see Kimmelstiel Wilson nodules
196
Most common cause of nodular glomerulosclerosis
DM
197
Histological progression of diabetic nephropathy
- Stage 1- thickened BM on EM
- Stage 2- increase in mesangial matrix but no nodules
- Stage 3- nodular lesions- kimmelstiel wilson
- Stage 4- advanced nodular glomerulosclerosis
198
Pathophys of amyloidosis
Pathophysiology – XS proteins clump together to form beta sheets which make fibrils deposit in EC space of tissues and cause damage
199
Types of amyloidosis
AL amyloidosis – Amyloid ‘light’ as excess light chains e.g. MM
AA amyloidosis – chronic systemic inflam responses to infections, cancers and AI conditions XS serum amyloid A which forms amyloid deposits in tissues
200
Most common form of familial amyloidosis, where is amyloid typically deposited?
FAMILIAL MEDITERRANEAN FEVER
Amyloid deposition in FMF is predominantly in the KIDNEY
201
What type of amyloidosis can occur in chronic renal failure patients? What protein is deposited?
Haemodialysis associated amyloidosis can occur in chronic renal failure patients, ESPECIALLY those on peritoneal dialysis
In this case, the protein deposited is BETA-2 MICROGLOBULIN
202
Stain for amyloidosis, findings?
AMYLOID IS CONGO RED STAIN POSITIVE, +ve FINDING SHOWS APPLE GREEN BIREFRINGENCE IN POLARISED LIGHT
NOTE: Negative finding is pink/red
203
Most common presentation of amyloidosis
npehrotic syndromc
204
Histology of amyloidosis
DEPOSITION OF EXTRACELLULAR PROTEINACEOUS MATERIAL EXHIBITING BETA SHEET STRUCTURE
205
Triad of nephritic syndrome
Hypertension Haematuria
Peripheral oedema
THINK: HHP
206
What is seen in urine of nephriti syndrome
red cell casts
207
most common glonerulonephritis in the world
IgA nephropathy
208
Immunofluorescence of IgA nephropathy
IgA deposits in mesangium
209
Important pattern of IgA neprhopathy
Typically 1-2 days after group A step think IgA acute
210
Prognosis of IgA nephropathy
third get better, third get CKD, third need dialysis
211
Difference between IgA nephropathy and post-streptococcal glomerulonephritis
BIG DIFF BETWEEN IGA AND POST STREP IS TIMING IGA IS ACUTE (1-2 DAYS), POST-STREP IS WEEKS AFTER. IgA is deposited in mesangium in IgA nephropathy, IgG is deposited in basement membrane in post-strep glomerulonephropathy.
212
immunofluorescence of post streptococcal glomeruloneprhtisi
Granular IgG deposits in basement membrane
213
What is raised on blood findings in post-streptococcal glomerulonephritis?
Raised anti-streptolysin O titre, reduced C3
214
Histology of acute crescenteric (rapidly progressive) glomerulonephritsi
- CRESCENTS FROM PROLIFERATION OF CELLS IN BOWMANS SPACE SEEN ON LIGHT MICROSCOPY OF ALL
215
What is rapidly progressive glomerulonephritis characterised by?
SEVERITY AND PRESENCE OF CRESCENTS (MACROPHAGES IN BOWMAN’S)
216
Cauess of acute crescenteric glomerulonephritis
- Anti-GBM disease (Goodpasture’s)
- Immune complexes
- Pauci-immune
o ANTI-NEUTROPHIL CYTOPLASM ANTIBODIES PRESENT
NOTE: cANCA seen in polyangiitis with granulomatosis against proteinase 3, pANCA seen in microscopic polyangiitis against myeloperoxidase
217
Summary slide showing types of rapidly progressive glomerulonephritsi
218
What Abs in goodpasture's syndrome? Against what?
Anti-glomerular basement membrane against COL4-A3 (COLLAGEN TYPE IV)
219
Difference between presentation of goodpasture's and granulomatosis with polyangitis
: in goodpasture’s get pulmonary haemorrhages and NO NOSE INOLVEMENT unlike granulomatosis with polyangiitis
220
Histology of goodpasture's
LINEAR DEPOSITION OF IGG ON GBM
NOTE: Crescents on light microscopy
221
Histology of immune complex glomerulonpehritis
Bumpy depositon of immune complexes in GBM or mesangium
NOTE: Crescents seen on light microscopy
222
Histology of pauci-immune/ANCA associated glomerulonpehritis
no/scanty immune complexes
NOTE: Crescents on light microscopy
223
How to differ between GPA and EGPA
: GPA cavitating lesions, saddle shaped nose and glomerulonephritis - cANCA
eGPA asthma, chronic rhinosinusitis and glomerulonephritis with same features as GPA (also eosinophils in blood - pANCA
224
HUS triad
haemolytic anaemia (MAHA), acute renal failure, thrombocytopenia
225
TTP pentad
haemolytic anaemia (MAHA), acute renal failure, thrombocytopenia, fever, neurlogic Sx
226
renal deisease with deafness and ocular damage
alport syndrome
227
Triad of alport syndrome
X linked gene causing problem with type IV collagen
228
Triad of alprot syndrome
Npephritic syndrome, bilateral sensorineural deafness, lens dislocations
229
Inheritance of benign familial haematuria? On histology?
