Histopathology Flashcards
(316 cards)
1
Q
CT Head non contrast reveals hyperdense enhancement adjacent to the circle of willis.
What is the likely diagnosis?
A
Subarachnoid haemorrhage
2
Q
What cancer is associated with the presence of “oat shaped cells” on biopsy?
A
Small cell lung cancer
3
Q
What type of murmurs are heard in hyperdynamic circulations - pregnancy, anaemia or severe blood loss?
A
flow murmur
soft, systolic murmurs heard best at the left lower sternal edge
4
Q
blood findings in PBC
A
elevated serum ALP and an elevated anti mitochondrial antibody titre.
5
Q
Features of Parkinson’s
A
TRAPS
Tremor
Rigidity (Cogwheel)
Akinesia, bradykinesia
Postural instability
Shuffling gait
6
Q
Most common solid organ cancer in males
A
prostate (adenocarcinoma)
7
Q
treatment of non metastatic prostate cancer
A
Radical prostatectomy
generally first line in people who can tolerate it and have a new diagnosis of low grade disease
Active surveillance (if surgery not desired/low risk of progression) -> Radical radiotherapy + androgen deprivation if progresses
8
Q
treatment of metastatic prostate cancer
A
Docetaxel based chemotherapy
Orchidectomy or anti-androgen therapy (bicalutamide)
9
Q
what infection predisposes you to squamous cell carcinoma of the bladder
A
schistosomiasis
10
Q
What structures, present in the large bowel, represent weak points in the bowel wall and allow for the formation of diverticula?
A
taenia coli
11
Q
What is the typical inheritance pattern of Hereditary non-polyposis colorectal cancer/Lynch Syndrome?
A
Autosomal dominant
12
Q
Kimmelstiel Wilson nodules found in a renal biopsy are associated with what underlying disease?
A
Diabetes mellitus
13
Q
what are the secondary causes of nephrotic syndrome?
A
diabetes
amyloidosis
14
Q
What is the first line treatment for severe haemachromatosis?
A
therapeutic phlebotomy
15
Q
Thickened basement membrane with spike and dome appearance due to electron dense deposits in the subepithelial layer”
with chronic hep B
A
Membranous glomerulonephritis
16
Q
treatment for Wilsons
A
Trientine
Penicilamine
17
Q
How are Multiple Endocrine Neoplasias inherited
A
autosomal dominant
18
Q
MEN 1
A
Pituitary adenoma
Parathyroid hyperplasia
Pancreatic tumours
19
Q
MEN 2a
A
Parathyroid hyperplasia
Medullary thyroid carcinoma
Phaeochromocytoma
Think all the Cs: Calcitonin (medullary thyroid cancer), Calcium (Parathyroid hyperplasia) and Catecholamines (Phaeo)
20
Q
MEN 2b
A
Medullary thyroid carcinoma
Phaeochromocytoma
Marfanoid body habitus
Mucosal neuromas
Think B is for Big (marfanoid) and Belly problems (mucosal neuromas)
21
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
22
Q
Persistent ST elevation post myocardial infarction in the absence of chest pain or other ischaemic features is suggestive of ….
A
ventricular aneurysm
23
Q
4 main types of invasive breast cancer
A
Invasive ductal (most common)
Invasive lobular
Mucinous carcinoma
Tubular carcinoma
24
Q
Expression of what cell surface receptor may confer a good prognosis in invasive breast carcinoma?
A
oestrogen receptor or progesterone receptor
25
Expression of what cell surface receptor may confer a bad prognosis in invasive breast carcinoma?
Herceptin 2
26
what can HER2 positive breast cancer be treated with
trastuzumab
27
What is seen on mammography with ductal carcinoma in situ?
microcalcification
28
What is the most common type of lung cancer in the UK?
(non-small cell) adenocarcinoma
29
which type of lung cancer is associated with women and non smokers
adenocarcinomas
30
what paraneoplastic syndromes arise from small cell lung cancer?
ADH → SIADH (Small cell)
ACTH → Cushing’s syndrome (Small cell)
AchR antibodies → myasthenia gravis
Lambert Eaton syndrome
31
what paraneoplastic syndromes arise from squamous cell lung cancer?
