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Year 5 Pathology > Histopathology > Flashcards

Flashcards in Histopathology Deck (135):
1

Stages of Atherosclerotic Plaque formation

1. Endothelial cell injury
2. Inflamm response in vessel wall: oxidized LDL
3. Formation stable plaque: vascular smooth muscle phenotype shift
4. Stenosis or plaque rupture

2

Non-modifiable risk factors for atherosclerosis

Age, sex (M), FHx, type A personality, estrogen deficiency

3

Modifiable risk factors for atherosclerosis

HTN, DM, smoking, hypercholesterolemia, inactivity, lipoprotein Lp(a)

4

How to differentiate unstable angina from NSTEMI

Troponin (raised in NSTEMI)

5

Signs thrombosis

Hx claudication, signs vasc insufficiency, hard arteries, onset over a few hours

6

Possible sequelae of HTN

Hypertensive retinopathy/encephalopathy/cardiomyopathy/nephropathy
CVA, MI
Increased glucose levels

7

Major causes LV Failure

IHD, HTN, valve disease, myocardial disease

8

Consequences LV failure

Pulmonary congestion and edema
Reduced renal perfusion -->salt and water retention, ATN
Reduced CNS perfusion -->encephalopathy

9

Causes RV failure

Left sided failure
Chronic lung pathology--cor pulmonale

10

Consequences RV failure

Portal, systemic, and peripheral congestion
TR
Renal congestion (R>L)

11

Sequelae HCM

Arrhythmias (AF) and sudden death, LV outflow obstruction, CHF

12

Signs and Sxs HCM

Syncope, HF, jerky pulse, double apical impulse, ESM (+/- pansystolic from MR)

13

ARVD
-cause
-genes
-consequences

Inflamm and thinning of RV wall. Fibrofatty replacement
Usu AD mutation in cell adhesion genes
Consequences: Arrhythmia, CCF

14

Aschoff body

Focus of fibrinoid necrosis
Seen in rheumatic fever

15

Type I respiratory failure-causes

Severe pneumonia, PE, asthma, fibrosis, LVF

16

Type II respiratory failure-causes

COPD, neuromuscular disease, severe acute asthma

17

ECG sign of PE

S1Q3T3 (on exams, not real life)

18

Definition pulmonary hypertension

>25mmHg at rest

19

Macroscopic findings in asthma

Overinflated chest, pathy atelectasis, mucus plugs

20

Microscopic findings in asthma

Edema, eosinophilic infiltrates, smooth muscle and mucosal gland hypertrophy

21

Chronic bronchitis

Chronic cough with sputum production. Most days >3/12 for at least 2 years

22

Emphysema affects which part of lung

Parenchyma distal to terminal bronchioles

23

Causes bronchiectasis

Congenital: CF, severe immunodefic
Acquired: post-infectious, bronchial obstruction

24

Complications bronchiectasis

Chronic H flu infxn,
secondary staph aureus/m catarrhalis/pseudomonas infxn
RVF
Amyloidosis

25

Extrinsic allergic alveolitis

Hypersensitivity penumonitis: immune rxn from inhaled antigens
Occupation related: farmers lung (thermophilic actinomyces), Bird fancier's lung (avian proteins).
Interstitial pneumonitis and non-caseating granulomas

26

Pneumoconioses

Inflamm lung conditions caused by inhalation of mineral dusts
30 yr lag period
Types:
-Coal dust (coal miners): lung nodules and massive fibrosis
-Silicosis: nodular fibrosis
-Asbestosis

27

AI causes of pulm fibrosis

Sarcoidosis: non-caseating granulomas and multisystem disease
RA
SLE
Systemic sclerosis
Ank spon

