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Year 5 Pathology > Histopathology > Flashcards

Flashcards in Histopathology Deck (302):
1

Definition of closed fracture

Clean break with intact soft tissue

2

Definition of comminuted fracture

Splintered bone with intact soft tissue

3

Definition of compound fracture

Fracture site communicates with skin surface

4

Stages of fracture repair

1. Organisation of haematoma at # site (pro-callus)

2. Formation of fibrocartilaginous callus

3. Mineralisation of fibrocartilaginous callus

4. Remodelling of bone along weightbearing lines

5

Common sites for osteomyelitis in adults

Jaw
Vertebrae
Toe

6

Features of osteomyeltis

General: Fever, Malaise, Leucocytosis, Chills
Local: Pain, Swelling, Redness
60% positive blood cultures

X-ray: mixed picture eventually lytic.

7

Stages of Lyme Disease

Stage 1 - Early localised characterised by rash (90%) usually within 7-10 days and between 1 & 50cm diameter.
Often thigh, groin, axilla (earlobe in children)

Stage 2 - Early Disseminated affects many organs, musculoskeletal, heart, nervous system.

Stage 3- Late, persistent dominated by arthritis.

8

Clinical features of rheumatoid arthritis

Mild anaemia
Raised ESR
RF+ve
+/- rheumaoid nodules
extra-articular features

9

Skin manifestations of rheumatoid arthritis

Pyoderma gangrenosum
Nodules
Ulcers (vasculitic)

10

Components of Felty's syndrome

RA
Neutropenia
Splenomegaly

11

Eye manifestations of rheumatoid arthritis

Keratoconjunctivitis
Scleritis
Scleromalacia
Episcleritis

12

Lung manifestations of rheumatoid arthritis

Fibrosing alveolitis
Obliterative bronchiolitis
Pleural effusion
Lung nodules

13

Extra-articualr manifestations of RA

Skin manifestations: ulcers, pyoderma gangrenosum, nodules
Lung manifestations e.g. fibrosis
Eye inflammation and scleromalacia
Sjogren syndrome
Carpal tunnel and peripheral neuropathy
Raynauds
Osteoporosis
Vasculitis
Felty's
Splenomegaly
Amyloidosis
Lymphadenopathy
Systemic symptoms/signs: fever, malaise, fatigue, weight loss

14

Rheumatoid arthritis affects small joints of the hands sparing the...

DIPJ

15

Deformities seen in rheumatoid arthritis

Radial deviation of wrist
Ulnar deviation of fingers
Swan neck deformity of fingers
Boutonniere deformity of fingers
Z shaped thumb
Swollen MP and PIP joints
Dorsal subluxation of MP joints
Atrophy of small hand muscles (Valleys)

16

Stages (histological) in development of rheumatoid arthritis

1. Unknown antigen reaches synovial membrane
2. T cell proliferation associated with increased B cells and angiogenesis
3. Chronic inflammation and inflammatory cytokines
4. Pannus formation
5. Cartilage and bone destruction

17

Predominant inflammatory cell in the synovial space (in rheumatoid arthritis)

Neutrophil

18

Joint most commonly affected by gout

Great toe

19

When gout affects the big toe it is called

Podagra

20

Causes (conditions) of pseudogout

Idiopathic
Primary hyperparathyroidism
Diabetes mellitus
Hypothyroidism
Wilsons disease
Hereditary
Low Mg
Low phosphate
Haemochromatosis

21

Crystals found in pseudogout

Calcium pyrophosphate

22

Birefringence: Gout is... Pseudogout is...

Gout: Negatively birefringent crystals
Pseudogout: Positively birefringent crystals

23

First line treatment for acute gout

Potent NSAID e.g. 500mg BD naproxen

24

Prophylaxis of pseudogout

Low dose colchicine (BD)

25

Treatment of pseudogout

Acute attack:
1 or 2 joints: Joint aspiration and intra-articular glucocorticoid (triamcinolone) injection
More than 2 joints: NSAIDs (first line) or colchicine

Prophylaxis: Colchicine

26

Prevention of gout

Acute attack: Potent NSAIDS e.g. naproxen (first line) or colchicine

Long term: allopurinol

Conservative: Reduced ETOH, and purine intake e.g. sardines, liver

27

Pseudogout crystal shape

Rhomboid

28

Medication used for pseudogout prophylaxis

Colchicine

29

A Brodie abscess is...

A subacute osteomyelitis that has been contained to a localised area and walled off by fibrous and granulation tissue.This is termed as Brodie's abscess.

30

Most common causative organism in osteomyelitis

Staph. aureus

31

Oesophagus layers

Epithelium: stratified squamous epithelium except the bottom part
Submucosa
Muscularis propria

32

Epithelial cell type in (most) of the oesophagus

Stratified squamous

33

What is the Z-line (oesophagus)

Columnar epithelium in the stomach, stratified squamous in the oesophagus. The transition between the 2 types is visible as a zig-zag line known as the Z-line. It is at the bottom of the oesophagus

34

Definition of ulceration in the GI tract

Erosion of the surface going beyond the muscularis mucosae.

35

What is Barrett's Oesophagus

AKA columnar lined oesophagus

Transformation of epithelial cells in the oesophagus from from stratified squamous epithelium to columnar epithelium

The columnar epithelium can be gastric type or intestinal type. Gastric type does not contain goblet cells. Intestinal type does.

Lose the sharp Z-line dividing white stratified squamous epithelium and red columnar epithelium.

In America for Barrett’s to be diagnosed the columnar epithelium must be intestinal type. In the UK this distinction is not made.

Barrett’s increased risk of cancer.

36

Squamous cell carcinomas produce...

Keratin

37

Adenocarcinomas produce...

Mucus

38

How does H.pylori cause lymphoma

H. pylori induces production of MALT (Mucosal Associated Lymphoid Tissue) in the stomach. A location where MALT is not normally found. If the drive on the proliferation of this lymphoid tissue continues for too long it can cause lymphoma in the stomach.

39

H pylori causes adenoma of the stomach due to

Inflammation which leads to metaplasia, which becomes dysplasia, which becomes adenocarcinoma

40

Which type of H.pylori is associated with more chronic infection?
Why?

cag-A-positive H. pylori

It has a needle like appendage that injects toxin into intracellular junctions separating the cells. It allows the bacteria to attach and colonise more easily and potentiates damage to the epithelium. It causes more inflammation.

