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Matt's Path REVERSE > Histopath > Flashcards

Histopath Flashcards

1
Q

betaHMC mutation

A

Hypertrophic Cardiomyopathy

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2
Q

Erythema marginatum

Subcutaenous nodules

A

Acute Rheumatic Fever

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3
Q

Acute Rheumatic Fever

A

Strep throat infection

Heart: pancarditis (endocarditis, myocarditis, pericarditis) + vasculitis
Joint: arthritis and synovitis
Skin: Erythema marginatum, subcutaneous nodules
CNS: encephalitis, Sydenham’s chorea

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4
Q

Jones Criteria

A

Diagnosis of Rheumatic Fever = group A strep infection + 2 major OR 1 major + 2 minor

Major (CASES)
Carditis
Arthritis
Sydenham's chorea 
Erythema marginatum 
Subcutaneous nodules 
Minor criteria
Fever
Raised ESR or CRP
Migratory arthralgia 
Prolonged PR interval 
Previous rheumatic fever
Malaise
Tachycardia
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5
Q

Beady fibrous vegetations

A

verrucae

Rheumatic fever

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6
Q

Aschoff bodies

A

Small giant-cell granulomas

Rheumatic fever

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7
Q

Anitschkov myocytes

A

regenerating myocytes

Rheumatic fever

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8
Q

Libman-Sacks

A

Associated with SLE and anti-phospholipid syndrome

small (<2mm) “warty” vegetations

Sterile

Platelet rich

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9
Q

Acute infective endocarditis

A

Staph aureus

Strep pyogenes

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10
Q

Subacute infective endocarditis

A

Strep viridans

Staph. epidemris

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11
Q

Culture negative infective endocarditis

A 
Coxiella
Mycoplasma
Candida
Brucella
Chlamydia
Mycoplasma
Bartonella

HACEK
Haemophilus, Aggregatibacter (previously Actinobacillus), Cardiobacterium, Eikenella, Kingella

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12
Q

Tricuspid infective endocarditis

A

IVDU

Staph aureus

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13
Q

Duke Criteria

A

Diagnosis of Infetcive Endocarditis
2 major
1 major = 3 minor
5 minor

Major:
Positive blood culture growing typical IE organism OR 2 positive culture >12 hours apart
Evidence of vegetation/abscess on echo OR new regurgitant murmur

Minor:
Risk factor (prosthetic valve, IVDU, congenital valve abnormalities)
Fever >38
Thromboembolic phenomena
Immune phenomena
Positive blood culture not meeting major criteria

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14
Q

Treatment of infective endocarditis

A

Acute:
Flucloxacillin for MSSA
Rifampicin AND Vancomycin AND Gentamicin for MRSA

Subacute:
Benzylpenicillin AND Gentammicin OR Vancomycin for 4 weeks

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15
Q

Mid-diastolic click and late systolic murmur

A

Mitral valve prolapse

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16
Q

Pericarditis

A

Types

Fibrinous: MI, Uraemia

Purulent: Staphylococcus aureus

Grenulomatous: TB

Haemorrhagic: Tumour, Tb, Uraemia

Fibrous = constrictive (arises from the above)