AD gene causing problem with type 4 collagen, thin basement membrane
230
Most common renal cause of AKI
- ACUTE TUBULAR NECROSIS
231
Causes of acute tubulointerstitial nephritis? Histology?
o DRUGS:
ABX (e.g. gentamicin)
PPIS
NSAIDS
DIURETICS
ATIN HISTOLOGY:
- EOSINIOPHILS DRUG HYPERSENSITIVITY
- GRANULOMAS
232
What is found in urine of acute tubular necrosis?
Brown casts, and epithelial casts
233
What is seen in urine of acute interstitial nephritis?
White cell casts, or white cells in urine with no infection
NOTE: Think of it as an allergic reaction
234
Most common causes of acute interstitial nephritis
Penicillins, allopurinol, NSAIDs
235
Causative agent of HUS
E.coli 0157:H7
236
What enzyme deficiecny in TTP
ADAMTS13 --> cleaves vwf, so left with platelet aggregation and fibrin depositon
237
How many stages of lupus nephritis? how does it present?
6 stages
Silent --> nephrotic --> nephritis
238
How is myeloma kidney different to amyloidosis causing nephrotic syndrome?
Myrloma kidney causes cast npehorpathy --> more common --> due to light chain deposition causing tubulointerstitial disease
80% of AL is due to multiple myeloma, but this causes light chain depositon in glomerulus
239
Inheritance of PCKD? Mutation? Presentiation?
AD, due to mutation in PKD gene encoding polycystin-1
CAues haematuria and kidney failure
Extra renal manifestations are liver cysts (most common) and berry aneurysms (SAH)ost c
240
Most common exta renal manifestation of PCKD
Liver cysts
NOTE: can also cause berry aneurysms
241
Second most common childhood malignancy after ALL
Nephroblastoma
242
oy of nephroblastoma
small round blue cells on microscopic appearance
243
Most common type of renal cell carcinoma, give two other types
- Clear cell (70%)
- Papillary (15%)
- Chromophobe (5%)
NOTE: Macroscopic appearance:
- Clear cell golden yellow with haemorrhagic areas
- Papillary – friable brown
- Chromophobe solid brown
Microscopic appearance:
- Clear cell nests of epithelium with CLEAR (TRANSPARENT) CYTOPLASM
- Papillary papillary tubopapillary growth patter OVER 5MM
- Chromophobe sheets of large cells WITH DISTINCT CELL BORDERS
244
Most common type of bladder cancer
transitional cell carcinoma
245
What is squamoos cell carcinoma of bladder caused by?
SCHISTOMIASIS + CHRONIC CYSTITIS
246
Most common form of prostate cancer in over 50s
ADENOCCARCINOMA MOST COMMON MALIGNANT TUMOUR IN MEN 25% OF ALL MALE CANCERS, 1 IN 8 WILL GET IT
247
precursor of prostate cancers
PROSTATIC INTRAEPITHELIAL NEOPLASIA (PIN)
248
painless frank haematuria
bladder cancer
249
Most common type of testicular cancer
Seminoma
250
Most common manlignant tumour in men
Prostate
251
How to calculate gleason score?
The Gleason score is calculated by adding together the two grades of cancer cells that make up the largest areas of the biopsied tissue sample.
252
most common tupe of renal stone, caused by?
Calcium oxalate, hypercalcaemiaW
253
Composition of renal stone from proteus infection, caused by?
- MAGENESIUM, AMMONIUM, PHOSPHATE (MAP/STRUVITE) PROTEUS INFECTION
o GIVE STAGHORN CALICULI
CAUSED BY UREASE (ENZYME RELEASED BY BACTERIA)
254
What causes uric acid stones?
Gout, Tumour Lysis syndrome
255
How to remember stages of CKD?
NB: Think of it like a clock, with 120 at 12, 90 at 3, 60 at 6, 30 at 9. Means that anywhere between 90-120 is 1. Anywhere between 60-90 is 2. Anywhere between 30-60 is 3 (A+B) etc.
256
Most common causes of CKD
Diabetes and HTN, diabetes is more common
257
How does HPV transform cells? What proteins doe s it produce?
- Producing 2 proteins which inactivate tumour suppressor genes:
o E6 inactivates p53
o E7 inactivates Rb (Retinoblastoma)
258
What protein is associated with serous endometrial carcinoma n 90% of casse?
p53
259
Types of VIN, how to differentiate?
Usual type:
HPV 16/18
Smoking
Differentiated type:
Lichen sclerosis
PROGRESSION TO SCC
260
Most common type of vulval carcinoma? Who does it present in?
SCC, presents in older women, associated with Lichen sclerosis
261
Who does vulval adenocarcinoma present in?
Teenagers, associated with COCP use
MOST COMMON TYPE IS SCC - older women, lichen sclerosis
262
How to differentiate between vulval SCC or adenocarcinoma?
SCC - older women, lichen sclerosis, most common
Adenocarcinom - teenagers, COCP
263
Actauly pathological process of CIN
Dysplasia
264
What occurs in CIN?
Clomunar epithelium of endocervix becoems squamous (opposite to barrets)
265
How to grade CIN? WHat stain is used?
