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MRCS Part A (KF edition) > Pathology > Flashcards

Pathology Flashcards

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1
Q

What is Trotter’s triad?

A

Diagnosis of Nasopharyngeal carcinoma

  • Unilateral conductive hearing loss
  • Ipsilateral facial and ear pain
  • Ipsilateral paralysis of soft palate

Association with EBV infection

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2
Q

What is the effect on APTT, PT and bleeding time in von Willebrands disease?

A

APTT: Increased
PT: Normal
Bleeding time: Increased

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3
Q

What is Lynch syndrome?

A

Characterised by aggressive right sided colonic malignancy and Endometrial cancer

Caused by microsatellite instability of DNA repair genes

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4
Q

What are the cell cycle phases and what happens in each phase?

A

G1: Cell grows, normal functioning

S: Chromosomes are duplicated

G2: cell checks the duplicates for errors preparing for cell division

Mitosis

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5
Q

At what part of the cell cycle does p53 (tumour suppressor gene) act on?

A

Inhibits progression to S phase from G1

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6
Q

What occurs in a Type 1 hypersensitivity reaction and which Ig is mediated by?

A

Occurs due to MAST CELL degranulation

Mediated by IgE

E.g. anaphylaxis, asthma

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7
Q

What occurs during a Type 2 hypersensitivity reaction and what Ig is it mediated by?

A

Due to Ab directed towards antigens on surface of cells (e.g. transfusion reactions, autoimmune haemolytic anaemia)

Mediated by IgG

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8
Q

What occurs in a Type 3 hypersensitivity reaction and what Ig is it mediated by?

A

Due to formation of immune complexes (e.g. SLE, glomerulonephritis)

Mediated by IgG

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9
Q

What is a type 4 hypersensitivity?

A

Delayed reaction mediated by T-lymphocytes

Takes 48-72hrs to see effects (e.g. contact dermatitis, Graft vs host disease)

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10
Q

What occurs in a Type 5 hypersensitivity reaction?

A

Due to AUTO-ANTIBODIES in autoimmune conditions

E.g. Graves’ disease, Myasthenia gravis etc

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11
Q

How does a Hyperacute transplant rejection present and why?

A

Presents within MINUTES with widespread thrombosis of graft vessels - Graft MUST be removed

Due to host Ab binding to antigens on donor cells (Type 2 hypersensitivity)

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12
Q

What is an Acute Transplant rejection and its underlying pathogenesis, and how is it treated?

A

Occurs in weeks to months

T cells (CD8) and lymphocyte infiltration

Treated with high dose steroids and immunosuppression

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13
Q

What are the most common HLA found on WBCs in organ rejection?

A

HLA A, B, DR

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14
Q

What type of hypersensitivity reaction is Acute haemolytic transfusion reaction and how does it present?

A

Type 2 hypersensitivity

PC: Fever, Hypotension, Tachycardia and Tachypneoa, jaundice, Pain presents within an hour

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15
Q

What are the 2 main types of Lung cancer and their sub types?

A

Non-small cell lung ca
- Adenocarcinoma
- SCC
- Large cell

Small cell lung lung ca

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16
Q

What are features of small cell lung ca and what population is it strongly associated with?

A

Cells with near-endocrine differentiation (secrete neuroendocrine hormones)

Typically arise centrally affecting the larger airways (bronchi). Metastasis early on.

Strongly associated with SMOKERS

Chemosensitive but rarely results in long lasting remission

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17
Q

What type of lung ca has the best prognosis?

A

SCC (NSCLC)

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18
Q

What is the most common lung ca?

A

Adenocarcinoma

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19
Q

What is the most common lung ca in smokers?

A

SCC (NSCLC)

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20
Q

What lung ca is commonly associated with hypercalcaemia and Pancoast syndrome?

A

SCC (NSCLC)

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21
Q

What is neoplasia?

A

Similar to hyperplasia but is abnormal multiplication and starting to lose normal shape

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22
Q

What is dysplasia and what can this be in response to?

A

Change in the normal shape, size and organisation

Usually a response to Chronic irritation or inflammation (i.e smoking or inflammation)

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23
Q

What is metaplasia?

A

Change in cell type. Changes can be reversible at this stage if stimulus is removed, otherwise it progress to anaplasia

High risk for malignancy

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24
Q

What is anaplsia?