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17
Q

Pericardial effusion

A

Chronic heart failure

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18
Q

Pericardial effusion

A

Usual cause: Chronic heart failure

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19
Q

Cardiomyopathy

A

Dilated = systolic dysfunction

Hypertrophic = dialstoilic dysfunction

Restrictive = diastolic dysfunction

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20
Q

Charcot-Leyden crystals

A

Asthma

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21
Q

Curschmann spirals

A

Asthma

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22
Q

Goblet cell hyperplasia, hypertrophy of mucous glands

A

Chronic bronchitis

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23
Q

Yellow nail syndrome

A

Yellow dystrophic nails
Pleural effusions
Lymphoedema
Bronchiectasis

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24
Q

Young’s syndrome

A

Rhinosinusitis
Azoospermia
Bronchiectasis

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25
Keratinisation | Intercellular prickles
Squamous cell carcinoma M>F Most common Smoking p53, c-myc mutations
26
EGFR mutation | mucin vacuoles
Adenocarcinoma F>M NON-Smokers glandular differentiation with mucin production EGFR --> give TKI (tyrosine kinase inhibitor)
27
RB1 mutation Ectoptic ACTH Lambert-Eaton
Small cell carcinoma Arise from neuroendocrine cells Smoking P53 and RB1 mutations Poor prognosis: mets early to bone, adrenal, liver brain Ectopic ACTH Cerebellar degeneration Lambert Eaton: rare autoimmune disorder that is characterized by muscle weakness of the limbs. It is the result of an autoimmune reaction in which antibodies are formed against presynaptic voltage-gated calcium channels
28
Poorly differentiated malignant epithelium tumour of the lung
Large cell carcinoma Poor prognosis Large cells Large nuclei No evidence of glandular or squamous differentiation
29
Carcinoid syndrome
Flushing Diarrhoea Bronchoconstriction Ectopic serotonin Tx: Octreotide
30
ERCC1
Poor response to cisplatin
31
Linitis plastica and signet ring cell
Gastric adenocarcinoma
32
5-ASA
Ulcerative colitis
33
Watershed areas of gut
Splenic flexure (SMA transition to IMA) Rectosigmoid (IMA transition to internal iliac)
34
Carcinoid crisis
``` Life-threatening vasodilation Hypotenion Tachycardia Bronchoconstriction Hyperglycaemia ```
35
Enterochromaffin cell origin
Serotonin producing Lung, bowel, ovaries, testes Carcinoid syndrome
36
Urinary 5-HIAA
Enterochromaffin cell cancer Carcinoid syndrome
37
Hypoproteinaemic Hypokalaemic
Villous adenoma
38
Risk factor for adenoma --> adenocarcinoma
1) Size (main factor) 2) dysplasia 3) villous component
39
Juvenile polyposis
Autosomal dominant In children Haemartomatous polyp 100s May require colectomy to stop haemorrhage
40
Peutz–Jeghers syndrome
Autosomal dominant -LKB1 Hamartomatous polyps Hyperpigmented macules on the lips and oral mucosa (melanosis) Increased risk of intussusception and malignancy
41
Hyperplastic polyp
Shedding of epithelium, cell build up 50-60 yrs
42
Pseudo polyp
IBD (UC)
43
Microsatellite instability
Hereditary non-polyposis colorectal cancer | HNPCC
44
Colorectal cancer
95% adenocarcinoma
45
Right-sided bowel tumours
Iron deficiency anaemia Weight loss
46
Left-sided bowel tumours
Change in bowel habit Crampy LLQ pain
47
CEA
colorectal cancer
48
Accumulation of fat droplets in hepatocytes
Hepatic steatosis (fatty liver)
49
Ballooning hepaotcytes Necrosis Mallory-denk bodies Fibrosis Pericellular fibrosis
Alcoholic hepatitis
50
Micronodular cirrhosis Bands of fibrous tissue Intra- and extra- hepatic shunting
Alcoholic cirrhosis
51
Neutrophil polymorphs Mallory-denk
Alcoholic hepatitis
52
Megamitochondria
Alcoholic hepatitis
53
NAFLD
Steatosis in non-alcoholics
54
NASH
NAFLD + inflammation Steatosis + inflammation in non-alcoholics
55
Interface hepatitis with plasma cells
Autoimmune hepatitis
56
Anti-LKM
Type II autoimmune hepatitis
57
Anti-SMA
Type I autoimmune hepatitis
58
Primary Biliary Cholangitis
Autoimmune inflammatory destruction of medium sized INTRAhepatic bile ducts Slow development of cirrhosis over many years (hence renamed form cirrhosis to cholangitis as can diagnose prior to cirrhosis) F> M 10:1 Increased serum ALP Increase cholesterol Increase IgM (late feature) Anti-mitochondrial antibodies NO BILE DUCT DILATATION Bile duct loss with granulomas Present with fatigue, pruritis, abdo discomfort Tx: ursodeoxycholic acid
59
Primary Scleroisng Cholangitis
Inflammation and obliterative fibrosis of EXTRAhepatic and INTRAhepatic bile ducts Multi-focal stricture formation with dilitation of preserved segments Onion-skinning fibrosis M > F Associated with IBD (Ulcerative colitis) Increase ALP p-ANCA Bile duct dilatation ERCP: beading of bile duct (multifocal strictures) Increase in cholangiocarcinoma
60
Absent aslpha globulin band on electrophoresis
A1AT deficiency
61
Haemorrhagic cystitis
Cyclophoshphamide use
62
Urinary schistosomiasis
Squamous cell carcinoma of bladder
63
Most common bladder tumour
Transitional cell (Urothelial) tumour 90% of bladder tumours Smoker Aromatic amines
64
Gleason system
Grading of Prostate cancer
65
Acute bacterial prostatitis
E.Coli
66
Most common germinal tumour
Seminoma 95% of testicular tumours are germ cell origin
67
AFP, HCG and LDH
tumour markers for teratoma - male peeing on pregnancy test story
68
Nephrotic syndrome
Triad: >3g/24 hr protein Hypoalbuminaemia Oedoema (+hyperlipidaemia)
69
Diffuse glomerular basement membrane thickening
Membranous glomerular disease = primary cause of nephrotic syndrome
70
Primary causes of nephrotic syndrome
Minimal change disease Membranous glomerular disease Focal segmental glomerulosclerosis
71
Focal and segmental glomerular consolidation and scarring
Focal segmental glomerulosclerosis
72
Membranous glomerular disease
Causes nephrotic syndrome Common in adults Diffuse glomerular basement membrane thickening Loss of podocyte foot processes Subepithelial spikey depsotis Can be primary or secondary to SLE, drug, malignancy Ig and complement in granular deposits along entire GBM 40% ESRF 2-20 yrs
73
Focal segmental glomerulosclerosis