CIN 1 (low grade) – up to one third of the thickness of the lining covering the cervix has abnormal cells. CIN 2 (high grade) – up to two thirds of the thickness of the lining covering the cervix has abnormal cells. CIN 3 (high grade) – the full thickness of the lining covering the cervix has abnormal cells.
Stain used is H&E
266
Process of CIN to cancer
. Dysplasia when cells are proliferating to create a disorganised structure. Neoplasia new cell formation from dysplasia, continuation from dysplasia.
Cancer INVASION OF BASEMENT MEMBRANE
267
Most common type of cervical cancer
Squamous cell cancer
268
Biggest RFs for SCC of cervix
HPV 16+18, COCP, smoking
269
Most common type of end0ometrial cancer
Adenocarcinoma
270
What is a fibroid? Who does it present in? Features?
Benign tumour of myometrium
Common 40% in women over 40, afro-carribean
Oestrogen dependent growth - enlarge during pregnancy, regress during menopause
271
Fibroids aka
Leiomyoma
272
What is seen on laparaoscopy of endometriosis?
Power burns, chocolate cysts, endometriomas
273
Histology of endometriosis
Powder burns
274
Subtypes of adenocarcinomas (most common type of endometrial carcinomas) - LEARN THIS SLIDE
275
What is Fitz-Hugh Curtis syndrome due to? How does it present?
Fitx-Hugh Curtis syndrome due to PID which causes adhesions of liver capsue to peritoneum peri-hepatic lesions “violin strings”
276
Types of epithelial ovarian tumours
- EPITHELIAL (SURFACE-DERIVED) (THINK: SM EC)
o SEROUS (Benign) most common epithelial, columnar epithelium, psammoma bodies (round microscopic calcific collections)
o MUCINOUS (Benign) mucin secreting cells
o ENDOMETRIOID (Malignant) co-exist with endometrial cancer/endometriosis, CA125, tubular glands
o CLEAR CELL (malignant) ASx with endometrioma, clear cells, hobnail appearance
277
Most common epithelial ovarian tumour
o SEROUS (Benign) most common epithelial, columnar epithelium, psammoma bodies (round microscopic calcific collections)
278
What type of ovarian tumour dco-exists with endometrial cancer/endometriosis?
Endometroid (malignant)
279
What type of ovarian tumour is associatied with endometrioma?
o CLEAR CELL (malignant) ASx with endometrioma, clear cells, hobnail appearance
280
Histology of granulosa-theca cells
Cal-exner bodies
281
What type of ovarian tumour secretes androgens?
Sertoli-leydig
282
Most common benign ovarian tumour in under 30? Associated with?
o DERMOID CYST (Mature cystic teratoma) (Benign) MOST COMON BENIGN OVARIAN IN UNDER 30 ASx with torsion, ROKITANSKY PROTUBERANCE
283
Most common malignant ovarian tumour in younger women?
dysgerminoma
284
What type of ovarian tumour secretes HCG?
Choriocarcinoma
285
Most common type of cyst
Follicular, commonly regress after severeal menstrual cysts
286
When is corpus lutem most common? What is it most likely to present with?
Corpus Lutem cyst most likely presents with intraperitoneal bleeds. COMMON IN EARLY PREGNANCE.
287
Rokitansky protuerberance
Dermoid cyst
288
Histology of serous cystadenoma
psamammoma bodies, caused by p53 mutation (E6 protein)
289
What are mucinous cystadenomas associated with?
Pseudomyxoma peritonei
290
What type of ovarian tumours have clear cells with clear cytoplasm and a hobnail appearance on histology?
Clear cell ovarian tumours
291
What mutation causes mucinous cystaenomas?
KRAS mutation
292
Difference between serous cystadenoma and mucinous cystadenoma in terms of mutations
P53 MUTATION CAUSES SEROUS CYSTADENOMA, KRAS MUTATION CAUSES MUCINOUS OVARIAN CYSTADENOMA
293
Difference between male and female teratomas
MALE TERATOMAS ARE NROMALLY MALIGNANT, UNLIKE FEMALES WHICH ARE NORMALLY BENIGN
294
What do immature teratomas secrete?
AFP
295
What type of ovarian cancer is seen in TUrners? How does it present?
DYSGERMINOMA IS SEEN IN TURNERS, PRESENTS WITH RAISED HCG AND LDH
296
Relationship between dysgerminoma and seminoma
Dysgerminoma is female counterpart to testicular seminoma (both most common for respective sex0
297
What hormone do granulosa theca cells produce?
Oestrogen
298
What is seen on histology of Krukenberg tumours?
Mucin producing signet ring cells
299
Tumour markers produced by germ cell testicular tumours
- AFP
- BHCG
- LDH
300
RFs for testicular cancer
- UNDESCENDED TESTICLES
- KLEINEFELTERS
301
Triple assessment summary
NB: Mammogram not very useful when breast is firmer (at a younger age). FNA is when you put needle into offending area and take a biopsy used for cystic leisons. Core biopsy is when you take a “punch” out and biopsy that solid lesions
302
On histology of mastitis
abundance of neutrophils
303
Managemnt of mastitis
Conservative for first 24 hours with warm compress, analgesia and continue breastfeeding
No improvement in 24 hours - oral ABx - Fluclox
304
Most common organism for mastritis
Staph aureus
305
Breast abscess presents with? Management?