A

Reversal in differentiation of cell OR loss of structural & functional differentiation

Characteristic of cancerous tumours

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25
What 4 changes in cells are seen in anaplasia?
- Loss of polarity - Pleomorphism (variation in size and shape - often bigger) - Nucleas:Cytoplasmic ratio (nuclei disproportionately enlarged to cell size) - Anisonucleosis (variation in size + shape of nuclei)
26
What is the distribution of dystrophic calcification and what conditions can it be associated with?
Tends to be localised in abnormal (DISEASED) tissue (e.g. calcific aortic stenosis Associated with TB, Chronic abscesses, Infarcts, Thrombi, CMV, Atherosclerosis Normal serum calcium
27
What type of fibril protein is deposited in inflammatory conditions?
Serum Amyloid A (AA) - Secondary amyloidosis Associated with chronic inflammatory disorders (e.g RA, IBD etc.)
28
What protein type is associated with Primary Amyloidsis and what conditions are they associated with?
Protein - AL (from Ig light chains) Seen in plasma cell disorders (e.g. Multiple Myeloma)
29
What type of protein is seen in patients with amyloidosis secondary to ESRD or dialysis?
B2-microglobulin
30
What is ALP a tumour marker for?
- Bone + liver mets - Pagets disease - Seminoma
31
What is AFP a tumour marker for?
Hepatocellular ca. Teratoma
32
What tumour marker can be elevated in Choriocarcinomas?
hCG
33
What are the tumour markers for Breast ca?
Ca 15-3 Ca 27-29 CEA (minor association)
34
What is the tumour marker for pancreatic adenocarcinomas?
Ca 19-9
35
A raised CA 125 is seen what type of cancer?
Ovarian ca
36
What is calcitonin a specific tumour marker for?
Medullary thyroid ca
37
What cancers are associated with EBV?
- Burkitts lymphoma - Hodgkins lymphoma - Nasopharyngeal ca
38
Cervical, anal and penile ca are associated with which virus?
HPV 16/18
39
Which oncogene is associated with retinoblastomas?
Rb1
40
What condition is the P53 oncogene associated with?
LiFraumeni
41
What is acute intermittent porphyria and how does it present?
6 Ps - Porphobillinogen deaminase deficiency - Pain in abdo (most common) - Psychological symptoms (anxiety, depression, hallucination etc.) - Peripheral neuropathy - Pee abnormality (dysuria, incontinence/retention) - Precipitated by drugs (e.g. barbiturates, oral contraceptives)
42
What subtype of cell is most often associated with popcorn cells seen in Hodgkin's lymphoma?
They are the lymphohistiocytic (L-H) variant of Reed Sternberg cells and are associated with nodular lymphocyte predominant Hodgkin lymphoma
43
What is Kwashiorkor?
Protein malnutrition resulting in skin lesions and oedema (low oncotic pressure), liver malfunction (fatty change due to low apolipoprotein synthesis) MEALS: - malnutrition - edema - anaemia - Liver (fatty) - Skin lesions PC: small child with swollen abdomen
44
What is the shelf life of whole blood and RBC if stored appropriately?
35 days
45
What is the shelf life of platelets and at what temperature should they be stored?
5 DAYS 20-24 degrees celsius
46
What type of murmur is seen in pulmonary or aortic stenosis?
Systolic murmur
47
When is a murmur heard in pulmonary or aortic regurgitation?
Early Diastole
48
What causes a mid-diastolic to late diastolic murmur?
Mitral stenosis Tricuspid stenosis
49
What is the most diagnostic histological factor of acute inflammation?
Neutrophil polymorphs
50
What is a granuloma?
Consists of microscopic aggregation of macrophages
51
What happens in Type A gastritis?
Autoimmune Abs to parietal cells causing reduction in cells = loss of intrinsic factor = B12 malabsorption = megaloblastic anaemia Causes elevated gastrin levels
52
What kind of gastritis is associated with H.pylori infection?
Type B - Antral gastritis Intestinal metaplasia may occur and will require surveillance endoscopy
53
What type of ulcer is Curling's ulcer and what is the pathophysiology?
It is a Stress ulcer Caused by mucosal ischaemia during hypotension/hypovolaemia (e.g. burns)
54
What is Menetriers disease?
Gross hypertrophy of gastric mucosal folds with excessive mucous production Pre-malignant condition. Associated with gastric ca
55
In a patient with abdominal pain with neurological signs, what main 2 diagnosis need to be excluded first?
Acute intermittent porphyria OR Lead poisoning until proven otherwise
56
What are features of lead poisoning?
- Abdo pain - Peripheral neuropathy - Fatigue - Blue lines on gum margins (20%) - Constipation
57
How is lead poisoning managed?