PTH/ PTHrP → primary hyperparathyroidism, hypercalcaemia and bone pain (Squamous cell)
32
inheritance pattern of benign familial haematuria
autosomal dominant
33
pre-renal causes of AKI
Most common cause of acute renal failure
renal hypo-perfusion e.g. hypovolaemia, sepsis, burns, acute pancreatitis, and renal artery stenosis.
34
renal causes of AKI
● Acute Tubular Necrosis (ATN): commonest renal cause of ARF.
● Acute glomerulonephritis.
● Thrombotic microangiopathy
35
post renal causes of AKI
Obstruction to urine flow as a result of stones, tumours (primary & secondary), prostatic hypertrophy and retroperitoneal fibrosis
36
First line investigation for pancreatic cancer
CT
37
associated tumour marker for pancreatic cancer
CA19-9
38
management of pancreatic cancer
palliative chemotherapy (FOLFIRINOX ie 5-FU based)
surgical Whipple's procedure if curative intent
39
examples of neuroendocrine tumours arising from the pancreas
Insulinomas - Whipple's triad of symptoms
Gastrinoma - Zollinger-Ellison syndrome + gastric ulceration
40
most common cancer in the UK overall
breast
41
most common cancers in men
Prostate (most common in men)
Lung
Bowel
Head and Neck
Other
42
most common cancers in women
Breast (most common cancer overall)
Lung
Bowel
Uterus
Other
43
most deadly cancers in men
Lung (most deadly)
Prostate
Bowel
Oesophagus
Other
44
most deadly cancers in women
Lung (most deadly)
Breast
Bowel
Cancer of unknown primary
Othe
45
Which tumour marker is used in the diagnosis of hepatocellular carcinoma?
alpha fetoprotein
46
most common cause of acute pyelonephritis
E.coli
leukocytic casts in urine
47
pathophysiology of chronic pyelonephritis
chronic, recurrent bacterial infections
obstruction: renal calculi, posterior urethral valves
urine reflux
48
pathophysiology of acute interstitial nephritis
drugs e.g. NSAIDs, diuretics, aminoglycosides, PPI
49
histological features of acute interstitial nephritis
granulomas
eosinophilia
50
pathophysiology of chronic interstitial nephritis
seen in the elders due to chronic analgesia use
51
Infection by what organism classically precipitates acute rheumatic fever?
Group A strep (pyogenes)
52
difference in presentation of post streptococcal glomerulonephritis and IgA nephropathy
Occurs 1-3 weeks after streptococcal throat infection
Presents 1-2 days (earlier than Acute postinfectious GN!) after an URTI with frank
haematuria*
53
Which hepatobilary pathology is classically associated with an elevated p-ANCA?
Primary Sclerosing Cholangitis
54
which movement of air is affected in obstructive lung disease
exhalation
55
which movement of air in affected in restrictive lung disease
inhalation,
therefore fine-end inspiratory crackles heard
56
stages of lobar pneumonia
1.Consolidation
2. Red Hepatisation (neutrophilia)
3. Grey Hepatisation (Fibrosis)
4. Resolution
57
diagnostic criteria for Acute Rheumatic fever
Jones
58
diagnostic criteria for infective endocarditis
Duke's
59
minor Jones criteria
Fever
Raised ESR/CRP
Arthralgia (migratory)
Prolonged PR
Previous RF
60
histological features of Rheumatic fever
Beady fibrous vegetations (verrucae)
Aschoff bodies (small giant-cell granulomas)
Anitschkov myocytes (regenerating myocytes).
61
treatment of rheumatic fever
benzypencillin
62
treatment of acute infective endocarditis
flucloxacillin
63
treatment of subacute infective endocarditis
benzypenicllin + gent/vanc 4 weeks
64
most commonly affected valve in rheumatic fever
mitral
followed by aortic
65
what are the benign renal tumours
papillary adenoma
oncocytoma
angiomyolipoma
66
what are the malignant renal tumours
renal cell carcinoma
nephroblastoma/Wilms
transitional cell carcinoma
67
ALP > ALT
biliary obstruction
68
AST > 3x ALT
highly specific for alcoholic hepatitis
69
ALT raised >1000
toxins, drugs, viruses, ischaemia
70
where can AST be found
liver
heart
muscle
71
Which common medication are hepatic adenomas associated with?
oral contraceptive pill
72
What type of fluid motion produces low sheer stress and is hence protective against the development of atherosclerotic disease?
laminar flow
73
most common cause of CKD in the UK
diabetes
74
What condition is characterised by microangiopathic haemolytic anaemia, thrombocytopenia and stroke-like symptoms in an adult?
