Histp Flashcards
1
Q
MM fetures
A
2
Q
Lentigo Maligna
A
3
Q
Superfical spreading melanoma
A
irregular borders with variaton in colour
4
Q
Nodular malignant melanoma
A
5
Q
Acral Lentigious
A
6
Q
Nikolsky Sign
A
7
Q
What is mycosis fungiodes?
A
Mycosis fungoides
Mycosis fungoides is a condition in which the skin is infiltrated by patches or lumps composed of white cells called lymphocytes.
it is associated with a pre-existing contact allergic dermatitis or infection with a retrovirus.
The name mycosis fungoides is historical and confusing: cutaneous T-cell lymphoma has nothing to do with fungal infection.
8
Q
Palisaiding is a feature of?
A
Nuclei align in the outermost layer BCC
(1) Peripheral palisading
(2) Rim of mucin
(3) Dermal nests of basaloid cells
(4) Intact epidermis
9
Q
XR osteomylitis features
A
Periosteal reaction
Involcurum
Irregular Lytic Lesions
Sequestra
10
Q
erythema chronica migrans
A
11
Q
Osteoid Osteoma
A
Plain radiograph in a 25-year-old man with cortical osteoid osteoma. Lateral view of the right tibia shows a radiolucent nidus surrounded by fusiform cortical thickening.
12
Q
Ostoid OSteoma
A
Radionuclide bone scan in a 25-year-old man with cortical osteoid osteoma (same patient as in the previous image) shows focal intense uptake of radioisotope corresponding to the site of radiographic abnormality, which is consistent with osteoid osteoma.
13
Q
Osteoma affects which body part?
A
Head and Neck
14
Q
Bony outgrowths attachted to normal bone
+ colon polyps
name the condition
A
Gardner syndrome
15
Q
What is osteoblastoma?
What does X-ray shwos
A
Similar to osteoid osteomas.
Osteoblastoma is a gaiant osteoid osteoma.
XR shows speckled mineralisation.
16
Q
Fluoroscopy
Features on barium small bowel follow-through include:
Crohns
A
aphthous ulcers initially
when severe leads to cobblestone appearance
may lead to sinus tracts and fistulae
pseudodiverticula formation: due to contraction at the site of ulcer with ballooning of the opposite site
string sign: tubular narrowing due to spasm or stricture depending on chronicity
17
Q
Pancreatic divisium
A
Failure of fusion of ventral and dorsal pancreatic duct system.
18
Q
Annular Pancreas
A
19
Q
Island of Pancreas
A
20
Q
A
21
Q
Asthma Histopathology
A
22
Q
Types of the renal cell carcinoma
Which one is the most common?
Which occurs in the dialysis patients?
A
Clear cell - the most common
Papillary - the dialysis patients
Chromophobe - pale eosinophylic cells
23
Q
Fitz Hugh Curtis Syndrome
A
24
Q
Bowens Disease
A
flat red scary patches on sun-exposed areas
BM intact
25
Macroscopic histopathology of endometriosis
Macroscopically:
● red-blue to brown nodules - “powder burns”
● “chocolate cysts” in ovaries (endometriomas)
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adenomyosis
27
Histolory of the serous ovarian tumor
Psamomma bodies
Psammoma bodies are round microscopic calcific collections. It is a form of dystrophic calcification. Necrotic cells forms the focus for surrounding calcific deposition. They have a lammelated concentric calcified structure, sometimes large enough to be seen on CT.
28
What is pseudomyxoma peritonei?
Pseudomyxoma peritonei is a very rare type of cancer that usually begins in your appendix as a small growth, called a polyp. ... It then spreads cancerous cells to the lining of the abdominal cavity (the peritoneum).
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squamo-columnar junction
30
Pretibilal myoxydema
What is pretibial myxoedema?
Pretibial myxoedema is a form of diffuse mucinosis in which there is an accumulation of excess glycosaminoglycans in the dermis and subcutis of the skin. Glycosaminoglycans, also called mucopolysaccharides, are complex carbohydrates that are important for tissue hydration and lubrication. The main glycosaminoglycan in pretibial myxoedema is hyaluronic acid, which is made by cells called the fibroblasts.
Pretibial myxoedema is also known as localised myxoedema, thyroid dermopathy, and infiltrative dermopathy.
