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Flashcards in Pathology Deck (102):
1

What is secondary vasculitis?

when vessels become inflamed as they are in proximity to inflam eg vessels beside the appendix which get inflamed during appendicitis

2

What is infection vasculitis?

when there is direct invasion of the vessel by pathogens and therefore inflammation of the vessel wall eg syphilis

3

What causes immune mediated vasculitis?

immune compex deposition and speciif antibodies (anti-endothelial)

4

What does ANCA stand for?

anti-neutrophil cytoplasmic antibodies

5

What is the difference between pANCA and cANCA?

p stnads for perinculear and just binds around nucleus whereas c stands for cytoplasmic and antibodies are diffuse throughout the cytoplasm

6

How is vasculitis classified?

by the size of vessels affected- large, medium or small

7

What is an example of large vessel vascultiis?

giant cell arteritis

8

What is seen on biopsy of giant cell arteritis?

granulomas in the media of the vessel with the elastic fibres almost completely obliterated- segmental with skip lesions

9

What is the signifance of skip lesions in biopsies?

a negative biopsy doesnt rule out as might hve biopsied okay area

10

What are the symptoms of giant cell arteritis?

affects temporal artery- temporal headache jaw claudication, scalp tenderness, blindness

11

What is the treatment for giant cell arteritis?

steroids

12

Why dont you get rashes with large vessel vasculitis?

big vessels arent near the skin

13

What type of vasculitis of polyarteritis nodosa?

medium vessel

14

Why is PAN thought to be caused by circulating immune complexes?

1/3rd of pts have hepB positivity with circulating immune compexes and antibodies

15

What is seen on biopsy of PAN?

transmural necrotising inflam- fibrinoid necrosis of vessel

16

What organs are affected in PAN?

kidneys- spares lungs (unusual)

17

What are the small vessel vasculitis?

Wegeners-granulomatosis with polyangiitis
Churg Strauss-eosinophilic granulomatosis
Henoch Schonlein Purpura
Cryoglobulinaemia
Goodpastures

18

What is crystal arthropathy?

gout

19

What is the cause of gout?

build up of urate and uric acid - end products of purine synthesis (adenine and guanine are purine based) so urate is formed in DNA replication etc.

20

What are the 2 pathways that can cause hyperuricaemia?

making too much or etting rid of too little

21

What can cause making too much urate?

usually idiopathic (unkown enzyme defect)
known genetic defect
increased cell turnover- cancer; psoriasis; tumour lyssi with chemo

22

What is the most common cause of gout?

under-excretion

23

What is a common drug that reducing urate excretion?

thiazide diuretics

24

Why does uric acid end up joints?

moves around and then crystallises in joints due to the lower temperatures there

25

What happens when uric acid is depostied in joints?

crystals stimulate an inflammatory response which causes damage

26

What does uric acid cause in the kidney?

stones and direct deposition in the tubules

27

What do the uric acid crystals look like?

needle-shaped crystals; show negative birefringence

28

What does negative birefringence mean?

crystals bend the light twice at a negative angel

29

What causes pseudo gout or chondrocalcinosis?

calcium pyrophosphate

30

what can cause psuedogout?

usually idiopathic but- hypercalcaemia (inc. hyperparathyroidism); haemachromatosis; hypomagnesia

31

What is the difference between the crystals in gout and pseudogout?

gout- negative bifringence whereas pseudogout-weak positive birefringence, crystals are thicker and bigger, rhomboid shape

32

What is Paget's disease?

abnormality of bone turnover

33

What causes Paget's?

increase osteoclastic activity which causes more bone but not normally structured

34

What causes Paget's?

genetics, viral infections

35

What is the difference pathologically between Paget's and normal bone?

normal bone is v. organised- looks like rings in trees whereas in Paget's there is thick excess bone with abnormal mosaic pattern

36

What causes pain in Pagets

microfractures and nerve compression

37

What bones does Paget's mainly affect?

axial bones

38

What does increased metabolism mean in terms of presentations?

heat, warm skin, AV shunt and high output HF

39

What secondary malignancy can Pagets cause?

osteosarcoma

40

What causes osteomalacia?

abnormal vitamin D metabolism (adult version of rickets) due to reduced sun exposure

41

What are the symptoms of osteomalacia?

bowed legs, square heads, pigeon chest, rickety roasry

42

What is a pathological fracture?

fracture is out of keeping with level of trauma

43

What are the initatal phases of fracture healing?

haematoma creates a fibrin mesh, there is influx of infllam cells which release cytokines-recruit osteoprogenitors from periosteum and medullary cavity

44

What is formed after 1 week in fracture healing?

callus and organised haematoma

45

What is seen at 2-3 weeks post fracture?

maximum girth of callus; woven bone deposited perpendicular to cortical bone some cartilage depostion at fracture site which undergoes endochondral ossification- bridigin witha bony callus

46

Why is it important to move around after a fracture?

so that bone can remodel in response to correct stresses

47

What can cause delayed healing?

poor blood supply and nutrition- can be caused by lots of soft tissue injury around fracture

48

What are the big 4 areas that bone mets come from??

lung, kidney, breast and prostate

49

What is different about the appearance of prostate mets on film compared to the majory?

met appears as an area of opacity rather than radiolucent as prostate is osteosclerotic rather than osteolytic