- DMSA - D-penicillamine - Dimercaprol
58
What happens in gangrene?
Necrosis with putrefaction of tissue Hb degenerates and results in deposition of iron sulphide (hence the black colour)
59
What is the most common type of necrosis?
Coagulative necrosis Early stages, histological appearances may demonstrate little change. Later stages, cellular outlines are seen with loss of intracellular detail
60
What are the causes of DIC? DISSEMINATED
Dx: D-dimer Immune complexes Snakebite, shock, heatstroke SLE Eclampsia, HELLP syndrome Massive tissue damage Infections Neoplasms Acute promyelocytic leukaemia Tumour products (TF etc.) Endotoxins (bacterial) Dead fetus (retained)
61
What are the most common blood test findings in DIC?
Prolonged clotting times Thrombocytopenia Decreased fibrinogen
62
How is DIC managed?
Platelets Fibrinogen Cryoprecipitate Treat underlying condition
63
What is neuropaxia and what is the usual prognosis?
Condition where the nerve is intact but electrical condition is affected Full recovery expected, autonomic function is preserved and Wallerian degeneration does not occur
64
What is it called when an axon is damaged but the myelin sheath is preserved?
Axonotmesis
65
What is Wallerian degeneration?
Axonal degeneration distal to site of the injury, typically occurring 24-36hrs following the injury Myelin sheath degenerates and is phagocytose by tissue macrophages
66
Which gene mutation is associated with absence of the vas deferens?
Cystic fibrosis CFTR gene mutations (40%) Some non CF cases are due to unilateral renal agenesis
67
What is choanal atresia?
Congenital disorder causing posterior nasal airway occlusion by soft tissue or bone Can be uni-/bi lateral Rx: fenestration procedures to restore patency
68
What is the inheritance pattern of Achondroplasia?
Autosomal dominant Cause of dwarfism due to defects in fibroblast GF receptor
69
What are radiological features of achondroplasia?
- Large skull with narrow foramen magnum - Short flattened vertebral bodies - Narrow spinal canal - Broad, short metacarpals
70
What is the pathophysiology of a cleft palate?
Non-fusion of the two palatine shelves Complete cases are associated with complete separation of the nasal septum and vomer from the palatine processes
71
What malignancies are associated with Li-Fraumeni syndrome?
Sarcomas and leukemias Dx when individual develops sarcoma <45yrs OR 1st degrees relative diagnosed with any cancer <45yrs
72
How is Hodgkins lymphoma staged?
Ann Arbor system Stage 1: Single lymph node region Stage 2: 2+ regions on SAME side of diaphragm Stage 3: Involvement of lymph nodes on BOTH sides of diaphragm Stage 4: Involvement of extra nodal sites
73
What type of cell is associated with Hodgkin's lymphoma?
Reed Sternberg cells
74
How does hereditary spherocytosis present?
Haemolytic anaemia Jaundice (hyperbilirubinaemia) Splenomegaly
75
What is a pheochromocytoma and how does it present?
Neuroendocrine tumour of chromatin cells of adrenal medulla HTN, Hyperglycaemia, Sweating, Headache, symptoms similar to panic attack
76
How is a pheochromocytoma diagnosed?
urine analysis: vanillymandelic acid (VMA) Serum metanephrine levels CT/MRI to localise lesion
77
How is a pheochromocytoma managed?
- Irreversible alpha blocker + beta blocker - Fluid resuscitation - Surgical excision
78
What CT findings of adrenal lesion suggest benign disease?
- <3cm in size - Lipid rich tissue - Thin wall to lesion - Homogenous texture
79
What is a glucagonoma?
Pancreatic tumour arising from alpha cells of the pancreas PC: diarrhoea, wt loss, necrolytic migratory erythema, elevated glucagon (>1000) Requires careful staging prior to surgery as usually malignant and non-resectable
80
What are Hassall's corpuscles?
Keratinised centre surrounded by medullary epithelial cells found in the thymus
81
Which pharyngeal pouch does the thymus develop from?
3rd pharyngeal pouch
82
In what age group does Ewing Sarcoma normally present and what is the commonest site to be affected?
Affects 10-20 years old Located in femoral diaphysis most commonly
83
What is actinomycosis and what is seen on histology and how is it treated?
Chronic, progressive granulomatous disease caused by gram +ve bacteria (actinomyces). Histology: sulphur granules + gram +ve organisms Rx: Long term penicillin therapy +/- surgical resection of extensive necrotic tissue, non-healing sinus tracts
84
Which polypeptide is present in all collagen types?
Glycine
85
What are the 4 subtypes of osteogenesis imperfecta with defect of type 1 collagen?
