Histopathology

Question 1

Name 3 syndromes which predispose to CNS tumours, and their mode of inheritance.

Answer 1

Neurofibromatosis 1/2, tuberous sclerosis 1/2, von Hippel lindau, turcot’s syndrome
Autosomal dominant

Question 2

What category of tumours are most and 2nd most common primary CNS tumours?

Answer 2

Gliomas

Meningiomas

Question 3

Name 2 common glial tumours seen in adults. Are they low or high grade?

Answer 3

Astrocytoma, oligodendroglioma.

High grade.

Question 4

Which mutations are associated with diffuse and compressive gliomas?

Answer 4

Diffuse: IDH mutations
Compressive: MAPK pathway (BRAF gene)

Question 5

What are the features of pilocytic astrocytoma?

Answer 5

Compressive glioma
Grade I
1st/2nd decade of life
Hallmark: Piloid ‘hairy’ cell – piloid astrocytes
Often Rosenthal fibres and granular bodies
Half have BRAF mutation

Question 6

What do astrocytomas eventually transform into?

Answer 6

Glioblastomas

Question 7

Which is the most aggressive and frequent diffuse glioma?

Answer 7

De novo glioblastoma (wildtype IDH)

Question 8

What is the hallmark of oligodendrogliomas?

Answer 8

Round cells with clear cytoplasm (fried egg appearance)

Question 9

What is the most and 2nd most frequent brain tumour in children?

Answer 9

Pilocystic astrocytoma

Medulloblastoma

Question 10

Which CNS tumour originates from neuroepithelial precursors of the cerebellum/dorsal brainstem?

Answer 10

Medulloblastoma

Question 11

Which CNS tumour is responsive to steroids?

Answer 11

Glioblastomas

Question 12

What are the 3 types of cerebral oedema?

Answer 12

Vasogenic, cytotoxic hydrocephalic

Question 13

What is non-communicating and communicating hydrocephalus?

Answer 13

Non-communicating: obstruction to CSF flow

Communicating: abnormal reabsorption of CSF into venous sinuses

Question 14

What are the 3 types of brain herniation?

Answer 14

Subfalcine, transtentorial/uncal, tonsillar (coning)

Question 15

What is the most common cause of haemorrhagic stroke?

Answer 15

Hypertension

Question 16

How does the presentation of bleeding differ between AVMs and cavernous angiomas?

Answer 16

AVM: high pressure, massive bleed

Cavernous angioma: low pressure, recurrent bleeds

Question 17

Most common causes subarachnoid haemorrhage?

Answer 17

Berry aneurysm rupture

Question 18

Most common type of stroke?

Answer 18

Ischaemic

Question 19

What type of trauma most commonly causes comas?

Answer 19

Diffuse axonal injury

Question 20

Name some human prion diseases

Answer 20

o Creutzfeldt-Jakob disease
o Gerstmann-Straussler-Sheinker syndrome
o Kuru
o Fatal familial insomnia

Question 21

Which is the transmissible protein in prion diseases?

Answer 21

PrP

Question 22

How are beta amyloid plaques formed in Alzheimer’s disease?

Answer 22

APP (amyloid precursor protein) cleaved but produces intact beta amyloid proteins, which condenses and forms plaques

Question 23

What are histological features of alzheimers?

Answer 23

Beta amyloid plaques, neurofibrillary tangles, hyperphosphorylated tau

Question 24

What is the histological feature of parkinson’s disease?

Answer 24

Lewy bodies made of alpha synuclein

Question 25

What are the features of pick's disease?

Answer 25

* Frontotemporal atrophy * Marked gliosis and neuronal loss * Balloon neurons * Tau positive pick bodies

Question 26

Which type of thyroid carcinoma is most closely associated with ionising radiation?

Answer 26

Papillary

Question 27

Which type of thyroid carcinoma typically metastasises to the bone?

Answer 27

Follicular

Question 28

Which type of thyroid carcinoma is associated with MEN?

Answer 28

Medullary

Question 29

Which type of thyroid carcinoma is the most aggressive?

Answer 29

Anaplastic

Question 30

What are the majority of renal calculi made of, and what causes it?

Answer 30

Calcium oxalate | Absorptive hypercalciuria, renal hypercalciuria

Question 31

Which 3 compounds are renal calculi most commonly made of?

