Pathology Flashcards
(120 cards)
1
Q
What are lines of Zahn?
A
A feature of thrombi that occur particularly when formed in the heart or aorta.
Alternating layers of platelets and fibrin (pale) and RBCs (darker)
2
Q
Which coronary artery usually supplies the SA node?
A
Right coronary artery (60% of people) Left circumflex (40% of people)
3
Q
Which coronary artery usually supplies the AV node?
A
Right coronary artery (90%)
4
Q
Which coronary artery is most commonly occluded?
A
Left anterior descending
5
Q
Which microscopic features would you expect if a tumour is malignant?
A
Abnormal mitotic figures Abnormal nuclear membrane Nuclear hyperchromasia Prominent nucleoli Enlarged pleomorphic nuclei
6
Q
What is Verhoeff’s elastic stain/ Elastic Van Gieson stain used for?
A
This stains elastin black
Can be used when examining lung tumours microscopically
If part of the tumour lies beyond the elastin, the pleura is involved
7
Q
Which type of lung cancer is usually a peripheral lesion that produces mucin?
A
Adenocarcinoma
8
Q
What is the prognosis of lung adenocarcinoma if there are fewer glands?
A
Poorer
9
Q
Which type of lung cancer is usually a central lesion with keratinisation, intercellular bridges and cavitation?
A
Squamous cell carcinoma
10
Q
What is the most common type of lung cancer?
A
Adenocarcinoma (non small cell)
11
Q
Which type of non small lung cancer has the strongest smoking association?
A
Squamous cell carcinoma
12
Q
What are lepidic adenocarcinomas?
A
Subgroup of adenocarcinoma of lung
Divided into mucinous and non mucinous
Have growth around alveolar walls
May be considered insitu in some cases. Don’t usually have lymph/ vascular invasion, and no architectural disruption/ complexity.
13
Q
What is the treatment of choice for small cell lung cancer?
A
Chemotherapy
14
Q
Does emphysema cause haemoptysis?
A
NO
15
Q
What percentage of lung cancers are treated by surgery?
A
15%
16
Q
Which type of lung cancer is most associated with asbestos?
A
Non small cell carcinoma
17
Q
Which type of lung cancer is most common in women and and non smokers?
A
Adenocarcinoma
18
Q
What is the most common type of skin cancer?
A
Basal cell carcinoma (75%)
19
Q
What is the 5 year survival for lung cancer?
A
10%
20
Q
What is used to assess the stage of melanoma?
A
Breslow's thickness Clark's scale Microsatellites Mitotic figures Ulceration Vascular invasion
(NOT SIZE OR DIAMETER)
21
Q
What is the most common type of skin cancer?
A
Basal cell carcinoma (75%)
22
Q
Skin punch biopsies can be used for diagnosing which types of skin cancer?
A
Basal cell carncinoma
Squamous cell carcinoma
23
Q
Which type of biopsy is used for diagnosing melanoma?
A
Excision biopsy
24
Q
What are the most common variants of melanoma?
A
Superficial spreading
Nodular
25
Fat wrapping is a histological feature of which type of IBD?
Crohn's
26
What are the histological features of Crohn's?
Granulomas
Fat wrapping
Transmural lymphoid aggregates
27
Crypt abscesses and cryptitis, mucin depletion and loss of haustra are features of which condition?
UC
28
Which type of IBD has a stronger association with bowel cancer?
Ulcerative collitis
29
How does smoking affect the risk of Crohn's?
Increases the risk
30
What surgery can be used in UC?
Subtotal colectomy with Terminal ileostomy or ileo anal pouch
31
What is the commonest type of colon cancer?
Adenocarcinoma
32
What TNM stage would a colon tumour which has invaded through the serosa be?
T4
33
An adenoma polyp increases the risk of _________
Colon cancer
34
What are poor prognostic indicators for colon adenocarcinoma?