Fluctuant swelling, swinging fevers. Give IV Abx and incision and draiange
306
Most common breast lesion that presents with discharge
papilloma
duct ectasia second most common
307
a sub/peri-areolar mass that presens in smokers with yellow-green discharge
Duct ectasia
308
What is fat necrosis often preceded by?
Trauma, radiotherapy
309
A breast mass that is unilateral and occurred after trauma
fat necrosis
310
Most common benign breast condition
Fibroadenoma
311
Most common breast lump in women 20-40
fibroadenoma
312
Single 1-5cm, unilateral, spherical, well dermarcated, firm/rubbery. painless, mobile breast mass AKA breast mouse
Fibroadenoma
313
Peripheral intraductal papilloma presents with
subareolar mass
314
central intraductal paipilloma presents with
blood or clear nipple discharge
315
Difference between discharge in duct ectasia and papilloma
NB: GREEN/YELLOW DISCHARGE DUCT ECTASIA, BLOOD-STAINED DISCHARGE INTRADUCTAL PAPILLOMA/CANCER. SMALL BUT IUMPORTANT RISK OF PROGRESSING TO DUCTAL CARCINOMA IN SITU AND THEREFORE INVASIVE CARCINOMA USUALLY EXCISED.
316
central, fibrous, stellate area
Radial scar
317
What is radial scar often confused for on mammography?
carcinoma
318
What is phyllodes tumour structurally similar to?
Fibroadenomas - but malignant version
319
Artichoke appearance, frond-like, branching
Phyllodes (means leaf) tumour
320
Lumpiness in breasts which changes according to cycle
Fibrocystic breast disease
321
Well dermarcated, fluctuant, transilluminable, clear nipple discharge
fibrocystic disease
322
RED FLAGS FOR FIBROCYSTIC DISEASE
FNA is blood stained, core biopsy reveals complex chystic contents
323
Summary table for breast conditions
324
What cancers does BRCA increase the risk of?
BRCA INCREASES THE RISK OF: (THINK: BOPP)
- BREAST CANCER
- OVARIAN CANCER
- PANCREATIC CANCER
- PROSTATE CANCER
325
How does pagest disease present? What can it develop from? What to look for on mammography?
ECZEMA OF NIPPLE THEN AREOLA NEVER GET ECZEMA ON NIPPLE NORMALLY CAN DEVELOP FROM DUCTAL CARCINOMA IN SITU
LOOKING FOR MICROCALCIFICATIONS
326
Where is lobular carcinoma in situ detected? Why? What does it lack?
ALWAYS DETECTED ON BIOPSY AS NO MICROCALCIFICATION
NB: LACK PROTEIN E-CADHERIN
327
What does ductal carcinoma in situ appear as on mammogram? What can it lead to?
APPEAR AS AREAS OF MICROCALCIFICATIONS ON MAMMOGRAM TYPICALLY FOUND ON SCREENING UNLESS GET PAGETS
NB: PAGETS CAN DEVELOP FROM DUCTAL
328
Summary slide showing different types of breast cancers
329
What receptors are tested for in breast cancer? Why?
HER2 RECEPTORS ARE TESTED FOR IN BREAST CANCER HERCEPTIN/TRASTUZUMAB USED TO TREAT (MONOCLONAL Ig TO HER2) HERCEPTIN HAS A DIRECT TOXIC AFFECT ON MYOCARDIUM SO MUST MONITOR LVEF
330
What receptors have the best prognosis in breast cancer? Why?
ER/PR HAVE BEST PROGNOSIS AS RESPONSE VERY WELL TO TAMOXIFEN TAMOXIFEN IS USED TO TREAT ER/PR POSITIVE CANCER
331
What mutation is asssociated with male breast canceers?
BRCA2 IS ASSOCIATED WITH MALE BREAST CANCERS
332
Most significant prognostic factor in breast cancer
AXILLARY LN INVOLVEMENT BEST PROGNOSTIC FACTOR IS NO INVASION OF LYMPH NODES
333
Most common cause of ischaemic stroke
Atherosclerosis
334
Most common cause of haemorrhagic stroke
SAH
335
Difference between stroke and TIA
Stroke lasts more than 24 hours, TIA resolves within 24 hours
336
Type of necrosis in stroke
Liquefactive, both ischaemic and haemorrhagic cause it
337
Most common cause of stroke
Ischaemic, due to atherosclerosis
338
Difference between ischaemia and infarction
Ischaemia - lack of o2 supply to tissue
Infarction - death of tissue due to lack of o2 supply
339
MOST COMMON SITE OF INTRA-PARENCHYMAL HAEMORRHAGE? Cause?
MOST COMMON SITE OF INTRA-PARENCHYMAL HAEMORRHAGE IS IN THE BASAL GANGLIA
CAUSE IN OVER 50% OF CASES IS HYPERTENSION
340
Cause of SAH? Most common site?
CAUSED BY BERRY ANEURYSM IN CIRCLE OF WILLIS
- MOST COMMON SITE OF BERRY ANEURYSM IS THE INTERNAL CAROTID ARTERY BIFURCATION
341
What causes prinzmetal angina?
coronary artery spasms
342
hypoattenuation around the circle of willis
Haemorrhagic stroke
343
What kidney condition is association with ruptured berry aneurysms?