Type 1: collagen is normal quality but insufficient quantity Type 2: Poor quantity and quality Type 3: Poorly formed collagen but normal quantity Type 4: Sufficient quantity but poor quality
86
What types of collagen are affected in Ehlers Danlos?
Abnormalities of Type 1 and 3 collagens
87
What are Aschoff-Rokitansky sinuses?
Aschoff-Rokitansky sinuses are the result of hyperplasia and herniation of epithelial cells through the fibromuscular layer of the gallbladder wall. They may be macroscopic or microscopic. Aschoff-Rokitansky sinuses may be identified in cases of chronic cholecystitis and gallstones
88
What cells are seen on OGD for diagnosis of Barrett's oesophagus?
Specialised intestinal metaplasia Goblet cells
89
What is the cell of origin of the majority of pancreatic cancers?
Ductular epithelial origin Over 90% of pancreatic carcinomas are adenocarcinomas
90
Wha type of thyroid cancer spreads through the bloodstream?
Follicular thyroid ca
91
What condition are benign thymomas associated with?
Myasthenia gravis
92
What condition is vinyl chloride associated with?
Malignant hepatic haemangiosarcoma
93
What is the site for a cholecystostomy?
Below 9th costal cartilage, right of the midline
94
What is a likely finding on microscopy in a patient with sarcoidosis?
Non-caseating granulomas
95
What are Reed-Sternberg cells?
Abnormal lymphocytes which are multi-nucleated giant cells
96
What would a renal biopsy show in a patient with amyloid?
Mesangial apple-green bifringence on Congo red staining under polarised light
97
What organism is associated with Stag-horn calculi?
Proteus
98
What is the effect on cholesterol in hypothyroidism?
Increased cholesterol and LDL
99
What Ab is found in Primary biliary cirrhosis (PBC)?
M2 subtype mitochondrial Ab
100
What type of laser is used in endoscopy?
Argon beam
101
Which cells in the kidney are responsible for production of EPO?
Interstitial cells in peri tubular capillaries
102
When should a total thyroidectomy be done in presence of a papillary cancer?
- >10mm - multi focal
103
What Abx can precipitate a flare up of G6DP and how does it present?
Ciprofloxacin PC: - intravascular haemolysis - jaundice - splenomegaly - raised LDH - Heinz bodies + bite cells on blood film
104
What is elevated in true anaphylaxis?
Elevated serum tryptase
105
What is the half life of T3 in the blood?
1 day
106
What is a severe vascular complication of an aortic valve replacement?
Aortic dissection
107
What is seen on biopsy in Ewing sarcoma?
Small, round blue cells
108
What is the histological finding in GCA?
Granulomatous inflammation with mononuclear cells with multinucleated giant cells, in the arterial wall
109
What is a marker for deep surgical site infections?
Serum Pro-calcitonin
110
What are the Abs associated with autoimmune hepatitis?
Anti-smooth muscle Abs Antinuclear Abs
111
When is laparoscopic fundoplication surgery considered in patients with GORD?
- Long standing disease - Uncontrolled by medications - Development of complications such as strictures or Barrett's despite medication
112
What type of thyroid cancer is characteristic for invading the thyroid capsule and blood vessels?
Follicular thyroid carcinoma
113
What is a prolonged QTc associated with?
Hypocalcaemia
114
What is a cause of a patient's bradycardia post mitral valve repair?
AVN dysfunction due to close proximity of mitral valve to AVN
115
What is the best method to assess severity of COPD?
Spirometry pre and post bronchodilator measurements
116
What type of gallstones are seen following ileal resection?
Black pigment stones
117
How would you secure the airway of a patient with severe facial trauma involving the maxilla?
Tracheostomy/Cricothyroidotomy
118
Why are thyroglossal cysts excised?
Prevent recurrent inflammation/infection
119
Which CNS nuclei is involved in symptoms exhibited in cluster headaches (tearing, congestion, headache)
Superior salivatory nucleus
120
What sign is seen on imaging in perforated peptic ulcer disease?
Rigler's sign (double wall sign) suggests pneumoperitoneum
121
What does a mutation of RET proto-oncogene lead to and what type of thyroid cancer is it associated with?
MEN type 2 Associated with Medullary thyroid ca
122
What is measured to monitor recurrence of thyroid ca post thyroidectomy?
Thyroglobulin
123
What is a positive heterophile antibody test indicative of?
Infectious mononucleosis
124
What amyloid protein is found in the heart?
ATTR / AL

MRCS Part A (KF edition) (22 decks)

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