28

Drug causes of pulmonary fibrosis

Bleomycin, Amiodarone, MTX

29

Non-small cell types of lung cancer

Squamous
Adenocarcinoma
Large cell
Undifferentiated/alveolar

30

Cause of primary spontaneous pneumothorax

Apical blebs

31

Causes of secondary spontaneous pneumothorax

COPD, asthma, pulm fibrosis, lung ca

32

Acquired causes pneumothorax

Traumatic, Iatrogenic (central lines, pleural aspiration, barotraumas, pacing wires)

33

Hepatic failure-definition

Clinical syndrome when >90% fn'al capacity of liver is lost

34

Common causes of acute liver failure

Acute viral hepatitis (AST >1000): Hep A/B/C, CMV, EBV
Alcoholic hep (AST >300, increased GGT and MCV), drug related hep (paracetamol, NSAIDs, Abx)

35

Clinical features acute liver failure

Hepatic encephalopathy, irritability/sleep disturbance/disorientation/coma, coagulopathy, conjugated jaundice, infxn (sepsis + MOF), Hepato-renal syndrome/hepato-pulmonary syndrome, progressive fibrosis, cirrhosis

36

Cirrhosis triad

Fibrosis, nodules regenerating hepatocytes, distortion liver architecture

37

Mech by which EtOH causes liver damage

Metabolic byproducts activate hepatic stellate cells, causing fibrosis

38

Features hemochromatosis

Liver: cirrhosis, HCC
Heart: CCF, arrhythmias, constrictive pericarditis
Endocrine: DM, panhypopituitarism, hypogonadotropism, loss libido
Joints: Chondrocalcinosis

39

PBC

Women>Men
Intrahepatic bile ducts (cholangiocytes)
Pruritis
Raised ALP and GGT
Anti-mitochondrial/IgM Abs

40

PSC

Sclerosis of intra- and extrahepatic ducts
Assoc w UC (75%)
Isolated raised ALP
Risk cholangiocarcinoma

41

Benign hepatic tumors

Hemangioma-most common
Liver cell adenoma

42

Hepatic hemangioma

3% population
Asymptomatic

43

Liver cell adenoma

Young women on COC

44

Malignant hepatic tumors

HCC
Cholangiocarcinoma

45

HCC

Develops on background of cirrhosis/chronic inflamm
1/3 have DNA mismatch repair defect

46

Cholangiocarcinoma

Malignancy of intrahepatic bile ducts
Non-specific presentation: jaundice, weight loss, pruritis, pain
Presents late w/ poor prognosis

47

Mech and presentation of annular pancreas

Failure of ventral bud to migrate
Presents in infancy similarly to pyloric stenosis

48

Pancreas divisum

Incomplete fusion ventral and dorsal buds
Predisposes to chronic pancreatitis, pancreatic ca

49

Risk factors for reflux esophagitis/GERD

Increased IAP: obesity, posture, large meals, EtOH
Hiatus Hernia

50

Complications GERD

Peptic stricture (scarring)
Barret's (10%)-columnar metaplasia
Adenocarcinoma

51

Squamous cell esophageal carcinoma-risk factrs and part esoph affected

RF: smoking, EtOH, achalasia
Middle third of esoph

52

Adenocarcinoma of esoph

Glandular differentiation
RF: Batrret's
Lower third esoph

53

Diffuse gastric adenocarcinoma

Normal mucosa
Signet rings cells
Highly infiltrative and aggressive

54

Gastric lymphoma

H pylori
Can lead to marginal cell lymphoma
Responds to Abx

55

Stromal tumors-cellular path

CT origin
Over-expression of Tyr Kin KIT
Exophytic
May be treated with Imantinib

56

Mech celiac disease

Inappropriate T cell driven inflamm ->lymphocytic enteritis

57

Extra-intestinal manifestations of IBD

Arthritis (ank spon)
Erythema nodosum
Uveitis

58

Concussion damages what structure

RAS

59

Diffuse axonal injury

Stretching and tearing white matter
Post-traumatic dementia and vegetative states

