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MRCS B > Pathology - cancer etc > Flashcards

Pathology - cancer etc Flashcards

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1
Q

What breast disease may present with yellow/ green nipple discharge

A

Infection

Duct ectasia

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2
Q

Duct ectasia pathophysiology/ XR appearance

A

Shortening/ dilation of lactiferous ducts in perimenopause.

XR - calcified dilated ducts

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3
Q

Presentation of Phyllodes tumour and management

A

Rapid growing, old women

Wide excision as 1/3 malignant

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4
Q

Presentation/ management of breast fibroadenoma

A

<30 yo, smooth painless mobile ?multiple

<3cm - monitor for 2 yrs

> 3cm - excise as low malignant potential

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5
Q

Appearance of breast fat necrosis on US

A

Hyperechoic mass

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6
Q

Microscopic appearance of ductal vs lobular breast ca

A

Ductal - nests + cords + glands
DCIS - micro calcifications

Lobular - diffuse stromal spread

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7
Q

What is Paget’s disease of breast

A

Extension of DCIS up lactiferous duct to skin

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8
Q

1st and 2nd most common thyroid cancer

A

1- Papillary
2- Follicular

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9
Q

Spread type of papillary vs follicular vs medullary thyroid ca

A

Papillary + medullary = lymph

Follicular = blood (lung/ bone)

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10
Q

Histology appearance of follicular vs papillary thyroid ca

A

Papillary: multiple lesions, rarely encapsulated

Follicular: focal and encapsulated

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11
Q

Origin of medullary thyroid cancer

A

Parafollicular C cells
(from neural crest cells)

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12
Q

What do thyroid parafollicular c cells normally do

A

Secrete calcitonin (counteract PTH and lower calcium) –> hypocalcemia

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13
Q

Surgical complications/ damage from thyroidectomy

A

Hypoparathyroid - low Ca

RLN damage

Hypothyroid

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14
Q

What disease is thyroid lymphoma associated with?

A

Hashimoto’s

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15
Q

Most common benign salivary gland tumour + ? malignant potential

A

pleomorphic adenoma

2-5% ca potential -> adenocarcinoma (V aggressive)

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16
Q

Most common malignant salivary gland tumour

A

Mucoepidermoid carcinoma

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17
Q

NH lymphoma of salivary glands associated with which condition?

A

Sjogren’s syndrome

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18
Q

Warthin’s tumour of salivary gland
- benign/ ca?
-patient type

A

Benign, low malignant potential

Old male smokers

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19
Q

Most common salivary gland tumour in CHILDHOOD

A

Haemangioma

Benign. malignancy rare.

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20
Q

Viral risk factor for salivary gland tumours?

A

EBV

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21
Q

Main tumour type of head and neck cancers

A

SCC

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22
Q

Lymph spread of nasopharyngeal ca

A

deep cervical

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23
Q

Lymph spread of oesophageal ca

A

Paraaortic

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24
Q

Oesophageal cancer tumour type

A

Upper 2/3 = SCC

Lower 1/3 = adenocarcinoma (2y Barretts)