41

Helicobacter infection increases the risk of gastric cancer ...fold

8-fold

42

H. pylori is gram...

Negative

43

Causes of gastritis

H. pylori
Drugs e.g. NSAIDs
CMV
Strongyloides (parasite)
IBD: Crohn's disease

44

Gastric cancer incidence high in which regions?

High incidence in Japan, Chile, Italy, China, Portugal, Russia

45

Gastric cancer
More common in men or women?

Men
1.8:1 ratio

46

Most gastric cancers are which type?

Adenocarcinomas

47

Describe the 2 types of gastric adenocarcinoma

Intestinal type: well differentiated. More closely linked wit intestinal metaplasia. Large glands containing goblet cells producing mucus.

Diffuse types: poorly differentiated, single cells (signet ring cells) containing mucus, not forming glands. Linitis plastica refers to the appearance of the stomach, resembling an old leather water bottle.

48

Types of gastric cancer

Adenocarcinoma (95%)
Squamous cell carcinoma
Lymphoma (MALToma)
Gastrointestinal stromal tumours (GIST): sarcoma. Mostly benign. Common enough that a significant number are malignant.
Neuroendocrine tumours

49

Gastric MALToma/ lymphoma usually originates from which cells?

B cells in the marginal zone of the MALT

50

Pathogens causing duodenal ulceration

H. pylori
CMV
Cryptosporidiosis
Giardia lamblia
Whipples disease: caused by tropheryma whippelii

51

Giardia common in which country

Russia

52

Antibodies found in coeliac disease

Endomysial antibodies
transglutaminase antibodies

53

MALToma associated with coeliac disease originates from which cells?

T cells
(enteropathy associated T cell lymphoma

54

Coeliac disease produces which histological changes?

Flattening/atrophy of duodenal villi
Hyperplasia of duodenal crypts
Increased lymphocytes

55

Hirschprungs disease

Congenital disorder.
Absences of ganglionic cells in myenteric plexus
Distal colon fails to dilate
Causes constipation, abdominal distension, vomiting, ‘overflow’ diarrhoea

Loss of function in RET proto-oncogene Cr10 and others...

56

...% of people with Hirschprung's are male

80%

57

Gene associated with Hirschprung's

RET proto-oncogene

58

Treatment of Hirschprung's disease

Resection of affected part of colon (Distal)

59

Volvulus

Complete twisting of a loop of bowel at mesenteric base, around vascular pedicle

Leads to intestinal obstruction/infarction

In infants occurs in small bowel

Occurs in sigmoid colon in adults (common in elderly)

60

...% of diverticulae occur in the left colon

90%

61

Pathogenesis of pseudomembranous colitis

Proliferation of C.diff bacteria e.g. due to antibiotic use
Production of A and B toxins by the c.diff bacteria
Inflammatory response and formation of pseudomembrane composed of inflammatory debris and white cells

62

Distinctive clinical features of C.diff colitis

Significant diarrhoea
Fever
Abdominal pain
Recent antibiotic exposure
Foul smelling stool (distinctive smell)

63

Treatment of C.diff colitis

Metronidazole or vancomycin

VANCOMYCIN MUST BE ORAL

64

Common sites for ischaemic bowel

Splenuc flexure (SMA transition to IMA)
Rectosigmoid (IMA transition to internal iliac)

65

Clinical features of IBD

Diarrhoea +/- blood
Fever
Abdominal pain
Acute abdomen
Anaemia
Weight loss
Extra-intestinal manifestations

66

Peak age of Crohn's onset

Peak onset on teens/twenties

67

Histological features of Crohn's disease

Whole of GI tract can be affected (mouth to anus) – commonly found in the terminal ileum and the large bowel
‘Skip lesions’
Transmural inflammation – entire thickness of wall inflammed
Non-caseating granulomas (collections of macrophages)
Sinus/fistula formation
Fat wrapping’
Thick ‘rubber-hose’ like wall
Narrow lumen
‘cobblestone mucosa’
Linear ulcers
Fissures
abscesses

68

Extra-intestinal manifestations of Crohn's disease

Arthritis
Uveitis
Stomatitis/cheilitis
Skin lesions
Pyoderma gangrenosum
Erythema multiforme
Erythema nodosum

69

Peak age of onset of ulcerative colitis

20-25 years

70

Key histological features of ulcerative colitis

Involves rectum and colon in contiguous fashion.
May see mild ‘backwash ileitis’ and appendiceal involvement but small bowel and proximal GI tract not affected.
Inflammation confined to mucosa
Bowel wall normal thickness
Shallow ulcers

71

Complications of ulcerative colitis

Severe haemorrhage
Toxic megacolon
Adenocarcinoma (20-30 x risk)

72

Extra-intestinal manifestations of ulcerative colitis

Arthritis
Myositis
Uveitis/iritis
Erythema nodosum, pyoderma gangrenosum
Primary Sclerosing Cholangitis (5.5% in pancolitis)

73

1st line drug for Crohn's maintenance treatment

Mesalazine (or other 5-ASA)

74

1st line drug for ulcerative colitis maintenance treatment

Mesalazine (or other 5-ASA)

75

Two types of lower GI adenomas

Tubular
Villous

(can be a mixture of the two)

76

Histological features of (GI) tubular adenomas

Irregular, pseudo stratified, high nuclear to cytoplasmic ratio because they are dysplastic

77

Hamartomatous are seen in...

Peutz Jeghers
Juvenile polyposis

78

Juvenile polyps are...

Focal malformations of the mucosa and lamina propria
Usually seen in children under 5 years
Can cause bleeding

79

Features of Peutz Jeghers

Multiple polyps (hamartomatous)
Mucocutaneous pigmentation
Freckles around mouth
Increased risk of intussusception
Increased risk of malignancy: GI (including pancreas), gonad, breast

80

Gene affected in familial adenomatous polyposis (FAP)

Chromosome 5q21, APC tumour suppressor gene

81

Familial adenomatous polyposis (FAP) average:
Age of onset
Number of polyps

25
1000

82

Familial adenomatous polyposis (FAP):
Minimum number of polyps
Mode of inheritance

100
Autosomal dominant

83

Gardner syndrome is...