Causes nephrotic syndrome Common in adults Focal and segmental glomerular consolidation and scarring Hyalinosis Loss of podocyte foot processes Ig and complement deposited in scarred areas 50% respond to steroids 50% ESFR in 10 years Primary Can be due to HIV nephropathy and Obesity
74
Mesangial matrix nodule = Kimmelstiel Wilson Nodules
= Diabetes nephropathy causes nephrotic syndrome
75
Apple green birefringence with Congo red stain
Amyloidosis Can cause nephrotic syndrome Chronic inflammation TB RA Multiple myeloma - AL protein deposition
76
Nephritic syndrome
Manifestation of glomerular inflammation (glomerulonephritis) Characterised: Haematuria (coca-cola urine) Dysmorphic RBCs and red cell casts in urine ``` May also have: Oliguria Increased urea and creatinine Hypertension Proteinuria (but sub nephrotic levels) ```
77
Causes of Nephritic Syndrome (5)
Acute post-infectious glomerulonephritis IgA nephropathy (Berger Disease) Rapidly progressive (Cresenteric) Glomerulonephritis (3 types) Hereditary nephritis (Alport's syndrome) Thin basement membrane disease (benign familial haematuria)
78
HLA-DRB1
Goodpasture's
79
Acute post-infectious (post-streptococcal) glomerulonephritis
Causes Nephritic syndrome 1-3 weeks after Group A alpha-haemolytic strep throat infection Streptococcus pyogenes Immune complex deposition Haematuria, red cell casts, hypertension, proteinuria, oedema, ASOT titre increased Decreased C3 LM: increased cellularity FM: grnaular depsoits of IgG and C3 in GBM EM: subendothelial humps
80
IgA Nephropathy (Berger Disease)
Commonest cause of glomerulonephritis worldwide (causes nephritic syndrome) Deposition of IgA complexes in glomeruli 1-2 days after URTI --> Frank haematuria Persistent or recurring frank haematuria Can be asymptomatic microscopic haematuria Can progress to ESRF FM: Granular deposition of IgA and complement in mesangium
81
Rapidly progressive (Crescentic) Glomerulonephritis
Most aggressive glomerulonephritis - can cause ESRF in weeks Nephritic syndrome + oliguria and renal failure All have crescents on LM 3 Types Type 1: Anti-GBM antibody (Goodpasture's --> Type IV collagen alpha 3) Linear deposition of igG in GBM +pulmonary haemorrhage Type 2: immune complexes SLE, IgA, Post-strep granular/lumps deposition of IgG in GBM/mesangium Type 3: pauci-immune (Not anti-GBM or immune complexes) c-ANCA: Wegner's p-ANCA: microscopic polyangiitis Scanty/lack of immune complex deposition +Vasculitis
82
Hereditary Nephritis (Alport's syndrome)
Causes Nephritic syndrome Can be asymptomatic haematuria x-linked recessive mutation in collagen IV alpha 4 chain Nephritic syndrome + sensorineural deafness + eye problems (cataracts and lens dislocation) Presents at 5-20 years and prepossesses to ESRF
83
Thin Basement Membrane Disease (Benign Familial Haematuria)
Asymptomatic haematuria (v.rarely nephritic syndrome) No decline in renal function Autosomal dominant mutation in collagen IV alpha 4 chain
84
Aysmptomatic haematuria
Think basement membrane disease Alport's IgA nephropathy
85
Nephritic syndrome + scanty immune deposition
Pauci-immune Wegners Microscopic polyangiitis
86
Nephritic syndrome + sensorineural deafness + lens dislocation
Alport's syndrome
87
Frank haematuria 2 days post URTI
IgA nephropathy
88
Increased ASOT titre, Low C3 and URTI 3 weeks ago
Post-streptococcal GN
89
Causes of Acute Tubular Injury
Commonest cause of acute renal failure Ischaemia --> prolonged pre-renal AKI Nephrotoxins (CHARM chain) ``` Cisplatin Heavy metals Aminoglycosides (Gentamicin) Radiocontrast medium Myoglobin ``` Chain: light chains in multiple myeloma Histology: necrosis of short segments of tubules
90
Tubulointerstitial Nephritis
A group of renal inflammatory disorders that involve the tubules and interstitium Acute pyelonephritis = leukocytic casts Chronic pyelonephritis Reccurent infections --> scarring of parenchyma Acute interstitial nephritis Hypersensitivity reactions to drugs Fever, skin rash, haematuria, proteinuria, eosinophilia Chronic interstitial nephritis Elderly with long-term analgesic consumption (NSAIDs/paracetamol) Hypertension, anaemia, proteinuria, haematuria
91
Thrombotic microangipathies
Thrombosis +MAHA +Thrombocytopenia +renal failure (mostly in HUS) Causes TTP - diffuse, esp in CNS HUS - confined to kidneys ``` TTP = headache, altered consciousness HUS= renal failure ```
92
Pre-renal causes of AKI
``` Hypovolaemia Sepsis Burns Acute pancreatitis Renal artery stenosis ``` Pre-renal = most common cause of AKI
93
Complications of AKI
``` Metabolic acidosis Hyperkalaemia Fluid overload HTN Hypocalcaemia Uraemia ```
94
Renal causes of AKI
Acute glomerulonephritis Acute tubular necrosis (most common renal cause) Thrombotic MAHA
95
Post-renal causes of AKI
Stones Tumours (Primary or Secondary) Prostatic hypertrophy Retroperitoneal fibrosis
96
Chronic renal failure stages
``` GFR >90 = stage 1 60-89 = stage 2 30-59 = stage 3 15-29 = stage 4 <15 = stage 5 ``` Start with 15, double, double again, add 30
97
PKD1
Autosomal Dominant Adult Polycystic Kidney Disease Chromosome 16 (polycystin 1) ``` Also PKD2 chromosome 4 (polycystin-2) ```
98
Lupus Nephritis
Can progress to chronic renal failure Stage from I - VI
99
Renal cell carcinoma
Clear cell carcinoma - well differentiated Papillary carcinoma - commonest in dialysis-associated kidney disease Chromophobe renal carcinoma - pale, eosiophilic cells Presents: palpable mass, haematuria, costovertebral pain Paraneoplastic syndrome: polycythaemia, hypercalcaemia, HTN, Cushing's syndrome, Amyloidosis
100
RUQ and peri-hepatitis
Fits High Curtis Syndrome Also: violin string peri-hepatic adhesions
101
"Powder burns"
Endometriosis
102
red-blue to brown nodules
Endometriosis
103
Bundles of smooth muscle
Fibroids
104
Endometrial Cancer
Subdivided: Endometrioid (80%) Oestrogen excess ``` Non-endometrioid (205) Papillary Serous Clear cell Unrelated to oestrogen --> more aggressive ```
105
VIN
Graded from I - III Associated with HPV-16 Usual type: 35-55 years, warty/basaloid SCC Differentiated type: older women, keratinising SCC (higher rate of malignant transformation)
106
Vulval Carcinoma
Mainly squamous cell carcinoma (arise from VIN) Or from other skin abnormalities (Paget's disease of the vulva - adenocarcinoma in situ)