Serosal invasion
Lymph node metastases
Vascular invasion
35
What are the vascular changes in acute inflammation?
1. Arteriole vasodilation = increased capillary blood flow
2. Increased permeability, increased blood viscosity
3. Leukocyte margination
36
Ulcerative collitis is associated with which hepatobiliary condition?
PSC
37
Anti mitochondrial antibodies are present in which condition?
PBC
38
PBC is more common in which age and gender?
Women aged 40-60years
39
What are the 2 main events in acute inflammation?
1. Vascular changes (vasodilation, increased permeability)
| 2. Leukocyte migration
40
What are the 4 stages of leukocyte migration?
1. Margination
2. Rolling (selectins)
3. Adhesion (integrins)
4. Transmigration into extravascular space
41
What effect does histamine have?
Arteriole dilation
| Increased permeability
42
What effect does bradykinin have?
Arteriole dilation
| Increased permeability
43
What effect does Il-8 have?
Migration and activation of inflammatory cells
44
What is pus composed of?
Neutrophils
Bacteria
Necrotic cells
45
What type of diseases are usually associated with lymphocytes rather than neutrophils in acute inflammation?
Viral infections eg. Viral hepatitis, meningitis and myocarditis
Autoimmune hepatitis
46
What are the potential consequences of acute inflammation?
1. Resolution
2. Scarring/ fibrosis
3. Progression to chronic inflammation
47
Which immune cells are involved in chronic inflammation?
Lymphocytes
Macrophages
Plasma cells
48
What is the role of CD4+ T cells in chronic inflammation?
1. Secrete cytokines
2. Activate effector cells (CD8+ and macrophages)
3. Cooperate with B cells
49
In chronic inflammation eg. Chronic cholecystitis, muscle is replaced by ______________
Fibrous scarring
So loss of normal function
50
What is the macroscopic appearance of a peptic ulcer?
Loss of mucosal folds
Flattening
Fibrous scarring of muscle
51
What are the stages in the evolution of a gastric ulcer?
Necrosis
Acute inflammation
Healing
Scar
52
Fibrous scarring in a chronic peptic ulcer can lead to complications such as _________
1. Pyloric stenosis -> projectile vomit
| 2. Gastric haemorrhage
53
What is the role of CD8+ T cells in chronic inflammation?
Effector cells: Kill by apoptosis, produce cytokines
54
Which biologically active products do macrophages release?
1. Proteases and toxins- tissue damage
2. Cytokines and chemokines- activate and recruit other cells
3. Growth factors- angiogenesis and fibrosis
4. Collagenases- remodelling of connective tissue
55
Which conditions have granulomas?
Infections- TB, Syphillis
Crohn's
Sarcoidosis
Foreign body conditions eg. keratin, silica
56
Which cells are mainly recruited in the immune response to TB?
T cells (delayed hypersensitivity)
57
A ___________ is a subpleural lesion, often in the mid and lower zones of the lung caused by mycobacterium TB.
Ghon Focus
The centre of this undergoes necrosis mediated by TNF.
58
Which cytokine mediations necrosis in the centre of a Ghon focus?
TNF released from T cells
59
In Ulceratice Collitis, the damaged ulcerated tissue heals via __________
Regeneration
60
If TB bacteria spread from the lungs via an infected lymph node into the pulmonary artery, this will cause _____________
Lung infection
61
If TB bacteria spread from the lungs via the pulmonary vein, this will cause _____________
Systemic infection
62
In Crohn's disease, the damaged smooth muscle heals by _______
Fibrosis
63
In Ulceratice Collitis, the damaged tissue heals via __________
Regeneration
64
Which types of cells have labile (steady state) renewal?
Epithelial cells
| Parenchyma of glands eg. liver, kidney
65
Which cell types are permanent and non replacing?
Neurones
| Cardiac muscle
66
_______ is a decrease in size of an organ after development.
Atrophy
67
_______ is a failure of a tissue or organ to reach normal size
Hypoplasia
68
What is hyperplasia?