TTP
75
How much glucose is given, in grams, for an oral glucose tolerance test for the diagnosis of diabetes?
75
76
most common type of bladder cancer
transitional cell carcinoma
77
layers of the skin
corneum
lucidum
granulosum
spinous
basale
78
seborrhoeic dermatitis is a reaction to which yeast
Malassezia furfur
79
key histology in psoriasis
parakeratosis
test tubes in a rack appearance
Munro's microabscesses
80
most common type of psoriasis
chronic plaque psoriasis
salmon pink papule, extensor surfaces
81
rash distribution in guttate psoriasis
rain drop plaque distribution
trunk of child
seen 2 weeks after group A strep infection
82
emergency in psoriasis
erythrodermic/pustular psoriasis
83
Auspitz sign
rubbing of psoriatic plaques causes pin point bleeding
84
what are the two associated features in psoriasis
nail changes and arthritis
arthritis multilans 'telescoping'
85
6Ps of lichen planus
purple
pruritic
polygonal
papular
plaques
86
which skin emergency in erythema multiform seen in
TENS and SJS
>30 TENS
<10 SJS
87
which autoimmune disease is dermatitis herpetiformis associated with
coeliac disease
IgA binds to basement membrane in extensor surfaces
88
IgG Ab against what in bullous pemphigoid
hemidesmosomes
89
IgG Ab against what in pemphigus vulgaris
desmoglein 1 and 3
90
which malignant skin lesion has a pearly surface and telangiectasia
BCC
91
which malignant skin lesion has rolled edges and is ulcerative
SCC
92
most important prognostic factor in melanoma
Breslow thickness
93
most common subtype of melanoma
superficial spreading
94
rash description in pityriasis rosea
salmon pink rash/herald patch in Christmas tree distribution
95
after what infection does pityriasis rosea occur
HHV-6 and HHV-7
96
What is the most common cause of acute interstitial nephritis?
drugs
include antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), and proton pump inhibitors (PPIs).
97
Which common medication are hepatic adenomas associated with?
oral contraceptive pill
98
What is the term used to describe small, tube shaped microscopic particles found in urine?
urinary casts
99
In the setting of a possible false positive PSA test, what should be done?
repeat test in 2 weeks
100
In the setting of a possible false positive PSA test, what should be done?
repeat test in 2 weeks
101
what is the tetrad of nephrotic syndrome
hypoalbuminaemia
proteinuria
oedema
hyperlipidaemia
102
In the emergency department what imaging is required in the initial workup of a suspected stroke?
why is it important to do?
CT head non contrast
Prior to the use of thrombolytic therapy, a CT head will exclude the presence of a significant haemorrhagic stroke, which has very different management to that of an ischaemic stroke.
103
symptoms of pancreatic cancer
nausea
reflex
belching
progresses to:
weight loss
jaundice
104
What histopathological description is given to cells that have lost their intercellular connections between neighbouring cells?
acantholysis
decreased cohesion between keratinocytes
105
spongiosis
intercellular oedema
106
What monoclonal antibody therapy targets human epidermal growth factor receptor 2 and is used in the treatment of breast cancer?
trastazumab
107
What protein is defective in adult polycystic kidney disease?
polycystin-1
108
What kind of cancer is associated with keratin pearls?
squamous cell carcinoma
(hyperkeratotic)
109
what is the triad of carcinoid syndrome
bronchoconstriction
flushing
diarrhoea
110
What surgical procedure may be used to treat pancreatic cancer affecting the head, neck and body of the pancreas?
Whipple's procedure
111
What sign describes painless jaundice in the presence of a palpable gallbladder?