107
Ovarian Tumour Types
**Epitheloid cell types** Serous cystadenoma Mucinous cystadenoma Endometrioid Clear cell **Germ cell types** Dysgerminoma Teratoma Choriocarcinoma **Sex cord/stroma cell types** Fibroma Granuloa-theca cell tumour Sertoli-Leydig cell tumour
108
Ovarian tumour producing androgens
Sertoli-Leydig cell tumour
109
Ovarian tumour producing b-hCG
Choriocarcinoma
110
Ovarian tumour producing E2
Granulosa-theca cell tumour
111
Hobnail appearance
Clear cell ovarian tumour
112
Psammoma bodies
Serous cystadenoma
113
Clear cytoplasma
Clear cell tumour
114
No Psammoma bodies
Mucinous cystadenoma
115
Oestrogen secreting tumour
Mucinous cystadenoma
116
Causes pseudomyxoma peritonei
Mucinous cystadenoma
117
Keratinising squamous epithelium + breast pain
Periductal mastitis Smokers Not associated with lactation
118
Fat necrosis
Inflammatory response to damaged adipose tissue PAINLESS breast mass / skin thickening / mammographic lesion
119
Fibrocytic Disease
Fibrocystic disease (finbroadenosis) Cystic changes: small cysts form by dilation of lobules Contain fluid Often calcified Fibrosis: inflammation and fibrosis secondary to cyst rupture Adenosis: increased number of acini per lobule (normally seen in pregnancy)
120
Finger-like projections into ducts
Gynaecomastia
121
Duct papilloma
Benign papillary tumour arising within duct system of breast Peripheral: within small terminal ducts Central: within larger lactiferous ducts Causes bloody discharge No LUMP Not seen on mammogram Ix: galactogram
122
Stellate pattern of glandular tissue
Radial scar Benign sclerosing lesion Central scarring surrounded by proliferating glandular tissue in a stellate pattern Resembles carcinoma on mammogram
123
BRCA1/2
Increase risk of: Breast cacrinoma Ovarian caner Prostate cancer Pancreatic cancer
124
Carcinoma in situ (breast)
Proliferation limited ti ducts/lobules by basement membrane Lobullar (LCIS): no calcification, ALWAYS incidental finding on biopsy Ductal (DCIS): Microcalcifcation on mammogram, much increased risk of breast carcinoma
125
Invasive breast carcinoma
Categorised into ductal, lobular or tubular Ductal: carcinoma that cannot be subclassified into another group - MOST COMMON Lobular: cells aloigned in single file chains/ strands Tubular: Well-formed tubules with low grade nuclei (rarely palpable as <1cm) Can also be mucinous --> secretes mucin
126
Triple assessment
Examination Mammorgaphy, USS or MRI FNA & Cytology
127
Breast carcinoma prognosis
ER/PR receptor positive --> GOOD HER 2 positive --> BAD
128
Basal-like carcinoma breast
Sheets of atypical cells with lymphocyte infiltration Stain: CK5/6/14
129
Phyllodes tumour
Interlobular stroma Typically large, fast-growing masses Mostly low grade, but can be aggressive Palpable mass >50 yrs
130
Low glucose, high protein and high lymphocyte on Lumbar Puncture
TB
131
Neurofibromatosis type II (NF2)
Meningioma
132
Ventricular tumour, hydrocephalus
Ependymoma
133
Indolent, chilhood brain tumour
Pilocytic astrocytoma
134
Soft, gelatinous calcified brain tumour
Oligodendroma
135
Commonest brain tumour (primary)
Astrocytomas Metastatic is more common tumour in CNS (lung, breast, malignant melanoma)
136
Tau protein Dementias
Corticobasal degeneration Frontotemporal dementia (linked to chromosome 17) Pick's disease Alzheimers (Tau and beta-amyloid)
137
Alpha-synuclein, ubiquitin
Dementia awith Lewy Bodies
138
Alzheimers
Senile plaques of beta-amyloid Neurofibrillary tangles of Tau
139
Alpha-synuclein
Present in both Lewy Body Dementia Parkinson's disease
140
Multiple Sclerosis Proteins
Myelin basic protein Proteo-lipid protein MS plaques show sharp margins of myelin loss
141
Multisystem Atrophy
Shy Drager: Autonomic dysfunction Striatonigral: difficulty with movement Olivopontocerebellar: Difficulty with balance and coordination Can appear very similar to Parkinson's BUT show poor response to parkinson medications
142
Loss of cancellous bone
Osteoporosis
143
Looser's zones
Pseudo fractures = osteomalacia
144
Brown's tumour
Primary Hyperparathyroidism Bone lesion that arises in settings of excess osteoclast activity, such as hyperparathyroidism. Brown tumours consist of fibrous tissue, woven bone and supporting vasculature, but no matrix.
145
Excess of unmineralised bone
Osteomalacia
146
Osteitis fibrosa cystica
Osteomalacia Marrow fibrosis + cysts
147
Mixed lytic and sclerotic bone
Paget's
148
Salt and pepper skull
Primary hyperparathyroidism
149
Subperiostal bone resorption in phalanges
Primary hyperparathyroidism
150
Mosaic pattern of lamellar bone
Paget's
151
Huge osteoclasts
Paget's >100 nuclei
152
Rachitic rosary
Prominent knobs of bone at the costochondral joints = Ricket's
153
Decrease bone mineralisation
Osteomalacia
154
X-ray feature of Paget's
Skull Osteoporosis circumscripta Cotton wool Vertebrae Picture frame Ivory vertebrae Pelvis Sclerosis and lucency
155
Colchicine
Acute treatment of gout
156
Pseudo-gout crystals
Calcium pyrophosphate crystals Rhomboid shaped
157
Osteosarcoma
Adolescence Knee 60% Malignant mesenchymal cells ALP+ve Elevated periosteum (Codman's triangle) Sunburst appearance
158
Chondrosarcoma
> 40 yrs Axial skeleton, femur, tibia, pelvis Malignant chondrocytes Lytic lesion with fluffy clacification AXIAL SKELETON
159
Ewing's Sarcoma
<20 yrs Long bone, pelvis Sheets of small round cells CD99 +ve t(11:22) Onion skinning of the periosteum
160
Giant cell (borderline malignancy)
20-40yrs F>M Knee-epiphysis Osteoclast-type multinucleate giant cells on background of spindle / ovoid cells Lytic/lucent lesions up to articular surface
161
Codman's triangle
Elevated periosteum Osteosarcoma
162
Onion skinning of periosteum
Ewing's sarcoma
163
T11:22
Ewing's sarcoma
164
Multinucleate giant cell swith ovoid/spindle
Giant cell (borderline)
165
Radiolucent nidus with sclerotic rim
Osetoid oesteoma
166
Gardner syndrome
multiple osteomas + GI polyps + epidermoid cysts
167
Bony outgrowths attached to normal bone
Oesteoma
168
Benign tumours of cartilage
Enchondroma
169
Oiler's syndrome
Multiple enchondromas
170
Maffuci's syndrome
Multiple enchondromas + haemangiomas
171
Cotton wool calcification
Enchondroma
172
Fibrous dysplasia
fibrous tissue in place of bone