31
What is Lambert Eaton
The weakness from **LEMS** typically involves the muscles of the proximal arms and legs (the muscles closer to the trunk). In contrast to myasthenia gravis, the weakness affects the legs more than the arms. This leads to difficulties climbing stairs and rising from a sitting position. Weakness is often relieved temporarily after exertion or physical exercise. High temperatures can worsen the symptoms. Weakness of **the bulbar muscles** (muscles of the mouth and throat) is occasionally encountered.[1] Weakness of the eye muscles is uncommon. Some may have double vision, drooping of the eyelids and difficulty swallowing,[1]
32
Anterior cerebral artery infarct
weakness in contralateral upper and lower linb
33
A 60-year-old patient presents with **chronic left-sided abdominal discomfort** and the passage **of fresh blood from the rectum**. He denies **weight loss** and on examination has **no palpable masses**. However a colonoscopy reveals **pouches of mucosa** extruding **through the muscle layer.**
**Diverticular Disease**
34
**Hyperplastic** Polyp
Seen at 50-60yrs, thought to be caused by shedding of epithelium cell
buildup
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**_Hamarteous Polyps_**
Found sporadically in some genetic/acquired syndromes
**Juvenile polyps** are **focal malformations of mucosa and lamina propria,** vast
majority in those \<5yrs old, mostly in rectum bleeding. Usually solitary, but
up to 100 found in **juvenile polyposis (AD) t**hat may require colectomy to
**stop haemorrhage.**
Also seen in **Peutz-Jeghers syndrome (AD - LKB1) = multiple polyps,**
mucocutaneous hyperpigmentation, freckles around mouth, palms and soles.
Have increased risk of intussusception and of malignancy regular
surveillance of GI tract, pelvis and gonads.
36
A 62 year old housewife returns to your outpatient clinic following another incidence of the **_passing of blood._** Previous **_sigmoidoscopy, DRE and barium enema’s_** have failed to identify any lesion and she denies weight loss and diarrhoea. However, blood tests show **_a microcytic anaemia._**
**Angiodysplasia:**
**Colonic angiodysplasia** is a common cause **of acute** or **chronic rectal bleeding** and ***iron deficiency anaemia**.* *Angiodysplasias are tiny - 1-5 mm in diameter -* **h*amartomatous capillary lesions i***n the colonic wall which produce bleeding out of proportion to their size. ***They are believed to be acquired**,* possibly as a result of tension on the veins where they pass through the muscularis. ***Diagnosis*:** subtraction mesenteric arteriography may demonstrate bleeding if rapid colonscopy: may visualise lesion ***Treatment: electrical coagulation via the colonoscope** r*esection of segment of colon if the above is unsuccessful
37
A 73 year old woman attends complaining of recent onset of tiredness. She is pale and **has hepatosplenomegaly** and **generalised lymphadenopathy** in the **neck, axillae and groins.**
**Chronic lymphocytic leukaemia:**
**Clinical features
Symmetrical _painless lymphadenopathy_
BM failure - _anaemia & thrombocytopenia symptoms, recurrent infections (50% deaths)_
_ Hepatomegaly & splenomegaly (less prominent)_**
**_Why not CML?_**
A myeloproliferative disease (others discussed later)
Middle-aged (40 to 60); median survival 3-5 years.
Often diagnosed on routine bloods (large number of differentiated neutrophils), now very
successfully treated in the majority
O/E: splenomegaly - often massive Why not AML? * **Lymphadenopathy less common** * BM function failure – Anaemia, Thrombocytopenia (bleeding), Neutropenia (infection) * Organ infiltration – hepatomegaly, splenomegaly, lymphadenopathy, bone pain, * CNS, skin, gum hypertrophy
Middle-aged (40 to 60); median survival 3-5 years.
Often diagnosed on routine bloods (large number of differentiated neutrophils), now very
successfully treated in the majority
O/E: splenomegaly - often massive Why not AML? * **Lymphadenopathy less common** * BM function failure – Anaemia, Thrombocytopenia (bleeding), Neutropenia (infection) * Organ infiltration – hepatomegaly, splenomegaly, lymphadenopathy, bone pain, * CNS, skin, gum hypertrophy
38
How to disntiguish between Hep B and Hep C?
Can hep B and hep C be distinguished clinically?
* the clinical course of HepC is milder than HepB or HepA and is frequently asymptomatic.
* HBV is much more easily transmissible (sexually or via blood products/needles) than HCV.
* HepC would be persistent infection and chronic hepatitis. Finally, the AST:ALT ratio can be useful in differentiating alcholic from viral hepatitis. AST:ALT \< 1 is indicative of viral hep, as in this case, while AST:ALT \> 2 is indicative of alcoholic hep.
* Both are blood bourne and IV drug users get them both!
