Path 5 Flashcards

Question

Which stains are positive in haemochromatosis?

Answer 1

Prussian blue and Perl's stain (both are +ve for iron)

Answer 2

haemochromatosis iron

Answer 3

positive for epithelial cells -> carcinoma

Answer 4

+ve for lymphoid cells / lymphocytes

Answer 5

+ve for acid fast bacilli - TB red against a blue background

Answer 6

TB colour: bright yellow

Answer 7

Ziehl Neelsen and Rhodamine-Auramine

Answer 8

Gomori's methanamine silver stain flying saucer shaped cysts

Answer 9

Pneumocystis jirovecii

Answer 10

Modified Kinyoung acid fast stain

Answer 11

Cryptosporidium parvum

Answer 12

Cryptococcus neoformans (yeast cells surrounded by halos)

Answer 13

India ink stain (yeast cells surrounded by halos)

Answer 14

Chlamydia psittaci (cytoplasmic inclusions seen)

Answer 15

Giemsa stain (cytoplasmic inclusions seen)

Answer 16

Mycobacterium leprae

Answer 17

1 in 5 infected people have symptoms - fever - rash - joint pain - headache - conjunctivitis - muscle pain Sx last for several days to a week

Answer 18

- mosquito bite - mother to child transmission in pregnancy - sex - blood transfusion

Answer 19

- crosses the placenta - targets neuronal progenitor cells (neuronal growth, proliferation, migration is disrupted)

Answer 20

- microcephaly - craniofacial disproportion - skull abnormalities - damage to the brain - seizures - problems with hearing (?SN hearing loss) - problems with vision - problems with feeding (issues swallowing) - problems with moving limbs and body

Answer 21

- All travellers – bite avoidance - Pregnant women – avoid travel to areas with current transmission - Avoid conception for 2 – 6 months after travel (prolonged viral shedding in semen) - Testing only if symptomatic or abnormalities identified on antenatal USS

Answer 22

No you have antibodies that protect you and the baby only primary infections are worrying

Answer 23

- miscarriage - congenital abnormalities (ventriculomegaly, CNS abnormalities) - preterm birth

Answer 24

Burkitt's lymphoma

Answer 25

enveloped dsDNA genome

Answer 26

Lies latent in monocytes and dendritic cells

Answer 27

B-cells epithelial cells NK cells T-cells

Answer 28

neurological abnormalities ocular abnormalities (e.g. microphtalmia) limb abnormalities GI abnormalities low birth weight skin scarring

Answer 29

- 10-20% pregnant women are susceptible to VZV - 10-20% pregnant women with varicella will have varicella pneumonia - encephalitis (Rare, but 5-10% cases are fatal) - pregnant women are 5x more likely to develop varicella pneumonitis compared to the general population

Answer 30

0.4% if maternal infection weeks 0-12 2% if weeks 12-20 studies have not shown cases after 28w

Answer 31

if immunity status is unknown, CHECK FOR ANTIBODIES FIRST If no antibodies <20 w give VZIG asap >20 w give oral antivirals (acyclovir or valacyclovir) for days 7-14 post exposure

Answer 32

- seek specialist advice - ≥ 20 weeks and she presents within 24 hours of onset of the rash - give oral acyclovir - if < 20 weeks the aciclovir should be 'considered with caution' RCOG guidelines

Answer 33

4w or 1 month

Answer 34

- iron deficiency - anaemia of chronic disease - sideroblastic anaemia - beta thalassemia

Answer 35

Ineffective erythropoiesis → the body produces enough iron but is unable to effectively put it in RBCs. Iron loading (bone marrow) causes haemosiderosis (endocrine, liver and cardiac damage due to iron deposition)

Answer 36

once weekly in the beginning once settled: every 3 months. Lithium levels should be measured 12h after taking the medication

Answer 37

-> cause bloody diarrhoea C - campylobacter H - Hemorrhagic E. coli (O157:H7) E - Entamoeba histolytica S - salmonella S - shigella

Answer 38

SEM (skin, eye, mouth disease) - 45% cases - initially benign, high risk of progression to CNS - must be treated (acyclovir) - usually first 14 days, up to 16w CNS (+/- SEM) - 30% cases - weeks 203 of life (up to 6) - Sx: seizures, lethargy, irritability, poor feeding, fevers - need CSF Disseminated - presents like sepsis - often in 1st week of life - multi organ involvement (liver, lungs, CNS, heart, GIT, renal tract, BM)