Courvoisier's sign
112
What tumour marker is most commonly used in the diagnosis of colorectal cancer?
carcinoembryonic antigen
113
What is the most common histochemical stain used to visualise cells for light microscopy, such as that used for diagnosis of cancers?
haemotoxylin and eosin stain
114
coughing up pink, frothy sputum, SOB, raised JVP, pitting oedema
pulmonary oedema
115
Whipple triad of symptoms: what are they and what condition are they representative of?
1. episodic hypoglycaemia
2. central nervous system (CNS) dysfunction temporally related to hypoglycaemia (confusion, anxiety, stupor, paralysis, convulsions, coma)
3. dramatic reversal of CNS abnormalities by glucose administration.
Insulinoma
116
what is the prognosis of a pancreatic adenocarcinoma
very poor
25% 1 year survival
117
point tenderness adjacent to the sternum bilaterally indicated...
costochondritis
118
chest pain + raised AST
MI
119
recent fracture +slightly raised ALP
normal
120
markers of hepatic synthetic function
PT
albumin
121
what does HER2 stand for
human epidermal growth factor receptor 2
122
What is the typical inheritance pattern of Maturity Onset Diabetes of the Young (MODY)?
autosomal dominant
123
Damage to what muscle within the heart may result in mitral regurgitation?
papillary muscle
124
painful fluid filled blisters; When you run your finger over the surface of one of the blisters, the roof of the blister easily comes away; biopsy reveals acantholytic cells, however the basal keratinocytes remain attached to the basement membrane.
pemphigus vulgaris
125
The ECG leads II, III and aVF represent which region of the heart?
inferior wall
126
A GFR of less than what value is considered reflecting End Stage Renal Failure in chronic kidney disesease?
15
127
High resolution CT scan reveals bronchial wall thickening with a positive signet ring sign.
bronchiectasis
128
What is the typical inheritance pattern of hypertrophic obstructive cardiomyopathy (HOCM)?
autosomal dominant
129
Graded using the Gleason system, what does each number represent?
First number = most common cell type seen. Second number = second most common cell type seen (highest grade)
130
what constellation of symptoms are seen in infective endocarditis
Clinical features:
● Constitutional:
○ Fever
○ Malaise ○ Rigors
○ Anaemia
● Cardiac:
○ New murmur (MR/AR usually)
● Immune phenomena:
○ Roth spots
○ Osler’s nodes
○ Haematuria due to glomerulonephritis
● Thromboembolic phenomena:
○ Janeway lesions
○ Septic abscesses in lungs/brain/spleen/kidney
○ Microemboli
○ Splinter haemorrhages
○ Splenomegaly
131
causes of acute infective endocarditis
staph aureus
strep pyogenes
132
An immune response directed against myelin basic protein and proteo-lipoprotein results in what autoimmune condition?
multiple sclerosis
133
There is no evidence of glandular or squamous differentiation. The cells are poorly differentiated with large nuclei. Which lung cancer?
large cell carcinoma
poor prognosis
134
What is the organism typically implicated in acute postinfectious glomerulonephritis?
Group A Streptococcus
i.e. Streptococcus pyogenes
135
two places prostate cancer usually spreads to
bladder
bone
136
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
results in clubbing of the digits
137
what do the delta cells of the pancreas secrete?
what is its role?
somatostatin
paracrine effect on alpha and beta cells to reduce glucagon and insulin secretion
138
how does Paget's disease of the breast present
eczema of nipple then areola, peau d'orange (oedema + pitting of breast)
139
what is Paget's disease of the breast associated with
breast cancer
140
which condition is characterized by apical akinesis and ventricular dysfunction on echocardiogram.
Takotsubo's Cardiomyopathy
Coronary arteries are usually unobstructed if an angiogram is performed.
141
which nephrotic syndrome does not respond well to steroids
membranous glomerular disease
142
A biopsy viewed under light microscopy shows thickening of the glomerular basement membrane.
Immunofluorescence shows the presence of antibody complexes and complement deposits throughout the glomerular basement membrane
membranous glomerular disease
143
What condition is the presence of granular ("muddy brown") casts seen in the urine associated with?