Increase in cell NUMBER due to hormonal or chemical stimuli
69
What is hypertrophy?
Increase in cell SIZE due to mechanical stimuli
70
Early cell injury is reversible and involves...
Na+ and water entry
Swelling
ER dilation
71
Late cell injury is irreversible and involves...
Proteins denaturing
Nucleus shrinks, fragments and disappears
Enzymatic digestion of cell
Necrosis (4-12 hours after)
72
_______ is programmed cell death which does not involve inflammation
Apoptosis
73
In Barrett's metaplasia, what happens to the oesophageal cells?
Stratified squamous replaced with simple columnar
Increased chance of malignancy
74
What is "primary intention" in terms of skin healing?
Linear incision, 2 edges of open skin are close and wound can be closed with sutures, staples etc.
The healing of a clean wound without tissue loss. This is faster than healing by secondary intention.
75
What is "secondary intention" in terms of skin healing?
Wounds created by trauma; loss of tissue so the wound is allowed to granulate
Epidermis grows from the bottom up
Healing process can be slow.
76
What are the main stages of skin healing?
1. Haemostasis: Clotting cascade
2. Inflammation
3. Proliferation (growth of new tissue): Fibroplasia and Granulation, Epithelialisation, Angiogenesis
4. Maturation and remodeling
77
What is granulation?
Formation of new tissue 2-5 days post wound formation
Rudimentary tissue that is stronger than the fibrin clot
Consists of blood vessels, fibroblasts, inflammatory cells, ECM components which are different in composition to normal ECM
78
What is the role of fibroblasts in proliferation?
Proliferate into wound 2-3 days after injury
Produce collagen
Secrete growth factors
Contractile: help the wound to contract
79
Scars are only ____% strong as the previous dermis
70-80%
80
In order for the liver to heal, hepatocytes must be stimulated out of which phase of the cell cycle?
Quiescent G0 phase
81
What are the consequences of liver cirrhosis?
1. Portal hypertension: splenomegaly, porto-systemic shunt, ascites, oesophageal varicies
2. Decreased Liver function: Jaundice, bleeding tendancy, thrombocytopenia, hepatic encephalopathy, gynaecomastia and palmar erythema, heptatocellular carcinoma
82
What are the 2 ways that liver tissue can heal?
1. Resolution- return back to normal
| 2. Repair- nodules and cirrhosis
83
What happens to heart tissue when it is damaged?
No healing capacity
| Inflammation, macrophages release cytokines eg. Il-6, fibroblasts produce MMPs
84
What are the consequences of myocardial fibrosis?
Ventricular aneurysm
Contractil dysfunction
Arrhythmias
Pericarditis
85
__________ is uncoordinated cell proliferation, which persists in the absence of stimuli
Neoplasia
86
What are the potential consequences of benign neoplasia?
```
Bleeding
Obstruction
Compression of other structures
Hormonal secretion
Progression to malignancy
```
87
What is an in-situ neoplasia?
Uncoordinated cell proliferation which has not invaded the basement membrane
Pre-cancerous
88
What are the 4 ways that malignant neoplasms can spread?`
1. blood
2. lymph
3. secondary deposits in primary organ
4. into cavities eg. pleura, peritoneum
89
What is a paraneoplastic syndrome?
Signs and symptoms in cancer patient, not due to the local effects of cancer cells
Due to humoral factors secreted by the tumour eg. hormones, cytokines or immune responses against the tumour
90
Compare the nuclear features of benign and malignant neoplasms.
BENIGN: Regular nuclear border, low mitotic activity, no hyperchromasia
MALIGNANT: Irregular nuclear border, high mitotic activity, hyperchromasia
91
Compare the tumour shapes of benign vs malignant tumours.
BENIGN: Sessile, Polyp, Papillary
MALIGNANT: Fungating, ulcerated, annular
92
What is an annular tumour?