A variant of FAP with extra intestinal features such as:
multiple osteomas of skull & mandible
epidermoid cysts
desmoid tumors
dental caries, unerrupted supernumery teeth
post-surgical mesenteric fibromatoses

84

Hereditary non-polyposis colorectal cancer features

Autosomal dominant mutation in DNA mismatch repair genes
Causes cancers in right colon (High frequency of carcinomas proximal to splenic flexure)
Causes few polyps
Fast progression to malignancy
Onset of colorectal cancer at an early age (under 50)
Poorly differentiated and mucinous carcinoma more frequent
Multiple synchronous cancers
Also associated with cancers of endometrium, ovary, small bowel, urinary system (including kidney)

85

Turcot syndrome is

Variant of Hereditary non-polyposis colorectal cancer (or FAP) also associated with brain cancers

86

Dukes staging of colon cancers

A = confined to wall of bowel
B = through wall of bowel (through muscularis propryia)
C = lymph node metastases
D = distant metastases

87

Causes of acute pancreatitis

Idiopathic
Gallstones
Ethanol
Trauma
Scorpion bite
Mumps/malignancy
Autoimmune
Steroids
Hypercalciamia/hyperlipidaemia/hyperparathyroidism
ERCP
Drugs (e.g. azathioprine, tetracycline, valproic acid, thiazide, co-trimoxazole)

Can be divided into 6 categories:
Obstruction of ducts
Metabolic/toxic
Poor blood supply (Shock and hypothermia)
Infection/inflammation
Autoimmine
Idiopathic

88

Effect of chronic pancreatitis on calcium

Causes hypocalcaemia

89

First pancreatic pro-enzyme activated in pancreatitis pathophysiology

Trypsinogen to trypsin

90

Pancreatic enzymes released from which cells

Acinar cells

91

How does gallstones cause pancreatitis

Stone lodged distal to merging of pancreatic and common bile ducts
Reflux of bile up pancreatic duct
Activation of trypsinogen to trypsin and then activation of ther pancreatic enzymes

92

How does alcohol (ethanol) cause pancreatitis

Alcohol leads to spasm/oedema of Sphincter of Oddi and the formation of a protein rich pancreatic fluid which can produce plugs which obstruct the smaller pancreatic ducts

93

Damage caused by release of lipases in pancreatitis

Fat necrosis: Fatty acids and glycerides bind with calcium and magnesium forming soaps seen as yellow/white foci.

94

Damage caused by release of elastases in pancreatitis

Damage to blood vessels and possible haemorrhagic pancreatitis

95

Damage caused by release of proteases in pancreatitis

Parenchymal destruction

96

Complications of acute pancreatitis

Pancreatic : pseudocyst, abscess
Gastrointestinal: UGI erosions, ileus, peritonitis
Systemic: shock, hypoglycaemia, hypocalcaemia

97

Pattern of injury in pancreatitis

Chronic inflammation with parenchymal fibrosis and loss of parenchyma
Duct strictures with intrapancreatic, calcified stones with secondary dilatations

98

Complications of chronic pancreatitis

Malabsorption

Diabetes mellitus (it is the acini cells that are damaged not the islets of langerhans. Therefore a lot of pancreatitis is required to result in diabetes)

Pseudocyts

Carcinoma of the pancreas (?)

99

Pacreatic pseudocysts are lined by...

Fibrous tissue, granulation tissue, inflammatory cells

100

Most pancreatic carcinomas are...

Ductal

101

Types of cystic neoplasms

Serous
Mucinous
Intraductal Papillary Mucinous Neoplasm (IPMN)

102

Risk factors for pancreatic carcinoma

Smoking - doubles the risk (25% of cases)
BMI and dietary factors e.g. meat and fat
Chronic pancreatitis
Diabetes – doubles the risk (80% of cases)
Genetic e.g. Peutz-Jeghers syndrome (polyp with pigmentation around the buccal cavity and other areas)
Age (increases with age)

103

Components of the metabolic syndrome

Fasting hyperglycaemia
Hypertension
Central obesity
Dyslipidaemia
Microalbuminaemia

104

Clinical features of acute pancreatitis

Severe epigastric pain radiating to back relieved by sitting forward.
Vomiting
Raised amylase
Raised lipase

105

Pancreatic intraductal neoplasia can lead to...
Mutation in which gene is commonly found in these lesions?

Ductal carcinoma
K-ras (95% of cases)

106

Macroscopic appearance of ductal carcinoma (pancreas)

Gritty and grey
Invades adjacent structures
Tumours in the head present earlier and, therefore, tend to be smaller

107

Microscopic appearance of ductal carcinoma

Moderately differentiated
Glandular (adenocarcinoma)
Secretes mucin
Set in fibrous stroma

108

Most pancreatic ductal carcinomas are in the...

Head of the pancreas
(followed by, diffuse, then body, then tail)

109

How and where does ductal pancreatic carcinoma spread

Direct: Bile ducts, duodenum
Lymphatic: Regional lymph nodes
Blood: Liver
Serosa: Peritoneum

110

2 main complications of ductal pancreatic cancer

Venous thrombosis: (they secrete mucin and once in the blood stream it activates the clotting cascade and forms thrombi in various parts of the body)

Chronic pancreatitis

111

Features of cystic pancreatic tumours

Usually multilocular
Contain serous or mucin secreting epithelium (cf. ovarian tumours)
Usually benign, mucinous tumours may be malignant

112

Appearance of neuroendocrine tumours (islet cell)

Circumscribed
Uniform cells
Cells arranged in nests/trabeculae with granular cytoplas,

113

Clinical features of ductal carcinoma of the pancreas

Older
Male
Weight loss (cachexia and anorexia)
Upper abdominal and back pain (chronic, persistent and severe)
Painless jaundice
Pruritus
Steatorrhoea
DM
Recurrent thrombophlebitis
Ascites
Abdominal mass
Virchow's node
Courvoursiers sign

Bloods: low Hb, raised Bili, raised Ca, positive CA19.9

114

What is courvoiser's sign

Courvoisier's law (or Courvoisier syndrome, or Courvoisier's sign or Courvoisier-Terrier's sign) states that in the presence of a palpably enlarged gallbladder which is nontender and accompanied with mild painless jaundice, the cause is unlikely to be gallstones.

Usually, the term is used to describe the physical examination finding of the right-upper quadrant of the abdomen. This sign implicates possible malignancy of the gall bladder or pancreas and the swelling is unlikely due to gallstones

115

Pancreatic cancer tumour marker

CA19.9

116

Chemotherapy pancreatic cancer

5-FU
Palliative

117

Pancreatic neuroendocrine are usually secretory or non-secretory?