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25
Subtypes of germ cell testicular tumour
1) Seminomas - often N bloods, maybe LDH 2) Non-seminomatous - teratoma, yolk sac, choriocarcinoma - raised AFP/HCG
26
Tumour markers
BHCG LDH AFP
27
Management of testicular cancers
Orchidectomy - stage 1 +/- adj chemo if high risk Stage 2+ : ned adj chemo before surgery Seminomas 2a can have radio
28
Types of non-germ cell testicular tumour
Leydig - secrete androgen, benign Sertoli - secrete oestrogen
29
Childhood/ infant testicular tumour
Rhabdomyosarcoma - arises in distal cord so felt separate to testes - v aggressive cancer
30
Definition of infective endocarditis
Inflammation of endocardium of heart inc valves
31
Why are valve replacement/ rheumatic fever pts more prone to infective endocarditis
Damaged / replaced valves -> turbulent blood flow. Increased chance of bacterial colonisation on damaged tissues
32
Pathohysiology of Rheumatic heart disease
Antibody/ T cell mediated response to streptococcal antigens/ proteins. Causes inflammation, fibrosis and stiffened/ calcified valves -> stenosis
33
Rheumatic heart disease findings (gross + micro)
Gross: acute - valve vegetations chronic - valve thickening/ calcification. Shortened + fused chordae tendinae Micro: Aschoff bodies (granulomatous inflammation)
34
Common infective endocarditis organisms
native - strep viridans IVDU - staph A replacement - CoNS / g-ve (HAKEK, Enterococcus)
35
Vascular phenomena of Infective endocarditis
Arterial emboli Septic pulmonary infarcts Mycotic aneurysm Intracranial haemorrhage Conjunctival haemorrhage Janeway lesions (painless, palms, flat)
36
Immunological phenomena
Glomerulonephritis Osler's nodes (pain/ dorsum) Roth's spots (brown mucous membrane) RF
37
Complications of infective endocarditis
MI Pericarditis CHF Aneurysm Abscess Arterial emboli GN AKI Stroke Mesenteric/ splenic infarct
38
Rx of infective endocarditis
6 weeks abx Valve replacement Heart transplant
39
MOA of warfarin
Vit K antagonist - inhibits factors 2 7 9 10
40
Reversal of warfarin
Vit K Prothrombin complex (Beriplex) FFP
41
Causes of aortic stenosis
Post inflam scarring (rheumatic) Age related calcific Congenitally deformed valve calcification
42
Aortic stenosis sudden death causes
MI Dissection
43
How does aortic stenosis occur
lipid accumulation > inflammation >calcification (sclerosis) > stenosis
44
Which coagulation pathway is NOT affected by warfarin
intrinsic pathway (big one)
45
Define thrombus
Solid material formed from constituents of blood
46
Which part of the tunica is most affected in GCA
Tunica media
47
Why is there visual loss in GCA
Ophthalmic artery involvement
48
Define osteoporosis + pathogenesis
Metabolic bone disease characterised by - Low bone mass + increased fragility Due to - excessive bone resorption and reduced bone formation
49
How do steroids cause osteoporosis (5)
Inhibit osteoblasts Stimulate bone resorption Stimulate renal Ca loss Inhibit GIT Ca absorption Inhibit sex steroids
50
Diagnostic criteria for multiple myeloma
Sixty - BM >60% plasma cells Light chain ratio >100 MRI - at least 1 focal bone lesion Calcium raised (>2.75) Renal failure Anaemia (Hb<100) Bone lesions (lytic or path #) - e.g. pepper pot skull
51
Leukemia vs myeloma vs lymphoma - what are they
Leukemia - liquid cancer of WBCs in bone marrow/ blood - lymphoid or myeloid Myeloma - solid plasma cells (lymphoid) in bone marrow Lymphoma - solid lymphoid cells in lymph system
52
How to prevent Addisonian crisis in pt on steroids going to surgery
Increase steroid dose pre surgery Convert to IV hydrocortisone
53
Causes of fat embolism
Long bone # Ortho surgery Burns pancreatitis DM Decompression sickness Cardiopulmonary bypass graft Management = supportive (Resp support, fluid + electrolyte)
54
Apoptosis vs Necrosis
Necrosis: Swelling, plasma membrane disrupted, enzyme digestion of cell contents. Pathologic + assoc inflammation Apoptosis: Shrinkage. Nucleus fragmented into nucleosomes, cell contents released into apoptotic bodies. Controlled
55
Pathology of necrosis - why does it happen
Ischemia > mitocondrial swelling > calcium influx > plasma membrane rupture. Death by release of cytochrome C from mitochondria
56
Dry vs wet gangrene
Dry: limbs, arterial occlusion, line of demarcation. Little sepsis as bacteria can't survive due to limited blood supply. Wet: bowel, venous occlusions, infected
57
Lung cancer which is epidermal growth factor +ve - treatment?
Imatinib (tyrosine kinase inhibitor)
58
Types of necrosis
Coagulative Gangrenous Caseous Liquefactive Fat Fibrinoid
59
Types of non-small cell lung cancer
Adenocarcinoma (40%) - non smokers, peripheral SCC (25%) - slow growing, central Large cell (10%)
60
Which type of lung cancer are paraneoplastic features + early mets more common in? What paraneoplastic syndromes?
small cell - SIADH - Lambery eaton myasthenic syndrome - cerebellar degeneration
61
Which type of lung cancer is more chemo sensitive?
small cell
62
Which type of lung cancer is most assoc with non-smokers
Non-small cell - SCC
63
Where does small cell lung cancer commonly occur?
Larger airways
64
Most common paraneoplastic syndrome of a pan coast lung tumour
ACTH causing Cushing's
65
What tumours met to bone?
Brain Lung Breast Kidney Prostate
66
TB testing?
Sputum - culture, Ziehl Nielsen staining Mantoux PCR - differentiate microorganism QuantiFERON (fin gamma assay) FNAC of nodes
67
What type of protein deposition is in TB?
Amyloid
68
What are giant cells
Multinucleated cells from fusion of macrophages -> form granuloma (e.g. Langerhans giant cells)
69
Causes of granulomas
Chrons TB Sarcoid RA Schistosomiais Leprosy
70
MEN syndromes tumour types
1 = 3Ps Pituitary Parathyroid Pancreas (gastronome, insulinoma, glucagonaoma, VIPoma) + Carcinoid (bronchial) 2 = Thyroid (parafollicular c cells - medullary) Parathyroid Phaeochromocytoma 2B = + neuromas/ marfanoid
71
Which type of MEN syndrome is not inherited? What is the inheritance pattern of the other types?
2B - sporadic mutation only MEN1/2 = autosomal dominant
72
What type of thyroid cancer has amyloid deposits on pathology?
Medullary
73
How does immunohistochemistry work?
Specific antigen localising on tissues by antigen antibody recognition = complement fixation. Antibodies linked to enzyme/ fluorescent dye which is activated on binding so they can be seen under microscope.
74

MRCS B (10 decks)

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