PCKD - AD - defect in polycystin 1
344
Initial investigation for haemorrhagic stroke? If _ve?
Non-contrast CT head, if neg do LP at 12 hours to look for xanthochromia and oxyhaemoflobin
345
Difference between extradural and subdural haemorrhage
346
Fracture of pterio caused by trauma, rupture of middle meningeal artery and lemon shape on CT
extradural haemorrhage
347
Rupture of bridging vein in an elderly aclholicc on anti coag with a banana shape on CT
Subdural haemorrahage
348
Common sign on examination of skull fracture
Straw coloured otorrhoea and rhinorrhoea
349
BATTLES SIGN
BLEEDING BEHIND EAR SHOWING SKULL BASE FRACTURE
350
CONTUSIONS
BRAIN IN COLLISION WITH SKULL AND GET SURFACE BRUISING IF PIA MATER TORN DURING THIS COLLISION BECOMES A LACERATION, NOT CONTUSION
351
CHRONIC TRAUMATIC ENCEPHALOPATHY
EFFECTS ON BRAIN OF REPEATED TRAUMA TO HEAD
352
Straw coloured fluid from nose or ears
traumatic brain inury
353
Summary slide for traumatic brain injury
354
Most common primary brain tumour in adults
Meningioma
355
Most common form of brain tumour
Seccondary - from lung, skin and breast
356
Most common brain tumour in children
Pilocystic astrocytoma
357
Second most common brain tumour in children
Medulloblastoma
358
Histology of pilocystic astrocytoma
- PILOID HAIRY CELLS
- ROSENTHAL FIBRES
359
Mutation in what for pilocystic astrocytoma
BRAF
360
MRI fidnings of pilocytic astrocytoma
- WELL CIRCUMCISED
- CYSTIC
- ENHANCING LESION
- FOUND IN CEREBELLUM
361
Summary slide of astrocytomas
362
Summary slide of brain cancer buzzworlds
363
Most common benign CNS tumour
Meningioma - psammoma bodies
364
5 A's of alzheimer
Amnesia
Apreaxia
Aphasia
Agnosia
Anomia
365
Most common dementia
Alzheimer's
366
Order of prevalence of dementia
Alzheimer's
Vascular
Lewy body
Frontotemporal
367
Imaging of AD
- CORTICAL ATROPHY
- WIDENED VENTRICLES
- NARROWED GYRI
- WIDENED SULCI
368
Aetiology of Alzheimer's
Accumulation of beta-amyloid plaques
Hyperphophorylation of TAu
369
Histology of lewy body demtnia
- ALPHA SYNUCLEIN
- UBIQUITIN
- LEWY BODIES
370
Waht staging for alzheimer's
BRAAK staging
371
Histology of pick's disease
- FRONTO-TEMPORAL ATROPHY
- MARKED GLIOSIS AND NEURONAL LOSS
- BALLOON NEURONES
- TAU POSTIVE PICK BODIES
NB: TAU IS STAINED POSITIVELY IN PICKS DISEASE AND IS LINKED TO CHROMOSOME 17:
372
Dementia Buzzwords
NB: vascular atherosclerotic build up of plaques progeressive deterioration in cognition. Pick’s disease (frontotemporal dementia) can lead to extremities of weird Sx gambling, inappropriate sexual advances.
373
What physiological change ioccurs in parkinsons?
Reduced stimulation of cortex by basal ganglia due to dopaminergic loss in substantia nigra
374
How does multiple system atrophy differ to parkinsons?
DUE TO ALPHA YNUCLEIN IN THE GLIAL CELLS NOT NEURONES
375
What do you stain for in Parkinson's
alpha synuclein
376
Summary slide showing parkinsonian Sx
NB: MSA postural hypotension, PSP diplopia when they look up, may be described as issues with cranial nerve in exam qns
377
Pathophys of parkinsons
378
Types of hydrocephalus? How do they differ?
NON-COMMUNICATING OBSTRUCTION IN PASSAGE OF FLUID
- MOST COMMON SITE OF OBSTRUCTION IS IN THE CEREBRAL AQUEDUCT
COMMUNICATING CSF CAN STILL FLOW BETWEEN THE VENTRICLES, WHICH REMAIN OPEN
379
Most common site of obstruction in non-communicating hydrocephalus
Cerebral aqueduct
380
How do both types of hydrocephalus differ in presentation?
Both types occur due to too much CSF in ventricles.
Communicating obstruction in outflow of CSF in neonates.
Non-communicating reduced absorption of CSF into veins meningitis (if get fibrosis of meninges)
381
Worst type of herniation
tonsillar worst one get cerebellum impinging on brainstem can cause coma and arrest.
382
What are the two types of cerebral oedema? How do they differ?
2 types of cerebral oedema vasogenic and cycotoxic. Vasogenic disruption in interface between blood & brain too much fluid coming in, but can’t remove from brain parenchyma into blood. Cytotoxic damage due to toxins or ischaemia brain tissue can die and swell oedema
383
TARGET SIGN ON IMAGING IN BRAIN
cavernous angioma
384
what is calcium stored in the bone as?
calcium hydroxyapatite
385
Types of bones
- CORTICAL
o LONG BONES
- CANCELLOUS
o VERTEBRAE AND PEVLIC
386
Gold standard site for bone histology
Iliac crest
387
X-ray features of osteoarthritis
Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts
388
Histology of RA
389
What is the genetic predisposition of RA? Pathophys?