Non-secretory

118

Types of secretory pancreatic endocrine tumour

Insulinoma
Gastrinoma: Zollinger-Ellison syndrome
VIPoma: secrete vasoactive intestinal peptide and cause diarrhoea (chronic watery with expected effects) RARE
Glucagonoma: causes necrolytic migrating erythema

119

Tumours in MEN 2A

Parathyroid
Thyroid
Phaeochromacytoma

120

Tumours in MEN 2B

Medullary thyroid
Phaeochromacytoma
Neuroma

(also marfanoid phenotype)

121

Commonest type of pancreatic endocrine secretory tumour
Prognosis?

Insulinoma
Not likely to metastasise

122

What are Rokitansky-Aschoff sinuses?

Pseudodiverticulae in the gallbladder wall.
Not abnormal but associated with cholecystitis

123

Types pancreatic malformations

Ectopic pancreas: more common in stomach and small intestine

Pancreas divisum: failure of fusion of dorsal and ventral buds leading to increased risk of pancreatitis

Annular pancreas: second part of the duodenum is surrounded by a ring of pancreatic tissue continuous with the head of the pancreas. This portion of the pancreas can constrict the duodenum and block or impair the flow of food to the rest of the intestines. It can present with duodenal obstruction at approximately 1 year. However many cases will be asymptomatic.

124

Causes of increased epithelial lymphocytes in gut

Coeliac disease
Cows milk protein sensitivity
Drugs (NSAIDs)
IgA deficiency
Tropical sprue
Post infective malabsorption
Dermatitis herpetiformis
(lymphoma)

125

Causes of villous atrophy

Coeliac disease
Giardiasis (very rarely)
Tropical sprue
Crohn’s disease
Radiation/chemotherapy
Bacterial overgrowth
Nutritional deficiencies (b12 and folate, secondary to ability to synthesis new DNA)
Graft versus host disease
Microvillous inclusion disease (in children)
Common variable immunodeficiency

126

Complications of coeliac disease

Malabsorption
Osteomalacia and osteoporosis
Neurological disease
Epilepsy
Cerebral calcification
Lymphoma
Hyposplenism

127

Autoimmune and other conditions associated with coeliacs disease

Dermatitis herpetiformis (prevalence = 100%)
Type 1 diabetes mellitus (prevalence = 7%)
Autoimmune thyroid disease
Down’s syndrome

128

Neurosurgery:
What is a Stereotactic biopsy?

I biopsy of an inoperable tumour.
Stereotactic neurosurgery involves mapping the brain in a three dimensional coordinate system. With the help of MRI and CT scans and 3D computer workstations, neurosurgeons are able to accurately target any area of the brain in stereotactic space (3D coordinate system). Stereotactic brain biopsy is a minimally invasive procedure that uses this technology to obtain samples of brain tissue for diagnostic purposes.

129

Neurosurgery:
What is an open biopsy?

A biopsy of an inoperable but approachable tumour.

130

How to name a CNS tumour

Names derive from putative cell of origin

Differentiation

Descriptive

131

Grading of CNS tumours is based on...

Outcome: survival time

132

Grades of CNS tumour (and brief description of each)

Long-term survival / cured – Grade I
Cause death in more than 5 yrs – Grade II
Cause death within 5 yrs – Grade III
Cause death within 6 mo-1yr – Grade IV

133

WHO grading system for CNS tumours is only reliable for...

Diffuse astrocytomas and meningiomas

134

Most common type of primary CNS tumour in adults

Gliomas

135

Types of gliomas

Diffuse infiltration
Fibrillary, gemistocytic astrocytoma (all grades)
Oligodendroglioma (all grades)
Mixed oligo-astrocytoma

Compressive margins
Pilocytic astrocytoma
Pleomorphic xantoastrocytoma
Subependymal astrocytoma
-------------------------------------
Ganglioglioma
Ependymoma

136

Infiltrative gliomas: possible grades

2-4

137

Most aggressive form of glioma

Glioblastoma (GBM)

138

Types of glial cells

Glial cells are non neuronal cells. They include:
Oligodendrocytes
astrocytes
ependymal cells
Microglia,

In the peripheral nervous system glial cells include: Schwann cells and satellite cells.

139

80% of gliomas are which specific type?

Diffuse astrocytomas

140

Mutation of... is present in 80% of cases of diffuse astrocytomas

IDH1

141

Features of diffuse astrocytomas

Infiltrative
Most commonly in cerebral hemispheres but can be found elsewhere e.g. cewrebellum (10%) and brainstem (more common in children/young adults)
WHO grade 2, progressing in 5-7 years to grade 4 GBM
Most common in ages 30-40
Low vascularity but endothelial and capillary proliferation
No necrosis at core
IDH1 mutation in 80%

142

About ...% of glioblastomas develop from a lower grade astrocytoma

10%

143

Features of an oligodendroglioma

5% of all primary brain tumours
Almost exclusively in cerebral hemispheres – frontal lobe in 50-60% of cases
WHO grade II – Anaplastic WHO grade III – difficult grading
Presents with long history of neurological signs – seizure is more frequent
Extends to grey matter
Chemosensitive

Better prognosis than astrocytomas – resection is important

80% mutation of IDH1; 75% codeletion 1p19q; usually normal p53

144

Features of pilocytic astrocytoma

WHO grade I
Usually 1st and 2nd decade - 20% of CNS tumours below 14 years and 15% between 14-18 years
Often cerebellar, optic-hypothalamic, brain stem
Often cystic. Always contrast enhancement
They can disseminate in the subarachnoid space (es: follow nerve roots)
Compressive margins (never diffuse infiltration)
Always show marked nuclear atypia and vascular/endothelial proliferation
Very often Rosenthal fibres (eosinophilic/pink staining) and granular bodies
Hallmark: Piloid “hairy” cell

145

WHO definition of a medulloblastoma

A malignant, invasive embryonal tumour of the cerebellum with preferential manifestation in children, predominantly neuronal differentiation, and an inherent tendency to metastasize via CSF pathway

146

Features of a medulloblastoma

Rare (0.5 per 100,000 year, in children)
75% arise in the vermis in children and hemispheric in adults
Present with cerebellar signs, cranial hypertension
WHO grade IV

147

Medulloblastomas present with...

Cerebellar signs, cranial hypertension

148

Features of meningiomas

24-30% primary intracranial tumours
Incidental in up to 10% of post-mortem
Usually adults – rare in patients younger than 40 (more aggressive)
Focal symptoms (seizure, compression)
Any site of craniospinal axis

149

Grading of meningiomas based on histology (and projected outcome)

Grade I – benign
Grade II (atypical) – 20% of meningiomas; 40% recurrence
Grade III (anaplastic) – 1% of meningiomas; often lethal in 1 year

150

What is the virchow robin space?
Why is important in CNS tumours?