Acute Tubular necrosis
144
which two conditions makes up COPD
chronic bronchitis
emphysema
145
What type of bladder cancer is associated with chronic cystitis?
squamous cell carcinoma
commonly associated with chronic irritation and inflammation of the bladder.
146
features of chronic pancreatitis on exploration
destruction of exocrine tissue, associated with fibrosis and calcification
147
biochemical findings in Wilsons disease
low caeruloplasmin
low serum copper
high urinary copper
148
how does Wilson's disease present
- liver disease e.g. liver failure
- neuro disease e.g. Parkinsonism
- kayser fleischer rings
149
age range for Wilson
young <20
150
What is the most common pattern of disease progression in Multiple Sclerosis?
relapsing remitting
151
what does the presence of faecal calprotectin in the stool reflect
presence of intraluminal neutrophils
152
in which liver condition will cytoplasmic Mallory Denk Bodies most commonly be found on biopsy
alcoholic hepatitis
153
features of acute interstitial nephritis
● A hypersensitivity reaction, usually to a drug (abx, NSAIDs, diuretics)
● Usually begins days after drug exposure
● Presents with: fever, skin rash, haematuria, proteinuria, eosinophilia
● Histology: inflammatory infiltrate with tubular injury, eosinophils & granulomas
154
The presence of white cell casts in the urine along with eosinophilia and recent antibiotic use
acute interstitial nephritis
155
what is seen in the urine on microscopy in acute pyelonephritis
leukocytic casts
156
lung disease pattern in pulmonary fibrosis
restrictive
low FEV1
lower FVC
increased FEV1/FVC
157
investigation for pulmonary fibrosis
high resolution CT of the lungs
158
Two main types of lung cancer - small cell and non small cell.
Which is more common
small cell
159
what are the non small cell cancers
adenocarcinoma (40%)
squamous cell (30%)
large cell
other
160
treatment of limited disease small cell cancer (in one lung only)
Chemotherapy + Radiotherapy
161
treatment of extensive small cell cancer (metastatic spread in both lungs)
palliative
162
most common paraneoplastic syndrome in small cell lung cancers
SIADH (15% of patients)
Cushing's syndrome (5%)
Lambert-Eaton Myasthenic syndrome (3%)
acromegaly
163
treatment of Stage 1 NSCLC (Small solitary tumour):
surgery
164
treatment of Stage 2 NSCLC (Large solid tumour or limited local spread):
Surgery followed by chemotherapy or immunotherapy
165
treatment of Stage 3 NSCLC (lymph node spread or multilobular disease):
Neoadjuvant chemotherapy with surgery
166
treatment of Stage 4 NSCLC (spread to other lung or distant metastasis):
palliation
167
3 histological features of sarcoidosis
1- non caseating granulomas
2- Schaumann bodies
3- asteroid bodies
168
skin involvement in sarcoidosis
erythema nodosum
lupus pernio
169
eye involvement in sarcoidosis
anterior and posterior uveitis
uveoparatoid fever
keratoconjunctivitis
lacrimal gland enlargement
170
what is raised in the bloods in sarcoidosis investigation
Calcium
ACE
171
what spirometry picture is sarcoidosis
restrictive
172
which layer of the large arteries are affected in atherosclerosis
tunica intima
173
difference in vessel occlusion in stable and unstable angina
stable: ~70% occlusion
unstable: ~90% occlusion
174
Prinzmental angina is not causes by atherosclerosis but by
coronary artery spasm
175
is there muscle death in angina
no
176
what is the most common cause of sudden death post-MI
VF
occurs in the first 24 hours
177
if you want to decrease stroke volume, what must be increased
increase the after load
178
how does cardiac damage affect stroke volume and cardiac output?
what respective changes do they cause?