173
Albright syndrome
Polyostotic dyplasia + cafe au lait spots + precocious puberty
174
Lytic well defined
Simple bone cyst
175
Speckled mineralisation
Osteoblastoma
176
Auspitz' sign
Rubbing plaques causes pin-point bleeding Psoriasis
177
"test tubes in racks"
Psoriasis
178
Annular target lesion
Erythema multiforme
179
IgG to hemidesmosomes + linear IgG at BM
Pemphigoid
180
IgG to hemidemosomal and netlike pattern of intercellular IgG
Pemphigus
181
Buckshot appearance
Malignant melanoma =pagetoid cells
182
Breslow thickness
Most important prognostic factor
183
Malignant melanoma on sun exposed areas
Lentigo malignant melanoma
184
SLE
Type III hypersensitivity reaction HLA DR3 (or 2) Anti-dsDNA Anti-Sm (anti-histone if drug induced) Criteria (4 of 11 ACR) SOAP BRAIN MD Serositis Oral ulcers Arthritis Photosensitivty ``` Blood disorders (AIHA, ITP, leucopenia) Renal imvolvement ANA +ve Immune phenomena (dsDNA, anti-Sm, Antiphospholipid Ab) Neuro symptoms ``` Malar rash Discoid
185
Limited Scleroderma
Anti-centromere ``` Calcinosis Raynaud's Esophageal dysmotility Sclerodactyl Telangiectasia ``` Onion skinning around arterioles Associated with pulmonary hypertension
186
Diffuse Scleroderma
Anti-Scl-70 Inflammation within or around muscle fibres Associated with pulmonary fibrosis
187
Anti-Jo1
Dermatomyositis | and polymyositis
188
Herald Patch
Pityriasis Rosea Christmas tree distribution Post-viral
189
Large vessel vasculitides
Takayasu's arteritis Temporal arteritis
190
Medium sized vasculitides
Polyarteritis nodosa Kawasaki's Buerger's disease (Thromboangitis obliterans)
191
Small vessel vasculitides
Wegner's (Granulomatosis with polyangiitis) Churg Strauss (Eosinophilic granulomatosis with polyangiitis) Microscopic polyangiitis Henoch Schonlein Purpura
192
Pulseless disease
Takayasu's Arteritis
193
Takayasu's Arteritis
"pulseless" Increase in Japanese women Vacular symptoms: Absent pulse, bruits, claudication
194
Scalp tenderness, headache, jaw claudication
Temporal arteritis
195
Temporal arteritis
Elderly Scalp tenderness Jaw claudication Blurred vision Increase ESR Histo: Granulomatous transmural inflammation + giant cell + skip lesion
196
Hypertrophic Cardiomyopathy
betaHMC mutation
197
Acute Rheumatic Fever
Erythema marginatum | Subcutaenous nodules
198
Strep throat infection Heart: pancarditis (endocarditis, myocarditis, pericarditis) Joint: arthritis and synovitis Skin: Erythema marginatum, subcutaneous nodules CNS: encephalitis, Sydenham's chorea
Acute Rheumatic Fever
199
Diagnosis of Rheumatic Fever = group A strep infection + 2 major OR 1 major + 2 minor ``` Major (CASES) Carditis Arthritis Sydenham's chorea Erythema marginatum Subcutaneous nodules ``` ``` Minor criteria Fever Raised ESR or CRP Migratory arthralgia Prolonged PR interval Previous rheumatic fever Malaise Tachycardia ```
Jones Criteria
200
verrucae Rheumatic fever
Beady fibrous vegetations
201
Small giant-cell granulomas Rheumatic fever
Aschoff bodies
202
regenerating myocytes Rheumatic fever
Anitschkov myocytes
203
Associated with SLE and anti-phospholipid syndrome small (<2mm) "warty" vegetations Sterile Platelet rich
Libman-Sacks
204
Staph aureus | Strep pyogenes
Acute infective endocarditis
205
Strep viridans | Staph. epidemris
Subacute infective endocarditis
206
``` Coxiella Mycoplasma Candida Brucella Chlamydia Mycoplasma Bartonella ``` HACEK Haemophilus, Aggregatibacter (previously Actinobacillus), Cardiobacterium, Eikenella, Kingella
Culture negative infective endocarditis
207
IVDU | Staph aureus
Tricuspid infective endocarditis
208
Diagnosis of Infetcive Endocarditis 2 major 1 major = 3 minor 5 minor Major: Positive blood culture growing typical IE organism OR 2 positive culture >12 hours apart Evidence of vegetation/abscess on echo OR new regurgitant murmur Minor: Risk factor (prosthetic valve, IVDU, congenital valve abnormalities) Fever >38 Thromboembolic phenomena Immune phenomena Positive blood culture not meeting major criteria
Duke Criteria
209
Acute: Flucloxacillin for MSSA Rifampicin AND Vancomycin AND Gentamicin for MRSA Subacute: Benzylpenicillin AND Gentammicin OR Vancomycin for 4 weeks
Treatment of infective endocarditis
210
Mitral valve prolapse
Mid-diastolic click and late systolic murmur
211
Types Fibrinous: MI, Uraemia Purulent: Staphylococcus aureus Grenulomatous: TB Haemorrhagic: Tumour, Tb, Uraemia Fibrous = constrictive (arises from the above)
Pericarditis
212
Chronic heart failure
Pericardial effusion
213
Usual cause: Chronic heart failure
Pericardial effusion
214
Dilated = systolic dysfunction Hypertrophic = dialstoilic dysfunction Restrictive = diastolic dysfunction
Cardiomyopathy
215
Asthma
Charcot-Leyden crystals
216
Asthma
Curschmann spirals
217
Chronic bronchitis
Goblet cell hyperplasia, hypertrophy of mucous glands
218
Yellow dystrophic nails Pleural effusions Lymphoedema Bronchiectasis
Yellow nail syndrome
219
Rhinosinusitis Azoospermia Bronchiectasis
Young's syndrome
220
Squamous cell carcinoma M>F Most common Smoking p53, c-myc mutations
Keratinisation | Intercellular prickles
221
Adenocarcinoma F>M NON-Smokers glandular differentiation with mucin production EGFR --> give TKI (tyrosine kinase inhibitor)
EGFR mutation | mucin vacuoles
222
Small cell carcinoma Arise from neuroendocrine cells Smoking P53 and RB1 mutations Poor prognosis: mets early to bone, adrenal, liver brain Ectopic ACTH Cerebellar degeneration Lambert Eaton: rare autoimmune disorder that is characterized by muscle weakness of the limbs. It is the result of an autoimmune reaction in which antibodies are formed against presynaptic voltage-gated calcium channels
RB1 mutation Ectoptic ACTH Lambert-Eaton
223
Large cell carcinoma Poor prognosis Large cells Large nuclei No evidence of glandular or squamous differentiation
Poorly differentiated malignant epithelium tumour of the lung
224
Flushing Diarrhoea Bronchoconstriction Ectopic serotonin Tx: Octreotide
Carcinoid syndrome
225
Poor response to cisplatin
ERCC1
226
Gastric adenocarcinoma
Linitis plastica and signet ring cell
227
Ulcerative colitis
5-ASA
228
Splenic flexure (SMA transition to IMA) Rectosigmoid (IMA transition to internal iliac)
Watershed areas of gut
229