* Hep C has potentially a much longer incubation period (it is asymptomatic until the chronic phase)
* We didn't used to test blood for Hep C. So a patient could present with symptoms of Hep C 10 years after a blood transfusion. Hep B has a shorter incubation period (it presents more acutely). Risk of transmission of blood bourne viruses via needlesticks: Hep B: 1 in 3 Hep C: 1 in 30 HIV: 1 in 300
39
A 35 year old woman presents with lower abdominal pain. She complains of difficulty in passing urine and has found blood in her urine on two occasions
Cystitis
40
A 30 year old woman presents with l**ower abdominal pain** accompanied **by fever.** She has been using **an intra uterine contraceptive device** since her wedding **three years ago.**
**Why?**
**_Endometritis_ = lower abdo pain + fever + intra uterine device.**
**Note that this is not the same as endom*etriosis.***
Presence of endometrial glands or stroma in abnormal locations outside the uterus
3 theories of aetiology: regurgitant/implantation from retrograde menstrual flow of
endometrial cells; metaplastic transformation of coelomic epithelial cells; vascular
**Clinically:**
● Pelvic pain, dysmenorrhoea, deep dyspareunia, ↓fertility
● Cyclical PR bleeding, haematuria, bleeding from umbilicus (depending on site of
endometrial deposits)
● Nodules/tenderness in vagina, posterior fornix or uterus; immobile uterus which is retroverted in advanced disease
41
A 23 year old presents with worsening vaginal bleeding and abdominal pain. This started about a month ago and she has not had sex since the bleeding started. She has missed her last two periods. Passing water and defecation are painful, and she has noticed some pain in her shoulders.
Ectopic pregnancy
42
Arias-Stella phenomenon What is it? How does it presents clinically?
43
Differentiation of this is regulated via the RANK gene product.
Osteoclast
44
Covers cortical surface of bone and delivers blood supply.
periosteum
45
This type of bone is 80-90% calcified and its function is mainly mechanical and protective.
Cortical
46
trabecular or spongy bone tissue [is the internal tissue of the skeletal bone and is an open cell porous network. Thin formations of osteoblasts covered in endosteum create an irregular network of spacesknown as trabeculae. Within these spaces are bone marrow and hematopoietic stem cells that give rise to platelets, red blood cells and white blood cells.[7] T
cancellous
47
bone, which has a regular parallel alignment of collagen into sheets ("lamellae") and is mechanically strong.
lamellar bone
48
plural endostea) is a thin vascular membrane of connective tissue that lines the inner surface of the bony tissue that forms the medullary cavity of long bones.
Endosteum
49
The shaft or central part of a long bone.
Diaphysis
50
**Methaphysis**
The **metaphysis** is the wide portion of a long bone between the epiphysis and the narrow diaphysis.
It contains the growth plate, the part of the bone that grows during childhood and as it grows, it ossifies near the diaphysis and the epiphyses.
51
An osteocyte, a star-shaped type of bone cell, is the most commonly found cell in mature bone tissue, and can live as long as the organism itself.[1]
Although osteocytes have reduced synthetic activity and (like osteoblasts) are not capable of mitotic division, they are actively involved in the routine turnover of bony matrix, through various mechanosensory mechanisms.
Osteocyte
52
Histological findings are of increased osteoid volume with widened osteoid seams and reduced mineralization
osteomalacia
53
Bone biopsy reveals sheets of cells with small, primitive nuclei and scanty cytoplasm. A positive immunoreactivity is seen with the MIC2 (CD99) antibody.
Ewing Sarcoma
54
literally "stone bone", also known as marble bone disease and Albers-Schönberg disease, is an extremely rare inherited disorder whereby the bones harden,
osteopatrosis
55
briitle bone disease. It results in bones that break easily. The severity may be mild to severe.
a blue tinge to the whites of the eye, short height, loose joints, hearing loss, breathing problems, and problems with the teeth.[1][3]
The underlying mechanism is usually a problem with connective tissue due to a lack of **type I collagen**
Osteogenesis imperfecta
56
is a dominantly inherited condition caused by a mutation of the calcium sensing receptor.
The result is that the kidney reabsorbes calcium very avidly as a primary problem. This results in hypocalciuria and hypercalcaemia.
Because the parathyroid gland calcium receptor also does not work, the parathyroids continue to secrete excess PTH despite the high calcium, so it looks just like primary hyperparathyroidism.
However removing the parathyroids does not help the calcium, as the primary cause of trouble is in the kidney. In true primary hyperparathyroidism however, the calcium that is filtered hugely exceeds the tubular maximum for calcium, so there is no chance of reabsorption, so the urinary calcium is high, with resulting renal stones (which NEVER happens in FHH)
. There are many surgeons who have operated wrongly on FHH patients, removing the parathyroid only to find the calcium does not get better. As a consequence, we have written guidelines to surgeons, reminding them of the importance of measuring urine calcium in such a patient before removing the parathyroid gland.