cardiac output decreased therefore increase RAS activation to retain salt and water
stroke volume decreased therefore stimulate SNS to increase total peripheral vascular resistance
179
what does the liver become due to stasis of venous blood in it
nutmeg liver
180
what type of cardiomyopathy does sarcoidosis or amyloidosis cause
restrictive
181
main mechanism causing aortic stenosis
calcification due to old age
182
causes of aortic regurgitation
infective endocarditis
Marfans
LV dilation
183
cause of mitral stenosis
rheumatic fever
184
causes of mitral regurgitation
infective endocarditis
post MI
185
which side of the heart does chronic rheumatic fever usually affect
left sides especially mitral valve
186
what are the two clinical signs of mitral valve prolapse
mid systolic click
late systolic murmur
187
what usually causes pericardial effusion
chronic heart failure
188
Mean pulmonary arterial pressure at rest
> 25 mmHg
189
class 2 pulmonary hypertension
due to left heart disease
190
class 3 pulmonary hypertension
due to lung disease (eg. ILD)
191
class 4 pulmonary hypertension
due to many clots overtime which cause fibrosis
192
what is the acute histological finding in pulmonary oedema
intra-alveolar fluid
193
what is the chronic histological finding in pulmonary oedema
iron laden macrophages (heart failure cells)
194
what causes diffuse alveolar damage in adults
ARDS
195
what causes diffuse alveolar damage in neonates
hyaline membrane disease
insufficient surfactant production in preterm
196
what is the mechanism of Barretts
intestinal metaplasia of the squamous mucosa
197
what feature present increases the likelihood of Barrett's becoming a cancer
goblet cells
198
which third of the oesophagus is oesophageal carcinoma seen
distal 1/3
as its is associated with Barrett's
199
which third of the oesophagus is squamous cell oesophageal carcinoma seen
mostly middle (50%)
200
what two risk factors are associated with squamous cell oesophageal carcinoma
smoking and alcohol
201
what are engorged dilated veins due to portal HTN called
varices
202
is a stomach ulcer pain better or worse with food
worse
203
is a duodenal ulcer pain better or worse with food
better
204
what are the two types of gastric cancer
intestinal (well differentiated)
diffuse (poorly differentiated, signet ring cell )
205
what are the two large vessel vasculitides
takayasu arteritis
temporal arteritis
206
what structure is affected in Takayasu arteritis
branches of the aorta
207
signs of Takaysu arteritis
pulseless
claudication
cold hands
208
what is seen on angiography in polyarteritis nodosa
microaneurysms (string of pearls/rosary beed appearance)
209
what are the two types of medium vessel vasculitis
polyarteritis nodosa
Buerger's disease
210
what underlying infection is seen in polyarteritis nodosa
Hep B
211
what is the classical appearance seen in angiogram in Buergers disease
corkscrew appearance
212
which demographic does burgers disease affect mostly
heavy smoking males < 35
213
how are microscopic polyangiitis and Wegeners similar but how do they differ
both have pulmonary and renal involvement
differ in antibody (pANCA in the former)
214
in the hexagonal hepatic lobule, what is in the centre
central vein
215
what is located on the corners of the hepatic lobule
portal triad
(portal vein, hepatic artery, bile duct)
216
which zone is closest to the portal triad
zone 1
periportal hepatocytes receives the most oxygen
217
which zone is closest to the central vein of the hepatic lobule
zone 3
perivenular hepatocytes are the most mature and metabolically active cells
218
which zone of the hepatic lobule is affected first by viral hepatitis
zone 1
219
which zone of the hepatic lobule is most sensitive to metabolic toxins
zone 3
220
where are stellate cells found
Space of Disseminated in between sinusoid and hepatocytes
221
what two things happen to the architecture of the liver in chronic inflammation
loss of microvilli
activation of stellate cells
222
what do activated stellate cells produce
collagen
223
what do activated stellate cells become
myofibroblasts
224
key histological finding in acute hepatitis caused by drugs or viruses
spotty necrosis
225
what does the severity of inflammation in chronic hepatitis determine
grade
226
what does the severity of fibrosis in chronic hepatitis determine
stage
227
4 events that occur when chronic hepatitis becomes cirrhosis
1. portal inflammation
2. interface hepatitis
3. lobular inflammation
4. bridging from the portal vein to central vein
228
what sort of necrosis occurs in interface hepatitis
piecemeal necrosis
229
what happens in interface hepatitis
cannot see the border between the portal tract and parenchyma
230
which histolopathological stage is critical in the evolution of chronic hepatitis to cirrhosis
Bridging from the portal vein to central vein.