``` Life-threatening vasodilation Hypotenion Tachycardia Bronchoconstriction Hyperglycaemia ```
Carcinoid crisis
230
Serotonin producing Lung, bowel, ovaries, testes Carcinoid syndrome
Enterochromaffin cell origin
231
Enterochromaffin cell cancer Carcinoid syndrome
Urinary 5-HIAA
232
Villous adenoma
Hypoproteinaemic Hypokalaemic
233
1) Size (main factor) 2) dysplasia 3) villous component
Risk factor for adenoma --> adenocarcinoma
234
Autosomal dominant In children Haemartomatous polyp 100s May require colectomy to stop haemorrhage
Juvenile polyposis
235
Autosomal dominant -LKB1 Hamartomatous polyps Hyperpigmented macules on the lips and oral mucosa (melanosis) Increased risk of intussusception and malignancy
Peutz–Jeghers syndrome
236
Shedding of epithelium, cell build up 50-60 yrs
Hyperplastic polyp
237
IBD (UC)
Pseudo polyp
238
Hereditary non-polyposis colorectal cancer | HNPCC
Microsatellite instability
239
95% adenocarcinoma
Colorectal cancer
240
Iron deficiency anaemia Weight loss
Right-sided bowel tumours
241
Change in bowel habit Crampy LLQ pain
Left-sided bowel tumours
242
colorectal cancer
CEA
243
Hepatic steatosis (fatty liver)
Accumulation of fat droplets in hepatocytes
244
Alcoholic hepatitis
Ballooning hepaotcytes Necrosis Mallory-denk bodies Fibrosis Pericellular fibrosis
245
Alcoholic cirrhosis
Micronodular cirrhosis Bands of fibrous tissue Intra- and extra- hepatic shunting
246
Alcoholic hepatitis
Neutrophil polymorphs Mallory-denk
247
Alcoholic hepatitis
Megamitochondria
248
Steatosis in non-alcoholics
NAFLD
249
NAFLD + inflammation Steatosis + inflammation in non-alcoholics
NASH
250
Autoimmune hepatitis
Interface hepatitis with plasma cells
251
Type II autoimmune hepatitis
Anti-LKM
252
Type I autoimmune hepatitis
Anti-SMA
253
Autoimmune inflammatory destruction of medium sized INTRAhepatic bile ducts Slow development of cirrhosis over many years (hence renamed form cirrhosis to cholangitis as can diagnose prior to cirrhosis) F> M 10:1 Increased serum ALP Increase cholesterol Increase IgM (late feature) Anti-mitochondrial antibodies NO BILE DUCT DILATATION Bile duct loss with granulomas Present with fatigue, pruritis, abdo discomfort Tx: ursodeoxycholic acid
Primary Biliary Cholangitis
254
Inflammation and obliterative fibrosis of EXTRAhepatic and INTRAhepatic bile ducts Multi-focal stricture formation with dilitation of preserved segments Onion-skinning fibrosis M > F Associated with IBD (Ulcerative colitis) Increase ALP p-ANCA Bile duct dilatation ERCP: beading of bile duct (multifocal strictures) Increase in cholangiocarcinoma
Primary Scleroisng Cholangitis
255
A1AT deficiency
Absent aslpha globulin band on electrophoresis
256
Cyclophoshphamide use
Haemorrhagic cystitis
257
Squamous cell carcinoma of bladder
Urinary schistosomiasis
258
Transitional cell (Urothelial) tumour 90% of bladder tumours Smoker Aromatic amines
Most common bladder tumour
259
Grading of Prostate cancer
Gleason system
260
E.Coli
Acute bacterial prostatitis
261
Seminoma 95% of testicular tumours are germ cell origin
Most common germinal tumour
262
tumour markers for teratoma - male peeing on pregnancy test story
AFP, HCG and LDH
263
Triad: >3g/24 hr protein Hypoalbuminaemia Oedoema (+hyperlipidaemia)
Nephrotic syndrome
264
Membranous glomerular disease = primary cause of nephrotic syndrome
Diffuse glomerular basement membrane thickening
265
Minimal change disease Membranous glomerular disease Focal segmental glomerulosclerosis
Primary causes of nephrotic syndrome
266
Focal segmental glomerulosclerosis
Focal and segmental glomerular consolidation and scarring
267
Causes nephrotic syndrome Common in adults Diffuse glomerular basement membrane thickening Loss of podocyte foot processes Subepithelial spikey depsotis Can be primary or secondary to SLE, drug, malignancy Ig and complement in granular deposits along entire GBM 40% ESRF 2-20 yrs
Membranous glomerular disease
268
Causes nephrotic syndrome Common in adults Focal and segmental glomerular consolidation and scarring Hyalinosis Loss of podocyte foot processes Ig and complement deposited in scarred areas 50% respond to steroids 50% ESFR in 10 years Primary Can be due to HIV nephropathy and Obesity
Focal segmental glomerulosclerosis
269
= Diabetes nephropathy causes nephrotic syndrome
Mesangial matrix nodule = Kimmelstiel Wilson Nodules
270
Amyloidosis Can cause nephrotic syndrome Chronic inflammation TB RA Multiple myeloma - AL protein deposition
Apple green birefringence with Congo red stain
271
Manifestation of glomerular inflammation (glomerulonephritis) Characterised: Haematuria (coca-cola urine) Dysmorphic RBCs and red cell casts in urine ``` May also have: Oliguria Increased urea and creatinine Hypertension Proteinuria (but sub nephrotic levels) ```
Nephritic syndrome
272
Acute post-infectious glomerulonephritis IgA nephropathy (Berger Disease) Rapidly progressive (Cresenteric) Glomerulonephritis (3 types) Hereditary nephritis (Alport's syndrome) Thin basement membrane disease (benign familial haematuria)
Causes of Nephritic Syndrome (5)
273
Goodpasture's
HLA-DRB1
274
Causes Nephritic syndrome 1-3 weeks after Group A alpha-haemolytic strep throat infection Streptococcus pyogenes Immune complex deposition Haematuria, red cell casts, hypertension, proteinuria, oedema, ASOT titre increased Decreased C3 LM: increased cellularity FM: grnaular depsoits of IgG and C3 in GBM EM: subendothelial humps
Acute post-infectious (post-streptococcal) glomerulonephritis
275
Commonest cause of glomerulonephritis worldwide (causes nephritic syndrome) Deposition of IgA complexes in glomeruli 1-2 days after URTI --> Frank haematuria Persistent or recurring frank haematuria Can be asymptomatic microscopic haematuria Can progress to ESRF FM: Granular deposition of IgA and complement in mesangium
IgA Nephropathy (Berger Disease)
276
Most aggressive glomerulonephritis - can cause ESRF in weeks Nephritic syndrome + oliguria and renal failure All have crescents on LM 3 Types Type 1: Anti-GBM antibody (Goodpasture's --> Type IV collagen alpha 3) Linear deposition of igG in GBM +pulmonary haemorrhage Type 2: immune complexes SLE, IgA, Post-strep granular/lumps deposition of IgG in GBM/mesangium Type 3: pauci-immune (Not anti-GBM or immune complexes) c-ANCA: Wegner's p-ANCA: microscopic polyangiitis Scanty/lack of immune complex deposition +Vasculitis