It is the immunological space between an artery and vein and the pia mater. It can be expanded by leucocytes.

Psueudoinvasion of meningiomas can occur along the space.

151

Commonest type of CNS tumour

Metastases/secondary

152

Tumours that most commonly metastasise to the CNS

Lung ca, melanoma, breast ca, renal ca and colon ca.

153

ICP is measured in mmHg and at rest, is normally...
mmHg for a supine adult

7–15

154

CSF is produced by...

Choroid plexus: 70-80%
Ependyma and subarachnoid vessels
Parenchymal capillaries

155

Normal CSF volume is...

90-150ml

156

Types of hydrocephalus

Non-obstructive/communicating: reduced reabsorption
Obstructive/non-communicating: Actual obstruction to flow of CSF

157

70-80% of strokes are which type?

Ischaemic

158

Embolic occlusion leading to stroke usually occurs in which vessels

Middle cerebral artery branches

159

Non-traumatic intraparenchymal haemorrhage most commonly occurs in...

Most common in basal ganglia

160

Risk factors for non-traumatic intraparenchymal haemorrhage

HTN (over 50% of bleeds)
Atherosclerosis
clotting disorders, neoplasms, amyloid, vasculitis, vascular malformations

161

Signs/symptoms of intraparenchymal haemorrhage

Raised intracranial pressure; severe headache, vomiting, rapid loss of consciousness; focal neurology

162

Cerebral AVMs present with... they become symtomatic between ages of...

Haemorrhage, seizures, headache, focal neurological deficits
20-50

(the risk if bleeding is around 1% annually but rises if bleed occurs. The risk of re-bleed is around 6% annually)

163

What is a cavernous angioma?

Well-defined malformative lesion composed of closely packed vessels with no parenchyma interposed between vascular spaces

(so basically a cavernous space filled with vessels)

164

Features of a cavernous angioma

Presents after 50
Has a few feeding vessels
Bleeds at low pressure
Present with headache, seizures, focal deficits, haemorrhage (similar to an AVM)
Angiography is usually NEGATIVE unlike AVM
Treatment is surgical

165

Types of brain herniation

Transtentorial (uncal gyral, mesial temporal) – medial temporal lobe compressed against the free margin of the tentorium cerebelli

Subfalcine (cingulate gyrus) – cingulate gyrus displaced under the falx cerebri

Tonsillar – cerebellar tonsils through the foramen magnum, this causes brain stem compression

166

Cause of most sub-arachnoid haemorrhages

Berry aneurism.

(In most of the 1% of people who have them they cause no problems.
Berry aneurisms tend to occur in the circle of willis at the junctions of the large vessels: most of them occur (80%) at the internal carotid artery bifurcation. The other 20% occur in the posterior circulation (vertibrobasilar circulation))

167

Common locations of berry aneurisms

Berry aneurisms tend to occur in the circle of willis at the junctions of the large vessels: most of them occur (80%) at the internal carotid artery bifurcation. The other 20% occur in the posterior circulation (vertibrobasilar circulation)

168

...% of people with berry aneurisms have multiple ones.

30%

169

Risk factors for berry aneurisms

Autosomal dominant polycystic kidney disease

(ADPKD)Ehlers-Danlos syndrome (type IV)
Marfan syndrome (controversial 3)
coarctation of aorta
bicuspid aortic valve
neurofibromatosis type 1 (NF1)
hereditary haemorrhagic telangiectasia
alpha 1 antitrypsin deficiency
cerebral arteriovenous malformation: a flow related aneurysm
fibromuscular dysplasia

170

% of people who die within days of a berry aneurism bleed

50% die within a few days, “Warning Bleed”
Prognisis worse if rupture after a warning bleed

171

Components of GCS (just the responses tested)

eye response (max 4)
verbal response (max 5)
motor response (max 6)

172

Subdural bleeds are due to bleeding from which type of vessel?

Veins.

173

Most extradural bleeds originate from which vessels

Meningeal arteries,

174

Unique feature of prion diseases

Proteinaceous infection only. No DNA or RNA involved.

175

List prion diseases found in humans

Creutzfeldt-Jakob disease
Gerstmann-Straüssler-Sheinker syndrome
Kuru
Fatal familial insomnia

176

Features of new varian CJD

Sporadic neuropsychiatric disorder
Patients

177

What is Gerstmann-Straüssler-Sheinker syndrome?

A familial version of CJD

178

Neuropathology of Alzheimer's disease

Extracellular plaques (protein deposition)
Neurofibrillary tangles (within neurons)
Cerebral amyloid angiopathy (CAA)
Neuronal loss (cerebral atrophy)

179

Key proteins in Alzheimer's disease

A-beta peptide.
Tau

180

A-Beta peptide is part of which protein

Amyloid precursor protein

Notes: Role of APP unclear but is is physiological. The processing of the precursor protein can be amyloidogenic, in which case inact ABeta protein is released and can begin forming plaques.

181

Which form of tau is pathological

Hyperphosphororylated tau is the pathological form.

182

How is amyloid plaque formed in Alzheimer's disease

Amyloid precursor protein is processed. The processing of the precursor protein can be amyloidogenic, in which case inact ABeta protein is released. If a cell produces too much A beta it releases it, the A beta can then begin forming plaques.

183

Alzheimer's disease usually starts in which lobe?

Temporal (amnesia)

Then progresses to parietal (difficulty dressing)
Then frontal (personality changes)
The occipital (difficulty recognising people)

184

What is Braack staging used for?

Staging of alzheimer's disease according to progression of tau pathology.

Stages 1 to 6. Disease starts in anterior hippocampus, spreads to posterior hippocampus, then temporal cortex, then occipital cortex.

Staging of Parkinson's using alpha synuclein. Stages 1-6.

185

Key protein in Parkinson's disease

α-synuclein

Lewy bodies are immunopositive for this

186

Causes of parkinsonism

Idiopathic Parkinson’s disease
Drug-induced Parkinsonism
Multiple system atrophy
Progressive supranuclear palsy
Corticobasal degeneration
Vascular pseudoparkinsonism
Alzheimer’s changes
Fronto-temporal neurodegenerative disorders
20 other disorders

187

Features of Pick's disease

Fronto-temporal atrophy (problems with decision making)
Marked gliosis and neuronal loss
Balloon neurons
Tau positive Pick bodies

188

Neurodegenerative diseases where Tau is a major protein

Alzheimer's
Pick's disease

Progressive supranuclear palsy
Corticobasal degeneration

189

Neurodegenerative diseases where alpha synuclein is a major protein

Parkinson' disease
Multiple system atrophy (affects glial cells)

190

The anterior pituitary secretes

Prolactin
ACTH
TSH
GH
FSH
LH

191

Pituitary adenomas are microadenomas if less than...