This causes blood to bypass hepatocytes and reduces function of liver (intrahepatic shunting)
231
what is bridging from the portal vein to central vein called
intrahepatic shunting (fibrotic bridges)
232
top 3 causes of liver cirrhosis
1. alcoholic liver disease
2. NAFLD
3. chronic viral hep
233
which metabolic disorders can lead to liver cirrhosis
galactosaemia
glycogen storage disease
234
which drug can lead to liver cirrhosis
methotrexate
235
how is liver cirrhosis classified
by the size of the regenerating nodueles
MICRO <3
MACRO >3 mm
236
Scoring system for prognosis of liver cirrhosis
Modified Child's Pugh Score
237
the elements of the Modified Child's Pugh Score
A- albumin
B- bilirubin
C- Clotting
D (distension) - Ascites
E- encephalopathy
238
Score for Child Pugh A
< 7
239
Score for Child Pugh B
7-9
240
Score for Child Pugh C
> 10
241
which condition do you see hepatocyte ballooning and necrosis
alcoholic hepatitis
242
is alcoholic cirrhosis micro or macronodular
micro nodular
243
most common cause of chronic liver disease in the West
NAFLD
244
when does NAFLD become NASH
steatosis + hepatitis
this can become cirrhosis
245
HLA association in autoimune hep
HLA-DR3
246
antibodies in Type 1 autoimmune hep
ANA (antinuclear Ig)
anti-SMA (anti-smooth muscle Ig)
anti-actin Ig
anti- soluble liver antigen Ig
247
antibodies in Type 2 autoimmune hep
Anti-LKM Ig (anti liver-kidney-microsomal Ig)
248
histology in PBC
bile duct loss with granuloma
249
histology in PSC
onion skinning fibrosis
beading/strictures
250
what cancer increases with PSC
cholangiocarcioma
251
histological changes seen in post strep glomerulonephritis
Light microscope (LM):↑cellularity of glomeruli
FluorescenceMicroscope(FM): granular deposits of IgG and C3 in GBM
Electron Microscope (EM): Subendothelial humps
252
Malignant HTN, what is the classic renal finding on histology
fibrinoid necrosis
253
which two conditions can lead to mucosa associated lymphoid tissue Lymphoma
1. H.pylori
2. Sjogrens syndrome
254
Women has acute appendicitis, 5mm tumour found in tip when it’s removed, what sort of tumour might it be?
neuroendocrine tumour
255
Fibro-epithelial tumour with abundant stromal elements
phyllodes tumour
256
classical histological findings in phyllodes tumour
“branching”/”leaf-like fronds”/”artichoke appearance”
257
Breast cancer which has a high, medium and low stage to it
Ductal carcinoma in situ
258
out of the two breast carcinomas in situ, which one has micro-calcification
ductal carcinoma in situ
no calcification in lobular carcinoma in situ
259
which breast disease changes in presentation according to the menstrual cycle
fibrocystic disease
260
which intraductal papillomas cause nipple discharge
Larger lactiferous ducts → central papillomas
261
A man with AF (Atrial fibrillation) develops fever, nausea, vomiting and pain in his right loin/flank. What is the most likely cause?
renal infarct
262
A man presents with the symptoms of a UTI and acute onset costovertebral pain. He is found to have pus cells and blood in his urine. What is the most likely cause?