Rapidly progressive (Crescentic) Glomerulonephritis
277
Causes Nephritic syndrome Can be asymptomatic haematuria x-linked recessive mutation in collagen IV alpha 4 chain Nephritic syndrome + sensorineural deafness + eye problems (cataracts and lens dislocation) Presents at 5-20 years and prepossesses to ESRF
Hereditary Nephritis (Alport's syndrome)
278
Asymptomatic haematuria (v.rarely nephritic syndrome) No decline in renal function Autosomal dominant mutation in collagen IV alpha 4 chain
Thin Basement Membrane Disease (Benign Familial Haematuria)
279
Think basement membrane disease Alport's IgA nephropathy
Aysmptomatic haematuria
280
Pauci-immune Wegners Microscopic polyangiitis
Nephritic syndrome + scanty immune deposition
281
Alport's syndrome
Nephritic syndrome + sensorineural deafness + lens dislocation
282
IgA nephropathy
Frank haematuria 2 days post URTI
283
Post-streptococcal GN
Increased ASOT titre, Low C3 and URTI 3 weeks ago
284
Commonest cause of acute renal failure Ischaemia --> prolonged pre-renal AKI Nephrotoxins (CHARM chain) ``` Cisplatin Heavy metals Aminoglycosides (Gentamicin) Radiocontrast medium Myoglobin ``` Chain: light chains in multiple myeloma Histology: necrosis of short segments of tubules
Causes of Acute Tubular Injury
285
A group of renal inflammatory disorders that involve the tubules and interstitium Acute pyelonephritis = leukocytic casts Chronic pyelonephritis Reccurent infections --> scarring of parenchyma Acute interstitial nephritis Hypersensitivity reactions to drugs Fever, skin rash, haematuria, proteinuria, eosinophilia Chronic interstitial nephritis Elderly with long-term analgesic consumption (NSAIDs/paracetamol) Hypertension, anaemia, proteinuria, haematuria
Tubulointerstitial Nephritis
286
Thrombosis +MAHA +Thrombocytopenia +renal failure (mostly in HUS) Causes TTP - diffuse, esp in CNS HUS - confined to kidneys ``` TTP = headache, altered consciousness HUS= renal failure ```
Thrombotic microangipathies
287
``` Hypovolaemia Sepsis Burns Acute pancreatitis Renal artery stenosis ``` Pre-renal = most common cause of AKI
Pre-renal causes of AKI
288
``` Metabolic acidosis Hyperkalaemia Fluid overload HTN Hypocalcaemia Uraemia ```
Complications of AKI
289
Acute glomerulonephritis Acute tubular necrosis (most common renal cause) Thrombotic MAHA
Renal causes of AKI
290
Stones Tumours (Primary or Secondary) Prostatic hypertrophy Retroperitoneal fibrosis
Post-renal causes of AKI
291
``` GFR >90 = stage 1 60-89 = stage 2 30-59 = stage 3 15-29 = stage 4 <15 = stage 5 ``` Start with 15, double, double again, add 30
Chronic renal failure stages
292
Autosomal Dominant Adult Polycystic Kidney Disease Chromosome 16 (polycystin 1) ``` Also PKD2 chromosome 4 (polycystin-2) ```
PKD1
293
Can progress to chronic renal failure Stage from I - VI
Lupus Nephritis
294
Clear cell carcinoma - well differentiated Papillary carcinoma - commonest in dialysis-associated kidney disease Chromophobe renal carcinoma - pale, eosiophilic cells Presents: palpable mass, haematuria, costovertebral pain Paraneoplastic syndrome: polycythaemia, hypercalcaemia, HTN, Cushing's syndrome, Amyloidosis
Renal cell carcinoma
295
Fits High Curtis Syndrome Also: violin string peri-hepatic adhesions
RUQ and peri-hepatitis
296
Endometriosis
"Powder burns"
297
Endometriosis
red-blue to brown nodules
298
Fibroids
Bundles of smooth muscle
299
Subdivided: Endometrioid (80%) Oestrogen excess ``` Non-endometrioid (205) Papillary Serous Clear cell Unrelated to oestrogen --> more aggressive ```
Endometrial Cancer
300
Graded from I - III Associated with HPV-16 Usual type: 35-55 years, warty/basaloid SCC Differentiated type: older women, keratinising SCC (higher rate of malignant transformation)
VIN
301
Mainly squamous cell carcinoma (arise from VIN) Or from other skin abnormalities (Paget's disease of the vulva - adenocarcinoma in situ)
Vulval Carcinoma
302
``` Epitheloid cell types Serous cystadenoma Mucinous cystadenoma Endometrioid Clear cell ``` Germ cell types Dysgerminoma Teratoma Choriocarcinoma Sex cord/stroma cell types Fibroma Granuloa-theca cell tumour Sertoli-Leydig cell tumour
Ovarian Tumour Types
303
Sertoli-Leydig cell tumour
Ovarian tumour producing androgens
304
Choriocarcinoma
Ovarian tumour producing b-hCG
305
Granuloa-theca cell tumour
Ovarian tumour producing E2
306
Clear cell ovarian tumour
Hobnail appearance
307
Serous cystadenoma
Psammoma bodies
308
Clear cell tumour
Clear cytoplasma
309
Mucinous cystadenoma
No Psammoma bodies
310
Mucinous cystadenoma
Oestrogen secreting tumour
311
Mucinous cystadenoma
Causes pseudomyxoma peritonei
312
Periductal mastitis Smokers Not associated with lactation
Keratinising squamous epithelium + breast pain
313
Inflammatory response to damaged adipose tissue PAINLESS breast mass / skin thickening / mammographic lesion
Fat necrosis
314
Fibrocystic disease (finbroadenosis) Cystic changes: small cysts form by dilation of lobules Contain fluid Often calcified Fibrosis: inflammation and fibrosis secondary to cyst rupture Adenosis: increased number of acini per lobule (normally seen in pregnancy)
Fibrocytic Disease
315
Gynaecomastia
Finger-like projections into ducts
316
Benign papillary tumour arising within duct system of breast Peripheral: within small terminal ducts Central: within larger lactiferous ducts Causes bloody discharge No LUMP Not seen on mammogram Ix: galactogram
Duct papilloma
317
Radial scar Benign sclerosing lesion Central scarring surrounded by proliferating glandular tissue in a stellate pattern Resembles carcinoma on mammogram
Stellate pattern of glandular tissue
318
Increase risk of: Breast cacrinoma Ovarian caner Prostate cancer Pancreatic cancer
BRCA1/2
319
Proliferation limited ti ducts/lobules by basement membrane Lobullar (LCIS): no calcification, ALWAYS incidental finding on biopsy Ductal (DCIS): Microcalcifcation on mammogram, much increased risk of breast carcinoma
Carcinoma in situ (breast)
320
Categorised into ductal, lobular or tubular Ductal: carcinoma that cannot be subclassified into another group - MOST COMMON Lobular: cells aloigned in single file chains/ strands Tubular: Well-formed tubules with low grade nuclei (rarely palpable as <1cm) Can also be mucinous --> secretes mucin