Malignancy growing centripetally
Usually a colonic adenocarcinoma
93
What is Dukes Stage A?
Colonic tumour invading no further than muscularis propria
94
What is Dukes Stage B?
Colonic tumour invading beyond the muscularis propria, no lymph node involvement
95
What is Dukes Stage C?
Colonic tumour invading beyond the muscularis propria, nodes involved
96
What is Dukes Stage D?
Metastatic
97
What is localised lymphadenopathy?
One lymph node region affected
98
What is regional lymphadenopathy?
2 or more adjacent lymph node regions affected
99
What is generalised lymphadenopathy?
2 or more non-continuous lymph node regions
OR
One node region plus splenomegaly
100
What are the causes of lymphadenopathy?
1. Leukocyte proliferation
2. Leukocyte influx
3. Neoplastic cell influx
4. Abnormal phagocytosed substances eg. silicone
5. Necrosis, pus
101
Which drugs may cause lymphadenopathy?
Anticonvulsants eg. Phenytoin, Carbamazepine
Immunosuppressants eg. Methotrexate
102
What are the features of malignant lymph nodes?
```
Hard
Fixed
Round
Painless
Large
Forms aggregates
Fatty hilum not visible
```
103
If pain is felt in an enlarged lymph node following alcohol consumption, which condition should be suspected?
Hogkin's lymphoma
104
What can cause cervical lymphadenopathy?
```
Pharyngitis
Otitis
Dental abscess
TB
Atypical mycobacterial infection
Cancer: head, neck, thyroid, lyphoma
```
105
_________ may cause a painless, non spreading cervical lymph node in children <5yrs
Atypical mycobacterial infection
106
If an infraclavicular lymph node is enlarged, which condition should be suspected?
Hogkin's lymphoma
107
________ lymph nodes are not palpable and can be enlarged due to sarcoidosis, lymphoma or TB
Mediastinal
108
What may be the consequences of mediastinal lymphadenopathy?
Superior Vena Cava syndrome (headaches, dilated chest veins)
Cough
Hiccups
109
What are the consequences of SVC obstruction?
```
Headaches
Feeling of fullness in face when bending over
Swelling in face, neck, chest
Dilated chest veins
SOB
Cough
```
110
What are the most common causes of SVC syndrome?
Lung cancer- usually small cell
| Non Hogkin's lymphoma
111
Axillary lymphadenopathy is usually _______ and can be caused by skin infection, tattoos, silicone
Benign
112
What structures do the inguinal lymph nodes drain?
Men: Penis, scrotum (NOT TESTES)
Women: Vulva
Both: Anus, Perineum, lower abdominal wall
113
If abdominal lymph nodes are enlarged, this is usually ________
Malignant
114
What are the potential causes of large benign lymph nodes?
1. Dermatopathic - node reaction to skin changes eg. eczema
2. Silicone reaction
3. Progressive transformation of germinal centres- linked to autoimmune disorders
4. HIV
5. TB
6. Kikuchi disease
115
What is Kikuchi disease?
Lymph node inflammation
Benign
Mimics lymphoma but is CD8+ instead of CD4+
116
What are the 3 types of lymph node biopsy?
1. Excision biopsy
2. Core needle biopsy
3. Fine needle aspiration
117
What are the disadvantages of fine needle aspiration for biopsying lymph nodes?
Smear looses architecture of tissue
May miss focal lesion
Can't exclude lymphoma
Can cause node necrosis
118
Which lung cancer is most associated with hypercalcaemia?
Squamous cell carcinoma
119
Which site in the body is the commonest site of metastases? Which tumours metastasize here?
Lung
Breast, colon, stomach, pancreas, kidney, melanoma, prostate
120
Which genes must be expressed in NSCLC to allow prescription of targeted molecular therapies/ immunotherapy?
EGFR mutation
ALK translocation
ROS1 translocation
PD-L1 expression