Familial hypocalcuric hypercalcaemia
57
osteotitis fibrosa cystica
where is it seen?
is a skeletal disorder resulting in a loss of bone mass, a weakening of the bones a**s their calcified supporting** structures are replaced **with fibrous tissue** and the formation **of cyst-like brown tumors** in and around the bone.
1st hyperparathyroidism
2nd Renal osteodystrophy
58
**Chronic Bronchitis**
60 year old life long smoker presents to her GP with a **10 day history of worsening shortness of breath,** **cough and wheeze**.
Her cough produces **a greenish sputum**.
On examination she is tachypnoeic and very cyanosed. Auscultation of her chest reveals **a harsh polyphonic wheeze** and signs of **a right lower lobe pneumonia.**
This lady has developed **type II respiratory** failure secondary to what pulmonary disease?
59
A 35 year old woman presents with weight loss and tiredness.
Her GP examines her and finds that she also has a fine tremor and is sweaty. Investigations: TSH \<0.01, Free T4 36.0.
There i**s low uptake on a technetium scan**. The aetiology could be viral or autoimmune.
**Subacute thyroiditis**
**Hyperthyroidism + Low uptake**
**Why?**
Thyroditis means simply inflammation of the thyroid, which might lead to increased thyroid production and higher level of the thyroid hormones.
**This would be characterised by**
**Subacute DeQuervains thyroiditis**: self-limiting post **viral painful goiter**
**Post partum**
60
A 42 year old woman presents to her GP suffering from **mild depression.** Her thyroid function is investigated: TSH 6.5, Free T4 5.6
Plasma cell infiltration & goitre. Elderly females. May be initial ‘Hashitoxicosis’. ++ Autoantibody titres
Antibodies to Thyroglobulin and Thyroperoxidase
**Hashimoto's thyroiditis**
Plasma cell infilitration and goitre.
61
Benign hemispherical neoplasms projecting from the endometrial mucosa into the uterine cavity. They can cause uterine bleeding and infertility and are commonest at the time of menopause
.
Endometrial Polyps
62
The most common cancerous neoplasm of the female genital tract. It appears most frequently between the ages of 55 and 65, with obesity, diabetes, hypertension and infertility being the major risk factors.
Postmenopausal bleeding untill proven otherwwise
Endometrial carcinoma
63
Neoplasms found in women aged between 30 and 40 as ovarian masses, usually unilateral. They are usually benign (90%) and are often the largest ovarian neoplasm.
mucinous tumor
64
Usually arises from CIN
Most commonly s**quamous cell carcinoma (70-80%),** but ~20% are adenocarcinomas, adenosquamous carcinomas and others.
Invasion through the basement membrane marks the change from **CIN to carcinoma**
Clinically: post-coital bleeding, intermenstrual bleeding, postmenopausal bleeding, discharge, pain. Staged using FIGO system
Majority of the lesions are benign and common presenting symptoms include pain
(mastalgia/ mastodynia), palpable masses and/or nipple discharge.
cervical carcinoma
65
***Most common type***
Mimics tubal epithelium i.e. **columnar epithelium**
**Psammoma bodies** common most common malignancy affects women **aged 30-40yrs**
**serous cystadenoma**
66
Squamous epithelium mixed with intestinal epithelium
Mature cystic teratoma
67
Fibrous tissue containing spindle cells and lipid
Thecoma
68
**Produce E2**
Look for **oestrogenic effects** – **irregular menstrual cycles, breast enlargement, endometrial/breast cancer**
Thecoma
69
Malignant signet ring cells containing mucin
Krukenberg tumour
Whilst Krukenberg tumours are metastases from a GI primary tumour,
70
Germ cells mixed with lymphocytes
dysgerminaoma
71
the most common malignacy in young women
sensitive to radiotheraphy
dysgerminaoma
72
Secrete androgens
Look for defeminisation (breast atrophy) and virilisation (hirsutism, deepened voice, enlarged clitoris)
Sertoli-Leyding cell tumors.
73
**intracellular glycogen**
* *Hobnail appearance**
* *malignant** with **poor prognosis**
**clear cell tumors**
74
**Skin pigmentation, nail dystophy and oral leukoplakia + BM failure** are associated with?
What is the chromosomal problem?
What other causes of congenital bone marrow conditions do you know?
Dyskariosis Congenita
Telomere Shortening
Fanconi Anemia
75
**aplastic anaemia + short stature + cafe au lait spots, common in Askazni Jews**
***_Fanconi Anemia_***
***_Autosomal Recessive_***
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