Invasive breast carcinoma
321
Examination Mammorgaphy, USS or MRI FNA & Cytology
Triple assessment
322
ER/PR receptor positive --> GOOD HER 2 positive --> BAD
Breast carcinoma prognosis
323
Sheets of atypical cells with lymphocyte infiltration Stain: CK5/6/14
Basal-like carcinoma breast
324
Interlobular stroma Typically large, fast-growing masses Mostly low grade, but can be aggressive Palpable mass >50 yrs
Phyllodes tumour
325
TB
Low glucose, high protein and lymphocyte on Lumbar Puncture
326
Meningioma
Neurofibromatosis type II (NF2)
327
Ependymoma
Ventricular tumour, hydrocephalus
328
Pilocytic astrocytoma
Indolent, chilhood brain tumour
329
Oligodendroma
Soft, gelatinous calcified brain tumour
330
Astrocytomas Metastatic is more common tumour in CNS (lung, breast, malignant melanoma)
Commonest brain tumour (primary)
331
Corticobasal degeneration Frontotemporal dementia (linked to chromosome 17) Pick's disease Alzheimers (Tau and beta-amyloid)
Tau protein Dementias
332
Dementia awith Lewy Bodies
Alpha-synuclein, ubiquitin
333
Senile plaques of beta-amyloid Neurofibrillary tangles of Tau
Alzheimers
334
Present in both Lewy Body Dementia Parkinson's disease
Alpha-synuclein
335
Myelin basic protein Proteo-lipid protein MS plaques show sharp margins of myelin loss
Multiple Sclerosis Proteins
336
Shy Drager: Autonomic dysfunction Striatonigral: difficulty with movement Olivopontocerebellar: Difficulty with balance and coordination Can appear very similar to Parkinson's BUT show poor response to parkinson medications
Multisystem Atrophy
337
Osteoporosis
Loss of cancellous bone
338
Pseudo fractures = osteomalacia
Looser's zones
339
Primary Hyperparathyroidism Bone lesion that arises in settings of excess osteoclast activity, such as hyperparathyroidism. Brown tumours consist of fibrous tissue, woven bone and supporting vasculature, but no matrix.
Brown's tumour
340
Osteomalacia
Excess of unmineralised bone
341
Osteomalacia Marrow fibrosis + cysts
Osteitis fibrosa cystica
342
Paget's
Mixed lytic and sclerotic bone
343
Primary hyperparathyroidism
Salt and pepper skull
344
Primary hyperparathyroidism
Subperiostal bone resorption in phalanges
345
Paget's
Mosaic pattern of lamellar bone
346
Paget's >100 nuclei
Huge osteoclasts
347
Prominent knobs of bone at the costochondral joints = Ricket's
Rachitic rosary
348
Osteomalacia
Decrease bone mineralisation
349
Skull Osteoporosis circumscripta Cotton wool Vertebrae Picture frame Ivory vertebrae Pelvis Sclerosis and lucency
X-ray feature of Paget's
350
Acute treatment of gout
Colchicine
351
Calcium pyrophosphate crystals Rhomboid shaped
Pseudo-gout crystals
352
Adolescence Knee 60% Malignant mesenchymal cells ALP+ve Elevated periosteum (Codman's triangle) Sunburst appearance
Osteosarcoma
353
> 40 yrs Axial skeleton, femur, tibia, pelvis Malignant chondrocytes Lytic lesion with fluffy clacification AXIAL SKELETON
Chondrosarcoma
354
<20 yrs Long bone, pelvis Sheets of small round cells CD99 +ve t(11:22) Onion skinning of the periosteum
Ewing's Sarcoma
355
20-40yrs F>M Knee-epiphysis Osteoclast-type multinucleate giant cells on background of spindle / ovoid cells Lytic/lucent lesions up to articular surface
Giant cell (borderline malignancy)
356
Elevated periosteum Osteosarcoma
Codman's triangle
357
Ewing's sarcoma
Onion skinning of periosteum
358
Ewing's sarcoma
T11:22
359
Giant cell (borderline)
Multinucleate giant cell swith ovoid/spindle
360
Osetoid oesteoma
Radiolucent nidus with sclerotic rim
361
multiple osteomas + GI polyps + epidermoid cysts
Gardner syndrome
362
Oesteoma
Bony outgrowths attached to normal bone
363
Enchondroma
Benign tumours of cartilage
364
Multiple enchondromas
Oiler's syndrome
365
Multiple enchondromas + haemangiomas
Maffuci's syndrome
366
Enchondroma
Cotton wool calcification
367
fibrous tissue in place of bone
Fibrous dysplasia
368
Polyostotic dyplasia + cafe au lait spots + precocious puberty
Albright syndrome
369
Simple bone cyst
Lytic well defined
370
Osteoblastoma
Speckled mineralisation
371
Rubbing plaques causes pin-point bleeding Psoriasis
Auspitz' sign
372
Psoriasis
"test tubes in racks"
373
Erythema multiforme
Annular target lesion
374
Pemphigoid
IgG to hemidesmosomes + linear IgG at BM
375
Pemphigus
IgG to hemidemosomal and netlike pattern of intercellular IgG
376
Malignant melanoma =pagetoid cells
Buckshot appearance
377
Most important prognostic factor
Breslow thickness
378
Lentigo malignant melanoma
Malignant melanoma on sun exposed areas
379
Type III hypersensitivity reaction HLA DR3 (or 2) Anti-dsDNA Anti-Sm (anti-histone if drug induced) Criteria (4 of 11 ACR) SOAP BRAIN MD Serositis Oral ulcers Arthritis Photosensitivty ``` Blood disorders (AIHA, ITP, leucopenia) Renal imvolvement ANA +ve Immune phenomena (dsDNA, anti-Sm, Antiphospholipid Ab) Neuro symptoms ``` Malar rash Discoid
SLE
380
Anti-centromere ``` Calcinosis Raynaud's Esophageal dysmotility Sclerodactyl Telangiectasia ``` Onion skinning around arterioles Associated with pulmonary hypertension
Limited Scleroderma
381
Anti-Scl-70 Inflammation within or around muscle fibres Associated with pulmonary fibrosis
Diffuse Scleroderma
382
Dermatomyositis | and polymyositis
Anti-Jo1
383
Pityriasis Rosea Christmas tree distribution Post-viral
Herald Patch
384
Takayasu's arteritis Temporal arteritis
Large vessel vasculitides
385
Polyarteritis nodosa Kawasaki's Buerger's disease (Thromboangitis obliterans)
Medium sized vasculitides
386
Wegner's (Granulomatosis with polyangiitis) Churg Strauss (Eosinophilic granulomatosis with polyangiitis) Microscopic polyangiitis Henoch Schonlein Purpura
Small vessel vasculitides
387
Takayasu's Arteritis
Pulseless disease
388
"pulseless" Increase in Japanese women Vacular symptoms: Absent pulse, bruits, claudication
Takayasu's Arteritis
389
Temporal arteritis
Scalp tenderness, headache, jaw claudication
390
Elderly Scalp tenderness Jaw claudication Blurred vision Increase ESR Histo: Granulomatous transmural inflammation + giant cell + skip lesion
Temporal arteritis

Matt's Path REVERSE (18 decks)

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