390
Pathophys of osteomyelitis
391
How do gout and pseudogout differ on imaging?
392
How to differentiate gout and pseudgout crystals
GOUT CRYSTALS NEGATIVE BIREFRINGENET NEEDLE SHAPED MONOSODIUM URATE CRYSTALS
PSEUDOGOUT CRYSTALS RHOMBOID SHAPED AND POSITIVELY BIREFRINGENT:
393
Summary slide for fibrous dysplasia
394
What is fibrous dysplasia associated with? What is the triad?
ASSOCIATED WITH MCCCUNE-ALBRIGHT SYNDROME (IF POLYOSTOTIC) TRIAD OF:
- FIBROUS DYSPLASIA
- CAFÉ AU LAIT SPOTS
- PRECCOIOUS PUBERTY
395
X ray of fibrous dysplasia
- SOAP BUBBLE OSTEOLYSIS AND SHEPHERDS CROOK DEFORMITY IF IN PROXIMAL FEMUR
396
Histology of fibrous dysplasia
CHINESE LETTERES MISSHAPEN BONE TRABECULAE
397
histology and Xray findings of osteochondroma
ON HISTOLOGY BONY PROTUBERANCE CAPPED IN CARTILAGE (THINK: OSTEO(BONE) CHOND(CARTILAGE) ROMA))
ON X-RAY MUSHROOM CAP ON BONE
398
Bone tumour with cotton wool or popocorn calcifications at the ends
endochromas
399
Most common bone tumours
mets
400
Most common primary bone sarcoma
osteosarcomaX
401
X ray findings of osteosarcoma
- ELEVATED PERIOSTEUM (CODMANS TRIANGLE)
- SUNBURST APPEARANCE
402
How to differ osteosarcoma and chondrosarcoma?
ALP STAINING POSITIVE IN OSTEOSARCOMA, COMPARED TO NEGATIVE IN EWINGS
403
Onion skinning of periosterum
ewings sarcoma
404
What is the only tumour that can be diagnosed genetically? How?
EWINGS SARCOMA IS THE ONLY BONE TUMOUR WHICH CAN BE DIAGNOSED GENETICALLY:
- T11:22 TRANSLOCATION
405
Summary slide showing malignant bone tumours
406
Layers of the epidermis
- Stratum corneum
- Stratum lucidum
- Stratum granulosum
- Stratum spinosum
- Stratum basale
- Basement membrane
407
Dermatology definitions (learn if have time)
Hyperkeratosis – INCREASE in size of stratum corneum and keratin
Parakeratosis – INCREASE in RETAINED nuclei in stratum corneum
Acanthosis – INCREASE in stratum spinosum
Acantholysis – REDUCE in cohesion between keratinocytes
Spongiosis – INTERcellular oedema
Actinic – Damaged by the sun
408
Examples of pre-malignant derm neoplasms and how to differentiate
Actinic Keratosis - HAVE A SANDPAPER LIKE TEXTURE
Keratacanthoma - dome shaped nodule with necrotic crusted centre
Bowen's disease - flat, red with scaly patches and is stand alone.
409
Precursors to squamous cell carcinoma of skin& how to differntiate
BOWENS DISEASE AND ACTINIC KERATOSIS ARE PRECURSORS TO SCC DIFFERENCE BETWEEN THEM IS BOWENS DISEASE IS FULL THICKNESS
410
Histology of actinic keratosis
Histology has the acronym SPAIN (Solar Elastosis, Parakeratosis, Atypia/dysplasia/Inflam/NOT full thickness)
411
Intra epidermal squamous cell acncer
Bowens disease
412
Difference between bowens disease and squamous cell carcinoma
SCC IS BOWENS DISEASE THAT HAS SPREAD THROUGH THE BASEMENT MEMBRANE
413
How does a basal cell carcinoma appear? AKA? Histology?
Appears with a pearly surface and telangiectasia
ALSO KNOWN AS A RODENT ULCER
ON HISTOLOGY: Mass of basal cells pushing down into dermis. Palisading (alignment of nuclei in outermost layer)
414
Melanoma histology? Staining? Prognosis?
Histology:
- ATYPICAL MELANOCYTES
- INITIALL RADIAL GROWTH PHASE, THEN VERTICAL PHASE
- BUCKSHOT APPEARANCE IN VERTICAL PHASE
NB: STAIN FOR MELANIN IS FONTANA
WORST PROGNOSIS IS DUE TO BRESLOW THICKNESS, >4MM 50% 5 YEAR SURVIVAL
415
Summary slide of skin cancers
416
Images of skin cancers
417
Squamous cell carcinoma in situ
Marjolin's ulcer
418
In chronic atopic dermatitis, skin becomes leathery and thick , known as?
Lichenification
419
Mutation in what gene causes eczema
Filaggrin
420
How to atopic and contact dermatitsi differ in hypersensitivity
Atopic - T1
Contact - T4
421
What cell is increased in atopic dermatitsi?
eosinophils
422
Histology of eczema
Spongiosis fluid collection in epidermis
Thickening of epidermis
423
How does SJS present? What presents similarly? How to differntiate?