60

Contusion

Hemorrhages on superficial brain structures
Coup and contrecoup

61

Traumatic intracerebral hemorrhage

Deep contusions
Assoc with diffuse axonal injury, edema, and SAH

62

Causes cerebral edema

Idiopathic
Generalized: Hypoxia, Metabolic disturbance, Trauma, HTN
Local: ischemia, hematomas, tumors

63

Clinical features cerebral edema

HA (stretch of receptors around intracranial BVs)-worse in AM and on moving, vomiting (stimulation centres on ponds/medulla), papilledema

64

Complications cerebral edema

Vascular damage (central v occlusion --> papilledema, hemorrhage/infarct), CN III/IV damage, CSF outflow obstruction, herniation

65

Benign intracranial HTN

HA + papilledema
No focal neurology

66

Gliomas

Astrocytomas (60%).
Most common type brain tumor. Slow initially, agressive with time

67

Oligodendrogliomas

Slow growing with calcification
Epilepsy

68

Ependymomas

Lining of ventricles -->CSF blockage

69

Meningiomas

From arachnoid cells.
Most comm adjacent to sinuses
Slow growing but incessant
Lead to compression and skull erosion

70

Neuroepithelial neoplasms

Common in kids
Medulloblastoma, Rb, neuroblastoma, ganglioblastoma

71

Alzheimers

Short term memory loss
Dysphasia and dyspraxia
Persecutory beliefs
5-10 year survival

72

Vascular dementia

Personality change, labile mood, preserved insight.
Stepwise progression

73

Lewy Body dementia

Fluctuating cognition, visual hallucinations, parkinsonism.
Worsened by anti-psychs

74

Pick's disease

Frontal lobe/executive fn impairment
Personality change
Preserved memory
Slow progression

75

CJD

Seizures, cerebellar ataxia, myoclonic jerks

76

MND

Progressive w/in 5 yrs
Bulbar
UMN and LMN
Group of neurodegenerative disorders, the most common of which is ALS
Cause ?glutamate receptor/apoptosis

77

Tx for Cushings

Decrease steroids, ketoconazole, metyrapone, trilostane

78

MEN I

Pituitary adenoma, parathyroid hyperplasia, pancreatic islet tumors

79

MEN IIA

Pheo, medullary thyroid, hyperparathyroidism

80

MEN IIB

Pheo, medullary thyroid, mucosal neuromas

81

Signs embolism

Recent MI, AF, aneurysm; soft artery, bruits, onset over seconds. No evidence previous disease

82

Hemosiderin laden macrophages

Aka heart failure cells
Seen mostly in Left heart failure

83

Nutmeg liver

Hepatocongestion.

Seen in right heart failure

84

Dressler's syndrome

AI complication 4w post-MI.
CP, fever, pericardial rub

85

Aschoff bodies

Granulomas seen in RhF

86

Anitschkow cells

Enlarged macrophages in Aschoff bodies.
RhF

87

Monckeberg arteriosclerosos

Focal calcification of media (small-med arteries)
>50 years
No inflamm

88

Oat cells

Seen in small cell lung carcinoma

89

Hyaline membrane disease

Aka respiratory distress syndrome
Pre-term neonates. Surfactant deficiency causes hyaline deposition and hypoxia

90

AA amyloid

Associated with inflamm

91

AL amyloid

Derived from IgG light chains
Associated with myeloma

92

Alpha-beta2 amyloid

Alzheimer's

93

Beta2 micro globulin amyloid

Dialysis patients

94

Duret hemorrhages associated with what complication?