1cm

192

Peak age of pituitary adenoma incidence

40-60 years

193

Clinical features of growth hormone adenomas

Prepubertal children - gigantism
Adults - acromegaly
Diabetes mellitus, muscle weakness, hypertension, congestive cardiac failure

Bitemporal hemianopia

194

What is Sheehan’s syndrome

Hypopituitarism caused by ischaemic necrosis following PPH (pituitary enlarges during pregnancy).

195

Most cases of hypopituitarism caused by...

Nonsecretory pituitary adenomas – compress the other cells that do produce hormones

196

Clinical manifestations of anterior pituitary hypofunction

Children - growth failure (pituitary dwarfism)
Gonadotrophin deficiency - amenorrhea and infertility in women. Decreased libido and impotence in men
TSH and ACTH deficiency - hypothyroidism and hypoadrenalism
Prolactin deficiency - failure of post-partum lactation

197

The posterior pituitary releases...

antidiuretic hormone (ADH) and oxytocin

198

Role of calcitonin

promotes absorption of calcium by the skeletal system

199

Calcitonin is synthesised by...

Thyroid contains a population of parafollicular or ‘C’ cells that synthesize calcitonin

200

Non-thyroid disease associated causes of thyrotoxicosis

Struma ovarii (ovarian teratoma with ectopic thyroid)
Factitious thyrotoxicosis (exogenous thyroid intake)

201

Most common cause of endogenous hyperthyroidism is...

Graves disease

202

Grave's disease triad

Thyrotoxicosis
Infiltrative ophthalmopathy with exophthalmos in up to 40%
Infiltrative dermopathy (pretibibial myxoedema) in a minority of cases

203

Most cases of thyroid carcinoma are...

Anaplastic
Follicular
Medullary or
Papillary

Papillary (75-85%)
Follicular (10-20%)
Medullary (5%)
Anaplastic (

204

Ionising radiation increases the risk of.... thyroid carcinomas

papillary

205

Histological features of papillary carcinoma

May have papillary architecture (but not all)
BUT diagnosis is based on nuclear features
Optically clear nuclei
Intranuclear inclusions
May be psammoma bodies (calcification)

206

Clinical features of papillary thyroid carcinomas

Nonfunctional
Present as painless mass in neck
May present with metastasis in cervical lymph node
May present with swollen lymph nodes
10 year survival up to 90%

207

Peak age of thyroid carcinoma incidence:
Papillary
Follicular
Anaplastic
Medullary

Any age
Middle age
Elderly patients
50-60

208

Histological features of follicular thyroid carcinoma

Follicular morphology
May be well demarcated with minimal invasion or clearly infiltrative
(spreads early)

209

Follicular thyroid carcinoma usually metastasises via bloodstream to..

Bone, liver, lungs

210

Histological features of medullary thyroid carcinoma

Neuroendocrine neoplasm derived from parafollicular C cells
Calcitonin produced is broken down and deposited as amyloid. Congo red dye can be used to show amyloid

211

Medullary thyroid cancer is associated with MEN....

2

212

Which type of thyroid carcinoma usually causes death within a year?

Anaplastic

213

Parathyroid hyperplasia is associated with MEN...

1

214

Normal parathyroid gland is ...% fat

50

215

Clinical manifestations of hypoparathyroidism

Neuromuscular irritability - tingling, muscle spasms, tetany
Cardiac arrhythmias
Fits
Cataracts

216

Adrenal cortex contains.... cells
Adrenal medulla contains... cells

Cortex – epithelial cells
Medulla – neural cells

217

Zones of adrenal gland from outside to in

Zona glomerulosa
Zona fasciculata
Zona reticularis
Medulla

218

The adrenal medulla secretes

Adrenaline and noradrenaline

219

Zona glomerulosa (of adrenal gland) secretes

Aldosterone

220

Zona fasciculata (of adrenal gland) secretes

Glucocorticoids

221

Zona reticularis (of adrenal gland) secretes

Androgens and glucocorticoids

222

Most cases of Cushing's syndrome caused by

Most cases caused by administration of exogenous glucocorticoids

223

Effect of iatrogenic (administration of exogenous glucocorticoids) Cushing's syndrome on adrenals. Contrast with Cushing's disease

PCS – adrenals become hyper plastic (also with paraneoplastic cushings)
ICS – adrenal atropy

224

Most cases of primary hyperaldosteronism due to...

Bilateral adrenal hyperplasia

225

What is Waterhouse-Friderichson syndrome?

Adrenal gland failure due to bleeding into the adrenal glands, commonly caused by severe bacterial infection: Typically the pathogen is the meningococcus Neisseria meningitidis

226

3 Causes of acute adrenal insufficiency

Sudden withdrawal of corticosteroid therapy
Haemorrhage (neonates)
Sepsis with DIC (Waterhouse-Friderichson syndrome)

227

Features of adrenocortical carcinomas

Carcinomas
Rare
Usually large
More commonly associated with virilizing syndrome than adenoma

228

Phaeochromocytoma rule of 10s

10% arise in association with a familial syndrome inc. MEN 2A and 2B, von Hippel-Lindau disease and Sturge-Weber syndrome
10% are bilateral
10% are malignant
In addition 10% of catecholamine-secreting tumours arise outside the adrenal (paragangliomas)

229

What is Von Hippel-Lindau (VHL) disease?

Von Hippel-Lindau (VHL) disease is an inherited disorder causing multiple tumours, both benign and malignant, in the central nervous system (CNS) and viscera. The most common tumours are retinal and CNS haemangioblastomas, renal cell carcinoma (RCC), renal cysts and phaeochromocytoma.

230

Tumours associated with the MEN sydromes are more or less aggressive than sporadic tumours?

More aggressive

231

Dose of ACTH in short synacthen test

Describe test

250mcg

Measure cortisol + ACTH at start of test

Administer 250 micrograms synthetic ACTH by IM injection.

Check cortisol at 30 and 60 minutes.

232

Genes associated with polycystic kidney disease

PKD1
PKD2

233

Renal failure due to PKD develops at what age?

Renal failure develops from 40-70 years

234

How is acute renal failure classified (what are the categories, and examples)?