TYPE IV HYPERSENSITIVITY REACTION AGAINST EPIDERMIS AND MUCOSA WHICH CAN LEAD TO SKIN NECROSIS THAT CAN BE WIPED OFF
TO DIFFERENTIATE BETWEEN SJS AND TOXIC EPIDERMAL NECROLYSIS LOOK AT AMOUNT OF BODY AFFECTED SJS IS <10%, TEN IS >30%
424
Chronic plaque psoriasis presents with? Where?
salmon pink, well-demarcated red plaques with silver scales. It appears on the extensors of knees, elbows and scalp.
425
Auspitz sign means what? Seen in what?
rubbing plaque leads to pinpoint bleeding, seen in plaque psoriasis
426
When does guttate psoriasis present? Triggered by what? How does it present?
Guttate psoriasis presents in CHILDHOOD, typically triggered by a STREP THROAT 2 WEEKS AGO Appears as small spots, with a rain drop plaque distribution over trunk and limbs
427
Who does flexural psoriasis in? How does it present?
Flexural psoriasis occurs in the elderly. It occurs on creases in the skin, in the groin, submammary, nasal cleft.
428
Parakeratosis
PSORIASIS - increase in retained nuclei in stratum corneum
429
Pathophys of psoriasis
T4 T cell hypersensitivity reaction within the epidermis
T cell recruitment and release of inflammatory cytokines e.g. TNF - alpha
Keratinocyte hyperproliferation
Epidermal thickening
430
Summary slide of psoriasis types
431
Difference between bullous pemphigoid and pemphigus vulgaris
- BULLOUS PEMPHIGOID:
o TENSE ON ERYTHEMATOUS BASE DO NOT RUPTURE
- PEMPHIGUS VULGARIS:
o EASILY RUPTURED RAW RED SURFACE
o NIKOLSKY +VE THIN TOP LAYER OF SKIN WILL SHEAR OFF, LEAVING SKIN PINK AND MOIST USUALLY VERY TENDER
432
Summary table showing difference between bullous pemphigoid, pemphigus vulgaris and pemphigus folicaeous
433
Pathophys of atherogenesis
- Endothelial Injury
- LDL gets enters subintimal space and gets trapped
- LDL oxidised
- Oxidised LDL gets taken up by macrophages via scavenger receptor becoming FOAM CELLS
- Foam cells apoptose causing cholesterol core
- Increase in adhesion molecules on endothelium results in MORE MACROPHAGES AND T CELLS
- Vascular smooth cells form fibrous cap
434
Types of blood flow and there properties
LAMINAR BLOOD FLOW IS ANTI-ATHEROGENIC, TURBULENT IS ATHEROGENIC
435
Complications of an MI
- Death
- Arrythmia
- Rupture
- Tamponade
- Heart Failure
- Valvular disease
- Aneurysm of ventricle (persistent ST elevation following MI)
- Dresslers syndrome
- Embolism
- Recurrence
436
skin fidnings in sarcoidosis
erythema nodosum (IBD, sarcoidosis), lupus pernio (lesion affecting the nose), skin nodules
437
What is uveoparotid fever? WHat is AKA? Presents with?
Eye manifestation of sarcoidosis
NB: UVEOPARATOID FEVER IS ALSO KNOWN AS HEERFORDT SYNDROME. IT CAN CAUSE BILATERAL UVEITIS, PAROTID ENLARGEMENT AND POTENTIALLY A FACIAL NERVE PALSY
438
Most common valve disease post MI
MITRAL REGURG IS MOST COMMON VALVE DISEASE POST MI CAUSED BY PAPILLARY MUSCLE RUPTURE OR NECROSIS
439
Persistent ST elevation post MI
VENTRICULAR ANEURYSM CAN DEVELOP FOR OVER A MONTH AFTER
440
Difference between pericardial effusion and tamponade
DIFFERENCE BETWEEN PERICARDIAL EFFUSION AND TAMPONADE IS TAMPONADE OBSTRUCTS THE CONTRACTILITY OF THE HEART
441
Most common causes of pericarditis by type
- FIBRINOUS MI
- GRANULOMATOUS TB
- PURULENT STAPHYLOCOCCUS
442
Nutmeg liver
APPEARANCE OF THE LIVER DUE TO CHRONIC HEPATIC VEIN CONGESTION BECOMES CARDIAC CIRRHOSIS OVER TIME (NOTE: PPQ)
443
Haemosiderin laden macrophages in lungs
MACROPHAGES WHICH HAVE TAKEN ONTO RBCS IN LUNGS AFTER ALVEOLAR HAVE BURST AKA HEART FAILURE CELLS
444
Histology of rheumatic fever
- BEADY FIBROUS VEGETATIONS
- ASCHKOFF BODIES
- ANITSCHOW MYOCYTES
445
Management of rheumatic fever
TREATED WITH BENZYLPENICILLIN
446
Diagnosis of Rheumatic fever is by what criteria?