Tectorial or tonsillar herniation due to tearing of vessels

95

"Rubber hose wall" of bowel

Crohns

96

Peptic ulcers versus erosions

Erosions heal in days and go into mucosa only
Ulcers take weeks to heal and extend into submucosa

97

Chronic gastritis

H pylori or AI
Lymphocyte infiltration or intestinal metaplasia
Risk carcinoma or MALT lymphoma

98

Gardner's

FAP + osteomas + epidermoid cysts + desmoid tumors

99

Micronodular liver cirrhosis

100

Macronodular liver cirrhosis

>3mm
Viral

101

ATP7B mutation

Wilson's disease

102

HFE gene mutation

Hemochromatosis

103

Cholangiocarcinoma

Adenocarcinoma of bile ducts
RF: PSC, live flukes, medical contrast media

104

Erythema multiforme

HSR secondary to infection (HSV, mycoplasma, fungi) or drugs (penicillin, phenytoin, barbiturates)

105

Munro-abscesses

Psoriasis

106

Subtypes melanoma

Lentigomaligna
Acrallentiginous
Superficial spreading
Nodular

107

Bowens disease

Squamous carcinoma in situ

108

Pityriasis rosea

Single scaly salmon colored macule (herald patch)
Then multiple in fir tree distribution

109

Nephritic syndrome

Hematuria
Red and white cell casts (tamm horsefall secretions)
Dysmorphic red cells
Oliguria
HTN

110

Muddy (brown) casts (urine)

Acute tubular necrosis

111

IgA nephropathy versus post-strep glomeruli nephritis

Extremely similar on exam questions.
Main differentiator is how often after resp infection....DAYS for IgA and weeks for PSGN.
IgA can also be preceded by GI infections
IgA also usually happens multiple times, irregularly but every few months until eventually subsides (won't usually give you this on exam)

112

Spike and dome deposits on renal question

Membranous glomerulonephritis

113

Duct ectasia

Green/white discharge from breasts.
>40 multips

114

Fibroadenomas

Mixed tumors.
Rapid growth in pregnancy and menstrual cycle.
Very mobile,

115

DCIS

Focal area calcification on mammogram and central necrosis

116

Phylloides tumor

Mixed tumor
Discrete, well circumscribed, mobile
>5cm
>40 years
Artichoke like (or leaf like)
Can be malignant

117

Infiltrating ductal carcinoma

Painful lump
May have Paget's disease of breast, tethering, nipple retraction, LAD, ulceration of mass.

118

Mastitis

Tender to touch, erythematous, edema.
S. Aureus
Breastfeeding mothers.

119

Giant cell tumor

Borderline malignant tumor of osteoclasts.
Lytic lesions in epiphyses (ESP KNEE)
Soap bubble

120

Signs osteomalacia

Pseudofractures (looser zones), craniotabes, bone pain, prox weakness

121

McCune Albright

Cafe-au-lait spots (unilateral)
Precocious puberty
Fibrous dysplasia

122

Renal osteodystrophy

Secondary hyperparathyroidism
Due to build-up of phosphate, damage to 1-a-hydroxylase, osteosclerosis, aluminum toxicity

123

Ortner's syndrome

Mitral stenosis, enlarged LA, laryngeal nerve palsy

124

Bone pain + soap bubble + shepherd's crook + Chinese letter trabeculae

Fibrous dyplasia

125

Endochondroma

Benign intramedullary cartilage tumor. Oft hands and feet
Oft asxs
If sxs-pain, fractures, swelling

126

Osteosarcoma

Pain and mass near joint
Increased ALP
Codman's triangle

127

Comminuted fracture

Bone splintered
Soft tissue ok

128

Greenstick fracture

PAEDS.
Abuse
Transverse

129

Compound fracture

Open
Penetrates skin surface (infection risk)

130

Transverse fracture

Partial or complete
Oft simple, clean break

131

Impacted fracture

Fracture site "crushed" inwards

132

Chemo for Her2/neu positive breast cancer

Trastuzumab

133

Intraductal papilloma

Bloody discharge
Premenopausal women
Benign (note -oma...not carcinoma)

134

Paget's disease of breast

DCIS that extends up duct to skin/nipple
Almost always associated with underlying carcinoma

135

Periductal mastitis

SMOKERS. Have relative Vit A deficiency--need vit A to maintain epithelial cells....keratin plugs....infection behind block. Causes mass

Presents with subareaolar mass and nipple retraction