Pre-renal
Failure of perfusion

Renal
Acute tubular injury
Acute glomerulonephritis
Thrombotic microangiopathy

Post-renal
Obstruction to urine flow

235

Why does acute renal tubular injury cause failure of glomerular filtration?

Blockage of tubules by casts
Leakage of fluid from tubules to interstitium reducing flow
Secondary haemodynamic changes

236

Glomerulonephritis sufficiently severe to cause renal failure is almost always associated with...

Glomerular crescents

237

Glomerulonephritis presents with...

Presents with oliguria with urine casts containing red and white blood cells

238

Acute glomerulonephritis

Acute inflammation of glomeruli leading to reduction in glomerular filtration

239

Crescentic glomerulonephritis is....

Rapidly progressing glomerulonephritis. It is characterised by a progressive rapidly deteriorating in kidney function

240

Causes of crescentic glomerulonephritis

Immune complex: SLE, IgA nephropathy, post-infectious GN

Anti-GBM disease

Pauci-immune – associated with anti-neutrophil cytoplasm antibodies (ANCA)

241

What is pauci-immune glomerulonephritis

A type of crescentic glomerulonephritis associated with ANCAs in which only scanty deposits of immunoglobulin and complement are present in glomeruli.

The ANCA anatibodies cause neutrophil activation which leads to glomerular necrosis. The condition also involves vasculitis in other organs e.g. lungs (haemorrhage).

It is associated with causes of vascular inflammation including Wegener granulomatosis and microscopic polyangitis

242

Brief pathogenesis of renal thrombotic microangiopathy

Red blood cells may become damaged by fibrin leading to haemolysis – microangiopathic haemolytic anaemia

Diarrhoea associated
Caused by bacterial gut infection – usually E. coli
Releases toxin that targets the renal endothelium

Non-diarrhoea associated
Often associated with abnormalities of proteins that control activation of the complement pathway on endothelium
May be familial

243

Nephrotic syndrome involves proteinuria above...

3.5g/24h

244

Features of nephrotic syndrome

Breakdown of selectivity of the glomerular filtration barrier leading to massive protein leak

Key features:
Proteinuria > 3.5g/day
Hypoalbuminaemia
Oedema

Also Hyperlipidaemia

245

Systemic causes of nephrotic syndrome

Diabetes mellitus
Amyloidosis
SLE

246

Local (primary glomerular disease) causes of nephrotic syndrome

Minimal change disease
Focal and segmental glomerulosclerosis
Membranous glomerulonephritis

247

How to test for amyloid deposits (histology)

Stains with Congo red stain and looks green under polarised light (apple green birefringence)

248

Commonest amyloid proteins in kidney

AL (amyloid light chains) derived from Ig light chains
SAA: serum amyloid associated protein. Acute phase protein raised in certain chronic inflammatory conditions e.g. RA

249

80% of patients with AL (amyloid light chains) will have...

Multiple myeloma

250

Nephrotic syndrome: Histological changes of minimal change disease:
Electron microscopy
Light microscopy
immunofluorescence

Glomeruli look normal apart from loss of podocyte foot processes on electron microscopy

No changes on light microscopy

No immune deposits visible

251

Commonest cause of nephrotic syndrome in children is....

Minimal change disease

252

Which PRIMARY cause of nephrotic syndrome responds best to steroids...

Minimal change disease

253

Which PRIMARY cause of nephrotic syndrome responds least to steroids...

Membranous glomerular disease

254

Nephrotic syndrome: Histological changes of membranous glomerular disease

Electron microscopy
Light microscopy
Immunofluorescence

Light microscopy: Diffuse glomerular basement membrane thickening

Electron microscopy: Loss of podocyte foot processes and subepithelial deposits (spikey)

Immunofluorescence: Ig and complement in granular deposits along entire glomerular basement membrane

255

Nephrotic syndrome: Histological changes of focal segmental glomerularsclerosis

Electron microscopy
Light microscopy
Immunofluorescence

Electron microscopy: Loss of podocyte foot processes


Light microscopy: Focal and segmental glomerular consolidation and scarring. Hyalinosis.

Immunofluorescence: Ig and complement in scarred areas

256

Primary causes of membranous glomerulonephritis

Many associated with antibodies to phospholipase A2 receptor

257

Secondary causes of membranous glomerulonephritis

SLE
Infection
Drugs
Malignancy

258

Manifestations of thin basement membranes

Hereditary defect in type IV collagen

In most cases microscopic haematuria is the only consequence

259

Commonest form of glomerulonephritis worldwide is...

IgA nephropathy

260

Normal GFR is above...

90

261

Stages of chronic kidney disease. GFR in:
Stage 1
Stage 2
Stage 3
Stage 4
Stage 5

Stage 1: >90 (normal)
Stage 2: 60-89 (mild)
Stage 3: 30-59 (moderate)
Stage 4: 15-29 (severe)
Stage 5:

262

Top 5 causes of chronic renal failure

Diabetes (19.5%)
Glomerulonephritis (15.3%)
Hypertension & Vascular disease (15%)
Reflux nephropathy (chronic pyelonephritis) (9.5%)
Polycystic kidney disease (9.4%)

263

List 4 malignant bone tumours

Osteosarcoma
Chondrosarcoma
Ewing's sarcoma
Giant cell (borderline malignancy)

264

Features of osteosarcoma:
Age peak
Bone(s) commonly affected
Histology features
X ray appearance

Adolescence

Knee (60%)

Malignant, mesenchymal cells, ALP positive

Elevated periosteum (Codman's triangle), Sunburst appearance

265

Features of chondrosarcoma
Age peak
Bone(s) commonly affected
Histology features
X ray appearance

>40 years

Axial skeleton
Femur/ tibia/ pelvis

Malignant chondrocytes

Lytic lesion with fluffy calcification, axial skeleton

266

Features of Ewing's sarcoma
Age peak
Bone(s) commonly affected
Histology features
X ray appearance

267

Genetic mutation found in most cases of Ewing's sarcoma

Translocation 11:22 (which fuses the EWS gene of chromosome 22 to the FLI1 gene of chromosome 11)

268

Presentation of Ewing's sarcoma

Localized pain, swelling, and sporadic bone pain with variable intensity

Signs and symptoms of systemic inflammatory illness such as fever, anaemia and leucocytosis.