acute pyelonephritis
263
Patient with a pancreatic mass following acute pancreatitis
pancreatic pseudocyst
264
Patient with a history of severe abdominal pain; during cholecystectomy the surgeons noticed grey specks around and on the pancreas
acinar cell carcinoma
multifocal fat necrosis
265
On doing a patient’s nephrectomy they notice a mass in the kidney that extends into the the renal vessels and into the perinephric fat
angiomyolipoma
266
Man goes deaf with bowed legs
Paget's disease
267
which cerebral haemorrhage is characterised by sudden onset thunderclap headache, LoC and vomiting
subarachnoid
268
which cerebral haemorrhage is characterised by bridging veins with slow venous bleed
subdural
269
which cerebral haemorrhage is characterised by rapid arterial bleed, lucid interval then LoC
epidural
270
“lemon” shape haemorrhage
epidural
271
"banana" shape haemorrhage
subdural
272
most common site of intraparenchymal haemorrhage of the brain
basal ganglia
273
where do most subarachnoid haemorrhages occur
bifurcation of the carotids
274
Patient with HIV, raised ICP, new onset epilepsy
primary CNS lymphoma
275
Low TSH and high T4 following viral infection, what is the diagnosis
viral thyroiditis/ De Quervains
276
Which thyroid cancer most commonly metastasises to the lymph nodes
papillary
277
What virus increases risk of nasopharyngeal cancer
EBV
278
cerebral haemorrhage associated with gradual headache, fluctuating consciousness
and behaviour changes
subdural
279
which are the non-traumatic and traumatic cerebral haemorrhages
traumatic: epidural and subdural
non-traumatic: intraparenchymal and subarachnoid
280
where has a Krukenberg tumour metastasised from
gastric
281
what liver change occurs in diabetics
NAFLD or NASH
due to insulin resistance
282
most common brain tumour in children
astrocytoma (pilocytic)
indolent childhood tumour
283
2nd most common brain tumour in children
medulloblastoma
284
most common brain tumour in adults
glioblastoma
285
2nd most common brain tumour in adults
meningioma
286
main mutation in pilocytic astrocytoma
BRAF
287
main mutation in GBM
IDH wildtype
288
what mutation in diffuse glioma is associated with longer survival and better response to chemo and radiotherapy
IDH mutation
289
which brain tumours are associated with psammoa bodies
meningioma
290
Publican with diabetes, fatty stools, weight loss, ‘slate grey skin’ and joint pains. What is the underlying diagnosis causing this
haemochromatosis
291
most common oesophageal carcinoma seen in the uk
adenocarcinoma
most common in Caucasians
292
A woman develops signs of hyperthyroidism. Bloods show low TSH and high thyroxine. Does not have good uptake on technetium scan. What is the likely diagnosis?
viral thyroiditis
293
which causes of hyperthyroidism have high uptake
Graves
Toxic Multinodular Goitre
Toxic adenoma
294
iodine uptake scan pattern in graves
diffuse
295
iodine uptake scan pattern in toxic multinodular goitre
mulitple hot nodules
296
iodine uptake scan pattern in toxic adenoma
solitary hot nodule
297
which causes of hyperthyroidism have a low uptake
De Quervains/ viral
Postpartum thyroiditis
ectopic
298
two drugs that can cause hypothyroidism
lithium
amiadorone
299
which thyroiditis causes a stony hard thyroid
Riedel's thyroiditis
300
What type of section is done for urgent diagnosis during surgery
intra-operative frozen section
301
What type of shunt is seen in Tetralogy of Fallot
right to left
302
primary bone tumour affecting the knee commonly
osteosarcoma
303
what is raised in osteosarcoma
ALP
304
X-ray findings in osteosarcoma
Codman triange
sunburst appearance
305
highly malignant bone tumour
Ewings
affects <20s
306
malignant bone tumour affecting over 40s
chondrosarcomas
(malignant proliferation of chondrocytes)
307
x-ray finding in chondrosarcoma
lytic lesions with fluffy calcification
308
most common benign bone tumour
osteochondroma
309
x ray sign for enchondroma
cotton wool calcification
310
x ray sign for osteiod osteoma
bulls eye
311
in which inherited disease is fibrous dysplasia seen
McCune Albright Syndrome
312
x ray findings in fibrous dyplasia
Soap bubble osteolysis
Shepherd’s crook deformity
313
What is the difference in bullae in pemphigus vulgaris and bullous vulgaris?
Bullous: large tense fluid fluid, on flexural surfaces, do not rupture as easily as pemphigus.
Pemphigus: easily ruptured, found on mucosal and skin. Nikolsky sign positive
314
what is bicalutamide and what is it used for
androgen antagonist
metastatic prostate cancer
315
neoplastic cells with transparent cytoplasm. Cells are arranged in nests with intervening blood vessels.
which renal cancer?
clear cell
316
in what condition are waxy urinary casts seen
CKD