50

What causes avascular necrosis?

bone infarction- alcohol; trauma etc etc

51

How does avascular necrosis appear?

wedged shaped infarct with creeping substitution (substituting infarcted dead bone with new bone)

52

What happens to the joint in osteoarthritis?

small cracks in cartilage until eventuallteh cartilage is completely worn away and there is bone on bone, bone surface becomes polished eburnation. cortical bone thickens greatly to cope with load and remodelling is disorgansied and produces abdnormal outgrowths-osteophytes

53

What causes subchondral cysts?

fractures in bone due to disorganised bone growth, synovial fliud leaks through bone forming small cysts

54

What are the features seen on x-ray of osteoarthritis?

loss of joint space; subchondral sclerosis; subchondral cysts; osteophytes

55

What is subchondral sclerosis?

eburnation etc

56

What is an osteochondroma?

cartilage capped bony projection arising on external surface of bone containing a marrow cavity that is continuous with that of the underlying bone

57

Who does osteochondroma affect?

affects males and females equally, affects the under 20s

58

Where do osteochondromas tend to occus?

develop near the epiphyses of long bones

59

What is an enchondroma?

benign hyaline cartilage tumour arising in medullary cavity

60

Where does enchomdroma tend to occur?

hands and feet

61

Who does enchonroma occur in?

young adults, males more than females

62

What is Ollier's disease?

a rare deleveopmental disorder where there are unilateral enchondromas; malignant transformation- 10-25%

63

What is Maffucci's Syndrome?

multiple enchondromatosis with soft tissue and visceral haemangiomas

64

What is osteoid osteoma?

benign osteoblastic tumour

65

Who is osteoid osteoma foudn in?

children adn young adults; males more than females

66

Where are osteoid osteomas found?

femur; tibia; hands/feet and spine

67

What is seen on pathology of osteoid osteoma?

central core of vascular osteoid and peripheral zone of sclerotic bone

68

What is seen on presentation of osteoid osteoma?

dull pain that is much worse at night
pain is releived by NSAIDs/aspirin- produces prostaglandins

69

What is a chondroblastoma?

a benign cartilage tumour arising in bone

70

Where are chondroblastomas found?

epiphysis of long bones

71

What age group is affected by chondroblastomas?

people in their 20s

72

What is the treatment for chondroblastomas?

biopsy and curretage plus adjuvant liquid nitrogen

73

What is the cell of origin presumed to be in giant cell tumours?

osteoclasts

74

Who are giant cell tumours seen in?

25-40 year olds; F>M

75

Where are giant cell tumours seen?

long bones, often around knee

76

What is an osteoblastoma?

solitary, benign and self-limited tumour that produces osteoid and bone

77

Where are osteoblastomas found?

metaphysis or diaphysis of long bones

78

What is seen on histology of osteoblastoma?

irregular spicules of mineralised bone adn osteoid suurounded by osteoblasts

79

How are osteoblastoma treated?

curettage; intralesional excision and enbloc resection

80

What is the prognosis ofr osteoid osteoma?

will resolve without treatment in around 33months

81

What is seen histopathologically in chondroblastoma?

closely packed polygonal cells plus areas of immature chondroid; mitotic activity low; distainct cytoplasmic borders with foci of "chicken-wire" calcification

82

What is seen on histology of giant cell tumours?

multinucleated giant cells in a sea of roudn to oval mononuclear cells

83

What is a chordoma?

very rare benign tumour arising from notochord remnants (midline tumour, often sacral region)

84

Who does chordoma arise in?

occurs in 40+; M:F is 1:2

85

What is the treatment for chordoma?

resection is difficult; radiation; chemo for late stage

86

What is the commonest primary malignant tumour of bone?

osteosarcoma

87

What are the cells of origin in osteosarcoma?

malignant osteoblasts forming osteoid

88

who does osteosarcoma affect?

young adults; older patients tedn to have predisposing condition- eg Paget's; M:F is 3:2

89

Where does osteosarcoma affect?

ends of long bones particularly distal femur; proximal tibia and proximal humerus

90

What are seen on histology of osteosarcoma?

osteoid production; nuclear stypia; hyperchromasia and a high mitotic rate

91

What is the treatment for osteosarcoma?

pre-op chemo; surgical resection; post-operative chemo

92

What is the second commonest primary malignant tumour of bone?

chondrosarcoma

93

What is chondrosarcoma composed of?

malignant chondrocytes

94

What is seen on histopathology of chondrosarcoma?

malignant nodules of chondrosarcoma infiltrate between the lamellar bone oblierating the marrow; separation of the nodules by fibrous bands would also be highly suggestive

95

What is the treatment for chondrosarcoma?

wide srgical excision

96

Where does Ewing's Sarcoma occur?

occurs in the metaphysis and diaphyssi of femur; tibia then humerus

97

Who gets Ewing's Sarcoma?

most common in teens; M:F is 3:2

98

What is the treatment for Ewing's sarcoma?

surgery; radiation; chemo

99

Where are the common sites of primary origin of bone mets?

thyroid; breast; lung (small cell); kidney; prostate

100

What is multiple myeloma?

malignant proliferation of plasma cells in bone marrow

101

Who gets multiple myeloma?

old peopl

102

What the side effects of multiple myeloma?

renal failure; bone destruction of axial skeleton