269

Presentation of osteosarcoma

Pain that may be worse at night
Pain in femur or immediately below the knee
Pathological fractures

270

Signs/symptoms of chondrosarcoma

Back or thigh pain
Sciatica
Bladder Symptoms
Unilateral oedema

271

Malignant bone tumours more common in middle age/older people

Chondrosarcoma

272

Features of Giant cell tumour of bone
Age peak
Bone(s) commonly affected
Histology features
X ray appearance

20-40 years (F>M)

Knee epiphysis

Osteoclast tyoe multinucleate giant cells on background of spindle/ovoid cells. Usually NOT malignant.

Lytic/lucent lesions right upto articular surface

273

What is osteosarcoma?

An osteosarcoma is a cancerous tumor in a bone. Specifically, it is an aggressive malignant neoplasm that arises from primitive transformed cells of mesenchymal origin (and thus a sarcoma) and that exhibits osteoblastic differentiation and produces malignant osteoid

274

What is chondrosarcoma?

Chondrosarcoma is a cancer composed of cells derived from transformed cells that produce cartilage. Resistant to chemotherapy and radiotherapy.

275

What is Ewing's sarcoma?

A malignant small, round, blue cell tumor. It is a rare disease in which cancer cells are found in the bone or in soft tissue. The most common areas in which it occurs are the pelvis, the femur, the humerus, the ribs and clavicle (collar bone)

276

Features of osteoid osteoma (adolescent)
Bone affected
Special features
Histology
X ray

Tibia/femur

Small benign bone forming lesion, night pain releived by aspirin.

Normal bone

Radiolucent nidus with sclerotic rim

277

Features of osteoma (middle age)
Bone affected
Special features
Histology
X ray

Head and neck

Bony outgrowths attached to normal bone
Gardners syndrome (a subtype of FAP): multiple osteomas, GI polyps, and epidermoid cysts

Normal bone

Radiolucent nidus with sclerotic rim

278

Features of osteochondroma
Age affected
Bone affected
Special features
Histology
X ray

Adolescent (develop during skeletal growth and cease when the growth plates fuse at puberty)

Long bones

Cartilage capped bony outgrowth
Hereditary multiple exostoses: multiple exostoses (bony spurs), short stature, and bone deformities.

Cartilage capped bony outgrowth

Well defined bony protuberance from bone.

279

What is diaphyseal aclasis?

Hereditary multiple exostoses (HME or MHE), also known as diaphyseal aclasis, is a rare medical condition in which multiple bony spurs or lumps (also known as exostoses, or osteochondromas) develop on the bones of a child. HME is synonymous with multiple hereditary exostoses and multiple osteochondromatosis

280

Features of enchondroma
Age affected
Bone affected
Special features
Histology
X ray

Middle age

Hands

Benign tumours of cartilage.
Ollier's syndrome: multiple enchondromas
Maffuci's syndrome: multiple enchondromas and haemangiomas

Normal cartilage

Lytic lesion, cottom wool calcification, expansile, O ring sign.

281

What is Ollier's syndrome?

Multiple enchondromas

282

What is Maffuci's syndrome?

Multiple enchondromas and haemangiomas

283

Features of fibrous dysplasia
Age affected
Bone affected
Special features
Histology
X ray

Middle age (F>M)

Femur

A bit of bone is replaced by fibrous tissue.
Albright syndrome: polyostotic dysplasia, cafe au lait spots, precocious puberty.

Chines letters (misshapen bone trabeculae)

Soap bubble osteolysis
Shepherd's crook deformity

284

Features of sarcoidosis (by organ system)

Skin: Lupus pernio, erythema nodosum

CNS: Meningitis, cranial nerve lesions

Eyes: Uveitis, keratoconjunctivitis

Parotids: Bilateral enlargement

Lungs: BHL (bilateral hilar lymphadenopathy), fibrosis, lymphocytosis (CD4+ in BAL)

Liver: Hepatitis, cholestasis & cirrhosis

285

3 key lab features of sarcoidosis

Hypergammaglobulinaemia
Raised ACE
Hypercalcaemia (due to Vit D hydroxylation by activated macrophages)

286

Clinical features of Kawasaki's disease

Fever
Erythema of palms & soles, desquamation
Conjunctivitis
Lymphadenopathy
Coronary arteries may be affected (MI)
otherwise disease is self limiting

287

Features of polyarteritis nodosa

Necrotising arteritis
Polymorphs, lymphocytes, eosinophils
Arteritis is focal and sharply demarcated
Heals by fibrosis
More often renal and mesenteric arteries

Nodular appearance on angiography (small aneurysms

288

Polyarteritis nodosa usually happens in which arteries?

renal and mesenteric arteries

289

Cause of histological ‘Onion skin’appearance in scleroderma skin histology

Intimal thickening of small arteries

290

What is dyskaryosis

Abnormal cytologic changes of squamous epithelial cells characterized by hyperchromatic nuclei and/or irregular nuclear chromatin. May be followed by the development of a malignant neoplasm.

291

Cell type in the ectocervix

The ectocervix is covered with nonkeratinized stratified squamous epithelium

292

Precancerous changes in the ectocervix squamous cells is known as

Cervical intraepithelial neoplasia, CIN

293

Grades of cervical intraepithelial neoplasia
Importance

CIN1
CIN2
CIN3

The risk of developing cancer is related to the grade of CIN. Most cases of CIN1 will go back to normal without any treatment.
CIN2 and CIN3 may develop into cancer in some cases, if left untreated

294

Cervical Glandular Intraepithelial Neoplasia is

Pre-cancerous change involving the inner glandular cells of the cervix.

295

Women of what ages are invited for cervical screening

25-65

296

Cervical screening is repeated every ... years

3-5

297

NHS cervical screening programme triage system

Low grade and borderline abnormalities have a HR-HPV test.
If HR-HPV positive – refer to colposcopy
If HR-HPV negative – routine recall
High grade abnormalities refer to colposcopy – no HR-HPV test

298

90% of genital warts caused by which HPV subtypes?

6 and 11

299

HPV subtype that cause most cervical cancers

16 and 18
Approx 70% of cervical cancers

300

Effect of smoking on HPV

Smoking can make clearing HPV from the body less effective and can make clearance of minor smear abnormalities slower and less efficient

301

General uses of fine needle aspirations (cytology)

Immediate on site evaluation
Primary diagnosis
Rules out other diagnoses
Staging
Post adjuvant therapy staging
Differentiate a new primary from recurrence

302

Advantages of cytology fine needle aspiration

Accurate
Quick
Acceptable to patient
Rapid turnaround time
Organised into fast access clinics run by cytopathologists for aspiration of palpable swellings

Cheap
Triage material for ancillary tests
On-site diagnosis allows immediate patient management