Answer 39

aciclovir (can be used in any trimester) if primary HSV in 3rd TM recommend C/S

Answer 40

very rare but severe baby gets HSV in utero from mother with primary infection Risks: Primary infection only Miscarriage Congenital abnormalities ( ventriculomegaly, CNS abnormalities) Preterm birth IUGR

Answer 41

Congenital Varicella syndrome - skin scarring - neurological abnormalities - ocular abnormalities - low birth weight - limb abnormalities - GI abnormalities

Answer 42

- 10-20% pregnant women susceptible - 5x higher risk of VZV pneumonia than gen pop (10-20% pregnant women with VZV will get this) - VZV encephalitis is rare but severe if presenting with exposure/sx -> check immunity status and measure antibodies

Answer 43

Exposure: if hx of infection or 2 vaccinations -> sufficient evidence of immunity; otherwise measure VZV IgG in blood; if VZV IgG <100 mIU/ml offer PEP PEP: aciclovir or valaciclovir Infection: treat with aciclovir

Answer 44

0.4% if maternal infection weeks 0-12 2% if weeks 12-20 20+ weeks: ?????????

Answer 45

VZV IgG <100 mIU/ml -> offer PEP

Answer 46

50 % susceptible 1% of them will develop infection in pregnancy 40% babies will get it

Answer 47

5% have clinical issues at birth, e.g. hepatosplenomegaly, petechia, most of them will have neurodevelopment disabilities later in life e.g. SN hearing loss, CP, epilepsy, cognitive impairment 5% develop issues later in later, mainly SN hearing loss 90 % normal at birth and normal development

Answer 48

before 8 weeks -> 20% spont abortion before 10 weeks 90% incidence of fetal defects after 18-18 weeks -> hearing defects and retinopathy after 20 weeks risk is much lower

Answer 49

via the placenta

Answer 50

Early manifestations: - Bone lesions - Microcephaly - Cataracts - Retinopathy - Meningoencephalitis - congenital cardiac disease (PDA, PS) - Purpura - Hepatosplenomegaly Late onset manifestations - Hearing loss - Intellectual disability - Panencephalitis - DM - Thyroid dysfunction

Answer 51

yes, it continues to damage the infant

Answer 52

rubella: starts on face, spreads to trunk measles: starts at hairline/behind ears, spreads cephalocaudally over 3 days `

Answer 53

Paramyxovirus – RNA virus

Answer 54

respiratory (isolate!) conjunctiva

Answer 55

respiratory (isolate!)

Answer 56

Congenital rubella syndrome Early manifestations: - Bone lesions - Microcephaly - Cataracts - Retinopathy - Meningoencephalitis - Congenital heart disease(PDA, PS) - Purpura - Hepatosplenomegaly Late onset manifestations - Hearing loss - Intellectual disability - Panencephalitis - DM - Thyroid dysfunction

Answer 57

Measles sx: - Prodrome 2-4 days - Conjunctivitis - Koplick spots - Rash Complications for mother: - Secondary bacterial infection - Otitis media / pneumonia / GI - encephalitis

Answer 58

- foetal loss, - preterm delivery - no congentila abnormalities - SSPE (subacute sclerosing panencephalitis – fatal, progressive disease of the CNS, occurs 7-10 years after natural infection

Answer 59

subacute sclerosing panencephalitis fatal, progressive disease of the CNS occurs 7-10 years after natural infection with measles possible complication of measles in pregnancy

Answer 60

respiratory and blood products

Answer 61

Virus detection (PCR) Serology

Answer 62

Virus detection (PCR) Serology

Answer 63

PCR of urine/saliva/amniotic fluid/tissue Serology

Answer 64

viral detection - lesion swab for PCR serology

Answer 65

- Mostly asymptomatic - Erythema infectiosum/ slapped cheek/5ths disease - Polyarthropathy - Transient aplastic crisis

Answer 66

6d post exposure - 1 week (infectious before sx commence)

Answer 67

Before 20 weeks * Transmission 33% * 9% risk of infection * 3% hydrops fetalis if infection) * 1% fetal anomalies * 7% fetal loss Refer to FMU, may require intrauterine transfusion No documented risks after 20 weeks

Answer 68

Fetal hydrops Cytotoxic to fetal red blood precursor cells -> anaemia -> accumulation of fluid in soft tissues and serous cavities. -> can rapidly cause fetal death

Answer 69

Coxsackie Perinatal newborn infection can occur in last week of pregnancy Neonates are at risk of myocarditis, fulminant hepatitis, encephalitis , bleeding and MOF.