Diagnosis:
- JONES CRITERIA:
o GROUP A STREP INFETION AND 2 MAJOR CRITERIA
o GROUP A STREP INFECTION AND 1 MAJOR + 2 MINOR
Major Criteria (CASES):
- Carditis
- Arthritis
- Sydenhams chorea jerky, uncontrollable and purposeless movements of the body
- Erythema marginatum skin rash specific to rheumatic fever pink, pale centre surrounded by a red, raised border
- Subcut Nodules
Minor Criteria (FRAPP):
- Fever
- Raised ESR or CRP
- Arthralgia
- Prolonged PR interval
- Previous Hx of Rheum Fever
447
Lung cancer htat affects proximal bronchi
small cell and squamous
448
lung cancer that affects distal bronchi
adenocarcinomas
449
Most common gene affected in HOCM
beta myosin heavy chain
450
Hypertrophy occurs where in HOCM?
IV septum
451
Most common cause of restrictive cardiomyopathy
Amyloidosis
452
Cardiac complication of SLE and APML, presents with?
Libmen sacks endocarditis. warty vegtations on endocardium that are sterile and platelet rich
453
Organisms which cause acute endocarditis
- STAPH AUREUS
- STREP PYOGENES
454
Organisms which cause subacute endocarditis
- STREP VIRIDANS
- STAPH EPIDERMIS
- HACEK
o HAEMOPHILUS
o AGGREGATIBACTER
o CARDIOBACTERIUM
o EIKENELLA
o KINGELLA
455
Difference between acute and subacute infective endocarditis
NB: Acute infective endocarditis develops suddenly and may become life threatening within days. Subacute infective endocarditis (also called subacute bacterial endocarditis) develops gradually and subtly over a period of weeks to several months but also can be life threatening
456
Most common valvular problems in IE
MITRAL AND AORTIC REGURG
457
Most common murmur in IE
REGURG MITRAL MOST COMMON, BUT IF IVDU TRICUSP
458
Diagnosis of IE is with what criteria?
Diagnosis of IE:
- DUKES CRITERIA
o 2 MAJOR
o 1 MAJOR AND 3 MINOR
o 5 MINOR
Major Dukes Criteria:
- POSITIVE BLOOD CULTURE GROWING TYPICAL IE ORGANISM
- VEGETATIONS ON ECHO/NEW REGURG MURMUR
Minor Dukes criteria:
- RF
- Fever
- Thromboembolic phenomena
- Immune phenomena
- Positive blood cultures that don’t meet major criteria
459
Immune phenomena in IE
- ROTH SPOTS EYES
- OSLER NODES RED, PAINFUL NODES ON HANDS OR FEET
- HAEMATURIA FROM GLOMERULONEPHRITIS
460
Thromboembolic phenomena of IE
- JANEWAY LESIONS
- SEPTIC ABSCESSES
- MICROEMBOLI
- SPLINTER HAEMORRHAGES
- SPLENOMEGALY
461
most specific antibody in SLE
anti-smith (ribonucleoproteins)
462
What does anti-histone antibody indicate in SLE?
INDICATES THAT IT IS DRUG INDUCED LUPUS FROM HYDRALAZINE
463
Histology of scleroderma
- INCREASED COLLAGEN DEPOSITION
- FIBROSIS
- ARTERIOLE ONION SKINNING APPEARANCE
464
Differences between diffuse and limited systemic sclerosis
- DIFFUSE:
o WIDESPREAD SX INCLUDING RENAL + CARDIO
o CAN LEAD TO PULMONARY FIBROSIS
- LIMITED:
o CONFINED TO FACE AND DISTAL ASPECTS OF LIMBS DISTAL TO KNEE AND ELBOW
o TYPICALLY CREST
o CAN LEAD TO PULMONARY HTN
465
Skin manifestations in myosiits
- GOTTRONS PAPULES CALLOUSES/REDDENING ON KNUCKLES
- HELIOTROPE RASH REDDENING AROUND EYES AND FACE
466
Presentation of Giant cell arteritis
- OVER 50
- PRECEDING POLYMYALGIA RHEUMATICA
- HEADACHE OVER EYE
- VISION DIFFICULTY
- ENLARGED TEMPORAL ARTERY
467
Histology of giant cell arteritis
- GRANULOMATOUS TRANSMURAL INFLAM
- GIANT CELLS
- SKIP LESIONS
468
Blood finding of giant cell arteritis? management?
HIGH ESR, NEEDS TEMPORAL ARTERY BIOPSY AND URGENT STEROIDS
469
What is polyarteritis nodosa associated with? What does it normally affect?
NORMALLY AFFECTS THE RENAL AND MESENTERIC ARTERIES
ASSOCIATED WITH HEPATITTIS B
470
What investigations are done for polyarteritis nodosa? What do they show?
Investigations include an angiogram SHOWS MICROANEURYSMS ON ANGIOGRAPHY (“STRING OF PEARLS”/ROSARY BEAD APPEARANCE)
471
On histolofy of polyarteritis nodosa
FIBRINOID NECROSIS & NEUTROPHIL INFILTRATION
472
Where is biopsy taken for polyarteritis nodosa?
Sural nerve (a superficial nerve in the calf of the leg
473
Presentation of thromboangiitis obliterans? Investigations?
474
Cytoplasmic ANCA (cANCA) is against
Proteinase 3
475
perinuclear ANCA (pANCA) is against
myeloperoxidase