Answer 31

Calcium oxalate, magnesium ammonium phosphate, uric acid

Question 32

What are the common sites for renal calculi impaction?

Answer 32

PUJ, pelvic brim, VUJ

Question 33

Benign renal neoplasms: 1. Mahogany brown, central area of scarring, nests of cells with loose oedematous connective tissue 2. <5mm epithelial tumours 3. Composed of fat, smooth muscle and blood vessels

Answer 33

1. Oncocytoma 2. Papillary adenoma 3. Angiomyolipoma

Question 34

3 commonest types of malignant renal cell carcinoma?

Answer 34

Clear cell, papillary, chromophobe

Question 35

Which grading system is used for renal cell carcinoma?

Answer 35

Fuhrman system

Question 36

Which malignant neoplasm has the typical histological appearance of small round blue cells?

Answer 36

Nephroblastoma (Wilm's tumour)

Question 37

What are the management options for benign prostatic hyperplasia?

Answer 37

o Alpha blockers – doxazosin o 5a reductase inhibitor – finasteride, duatseride o Transurethral resection of the prostate (TURP)

Question 38

What is the strongest prognostic indicator for prostate cancer?

Answer 38

Gleason score

Question 39

What is the most important risk factor for testicular germ cell tumours?

Answer 39

Cryptorchidism

Question 40

Why do testicular germ cell tumours have such a good prognosis?

Answer 40

high sensitivity to modern platinum-based chemotherapy regimes

Question 41

what are the low and high risk strains of HPV?

Answer 41

Low: 6, 11 High: 16, 18

Question 42

What is the characteristic cytological feature of HPV infection

Answer 42

Koilocytes

Question 43

How does a complete and partial hydatidiform mole form?

Answer 43

Complete: Empty egg + haploid sperm which duplicates, or empty egg + 2 haploid sperm Incomplete: Normal egg + 2 haploid sperm, or normal egg + 1 diploid sperm

Question 44

Commonest type of aggressive ovarian carcinoma?

Answer 44

Serous

Question 45

Which ovarian cancers are associated with endometriosis?

Answer 45

Clear cell | Endometrioid

Question 46

What are krunkenberg tumours and their characteristic features?

Answer 46

2ry ovarian tumours Bilateral metastases Composed of mucin producing signet ring cells Commonly gastric or breast origin

Question 47

Which is a cancer that commonly metastasises to the ovaries?

Answer 47

Colorectal carcinoma

Question 48

What are 2 important mutations involved in hereditary ovarian cancer?

Answer 48

BRCA, HNPCC

Question 49

Which drug causes SLE and what test can be used to determine it?

Answer 49

Hydralazine | Anti-histone antibody

Question 50

Which test is used to screen for SLE?

Answer 50

ANA

Question 51

Which specific autoantibodies are used to diagnose SLE?

Answer 51

Anti-dsDNA, anti-smith, anti-histone

Question 52

Which antibodies are present in diffuse and limited scleroderma?

Answer 52

Diffuse: anti-topoisomerase Limited: anti-centromere

Question 53

What are the immunofluorescence patterns seen with anti-nuclear antibody staining and what conditions do they represent?

Answer 53

SLE: whole nucleus Systemic sclerosis: nucleolus Mixed connective tissue disease: speckled

Question 54

What are some chemical pathological features of sarcoidosis?

Answer 54

Raised ACE Hypercalcaemia Hypergammaglobulinaemia

Question 55

What are some features of polyarteritis nodosa and what virus is it associated with?

Answer 55

``` Medium vessel vasculitis Necrotizing arteritis Gut ischaemia, renal impairment Beaded appearance due to aneurysms on angiogram Hepatitis B ```

Question 56

What is the antibody and target associated with 1. granulomatosis with polyangiitis? 2. eosinophilic granulomatosis with polyangiitis?

Answer 56

1. C-ANCA against proteinase 3 | 2. P-ANCA against myeloperoxidase

Question 57

What are the triads associated with: 1. granulomatosis with polyangiitis? 2. eosinophilic granulomatosis with polyangiitis?

Answer 57

1. ENT, lungs, kidneys | 2. asthma, eosinophilia, vasculitis