Answer 70

- Gestation - Date of onset, clinical features, type and distribution of rash, associated features - Past relevant history of infection - Past relevant history of antibody testing - Past immunisation history (and dates/places) - unwell contacts - Travel history

Answer 71

- avoid conception for 2-6 months after travel (prolonged viral shedding in semen) - avoid travel to endemic areas in pregnancy

Answer 72

staph, strep, coliform bacteria, clostridium perfringens usually start form the uterus and spread by lymphatics and blood vessels upwards, deep tissue layer involvement

Answer 73

cervical intraepithelial neoplasia

Answer 74

Human Papilloma Virus -present in 95% Many sexual partners Sexually active early Smoking Immunosuppressive disorders

Answer 75

squamocolumnar junction between the columnar epithelium and the transformation zone

Answer 76

Papanicolaou-test screening (Pap smear) and human papillomavirus (HPV) vaccination

Answer 77

Papanicolaou-test screening

Answer 78

degree of atypia on cytology

Answer 79

Patients are usually asymptomatic in the early stages and develop symptoms later in the course of the disease. Early symptoms Abnormal vaginal bleeding: irregular vaginal bleeding, heavy, irregular menstrual bleeding, postcoital spotting Abnormal vaginal discharge: blood-stained or purulent malodorous discharge (not necessarily accompanied by pruritus) Dyspareunia Pelvic pain Late symptoms: hydronephrosis, lymphedema, fistula formation Cervical examination: ulceration, induration, or an exophytic tumor

Answer 80

Squamous cell carcinoma - 80% - HPV 16 Adenocarcinoma - 20% - HPV 18 Small Cell Carcinoma - 2% - neuroendocrine tumour

Answer 81

latent/non-productive: HPV continues to reside in the basal cell, infectious visions are NOT produced, viral DNA replication is coupled to epithelial cell replication. complete viral particles are not produced. no cellular effects seen. infection can only be identified with molecular methods. -> leads to immune response and regression productive: viral DNA replication occurs independent of host chromosomal DNA synthesis. Large number of viral DNA are produced and result in infectious visions. characteristic histological and cytological features are seen. -> can lead to malignant cells.

Answer 82

encodes proteins E6 and E7 these bind to and inavtivate two tumour suppressor genes: - p53 (E6) - Retinoblastoma (Rb) gene protein (E7) both interfere with apoptosis and increase unscheduled cellular proliferation both of which contribute to oncogenesis.

Answer 83

encodes proteins E6 (mainly HPV and E7 mainly HPV ( these bind to and inavtivate two tumour suppressor genes: - p53 (E6) - Retinoblastoma (Rb) gene protein (E7) both interfere with apoptosis and increase unscheduled cellular proliferation both of which contribute to oncogenesis.

Answer 84

Mostly: nothing happens, body eliminates the infection. HPV becomes undetectable in 2 y relatively few develop symptoms Persisten infection with high risk HPV types is associated with pre-cancerous and cancerous cervical changes.

Answer 85

molecular genetic approaches. HPV DNA test (nucleic acid solution hybridisation assay with signal amplification that uses long synthetic RNA probes complementary to low risk HPV types 6, 11, 42, 43 and 44 as well as high risk types 16, 18, 31, 33, 35, 39, 45, 51, 56, 58, 59, 68)

Answer 86

endometrial serous carcinoma

Answer 87

PTEN CTNNB1 Her-2 amplification

Answer 88

ovarian mass (e.g. cyst or cancer) ovary >5cm

Answer 89

- whirlpool sign - one ovary is larger than the other (due to oedema and blood pooling) - decreased or absent blood flow

Answer 90

- urgent surgical detorsion (to avoid ischaemia and loss of the ovary and tube) - unilateral sapling oophorectomy if ovary cannot be saved

Answer 91

- ovarian torsion - ruptured ovarian cyst - tubo ovarian abscess - ectopic pregnancy

Answer 92

sudden onset pain either spontaneous or e.g. during sex or exercise

Answer 93

Minor bleeding -> hameodynamic status and Hb not affected -> treat with NSAIDs -> sx should resolve in a few days. Major bleeding - present with peritoneal irritation e.g. guarding, tenderness - USS shows blood in cavity - admit and give IV fluids - surgery may be needed to stop bleeding and remove the cyst

Answer 94

- acute lower abdo pain - fever - chills - vaginal discharge - mass is tender and painful - high WCC - USS shows complex mass that obliterates normal architecture.

Answer 95

- admit urgently - abx - may need surgery

Answer 96

- admit urgently - abx - may need surgery

Answer 97

<10 cm thin, regular walls ulilocular filled with anechoic fluid (homogenous) -> benign

Path 5 Flashcards

(133 cards)