Pathology 2 Mo's notes Flashcards

Question

Which coagulation pathway is not affected by warfarin?

Answer 1

Intrinsic pathway

Answer 2

a blood clot formed in situ within the vascular system of the body and impeding blood flow

Answer 3

mechanical valve tissue valve TAVI - transarterial valve insertion Aortic balloon valvulopasty

Answer 4

Inflammatory disease of blood vessels (large and medium) of the head, mainly branches of ECA.

Answer 5

intimal thickening elastic lamina fragmentation infiltrateof T-cell and macrophages giant mulitnucliated cells

Answer 6

Ophthalmic artery involvement

Answer 7

Corticosteroids. Start prednisolone 60mg/d PO immediately or IV methylprednisolone if evolving visual loss or history of amaurosis fugax. Typically a 2-year course.

Answer 8

* Histologically normal bone that is decreased in quantity. * Postmenopausal osteoporosis the increase in osteoclast activity affects mainly bones or portions of bones that have increased surface area, such as the cancellous compartment of vertebral bodies. * The trabecular plates become perforated, thinned, and lose their interconnections, leading to progressive micro fractures and eventual vertebral collapse

Answer 9

* Low bone mass * Micro architectural deterioration of bone tissue * Increase bone fragility * Loss of bone matrix

Answer 10

* Direct inhibition of osteoblast formation * Direct stimulation of bone resorption * Inhibition of GIT calcium absorption * Stimulation of renal calcium losses * Inhibition of sex steroids

Answer 11

* Idiopathic * Postmenopausal * Senile

Answer 12

Endocrine - addisons, DMT1, HPTH GI - malabsorption Drugs - etoh, corticosteroids Misc - anaemia, immobilisation

Answer 13

* Skeletal metastasis * Paget's disease * Multiple myeloma * Rickets * Osteomalacia * Osteogenesis imperfecta * Radiotherapy

Answer 14

It’s a plasma cell neoplasm commonly associated with lytic bone lesions, hypercalcemia, renal failure, and acquired immune abnormalities. It produces large amounts of IgG 55% or IgA 25%. It is the most common primary bone tumor in elderly

Answer 15

* Punched-out lytic skull lesions on x-ray * M spike on protein electrophoresis * Ig light chains in urine (Bence Jones proteins) * CRAB: o HyperCalcemia (corrected calcium > 2.75 mmol/l, > 11 mg/dL) o Renal insufficiency attributable to myeloma o Anemia (hemoglobin < 10 g/dl) o Bone lesions (lytic lesions or osteoporosis with compression fractures)

Answer 16

Are monoclonal globulin proteins or immunoglobulin light chain found in the urine. The proteins are produced by neoplastic plasma cells. Bence Jones proteins are present in 2/3 of multiple myeloma cases.

Answer 17

* Long bone fracture (closed) * Major Burns * Acute pancreatitis * DM * Orthopedic surgery (intramedullary nailing, joint reconstruction) * Decompression sickness * CPBG (cardiopulmonary bypass graft)

Answer 18

* Respiratory (O2/mechanical ventilation) * Fluid and electrolytes balance * General (DVT, sepsis, nutrition)

Answer 19

Gangrene (or gangrenous necrosis) is a type of necrosis caused by a critically insufficient blood supply

Answer 20

Accidental and unregulated form of cell death resulting from damage to cell membranes and loss of ion homeostasis

Answer 21

Severe/prolonged ischemia: severe swelling of mitochondria, calcium influx into mitochondria and into the cell with rupture of lysosomes and plasma membrane. Death by necrosis due the release of cytochrome C from mitochondria

Answer 22

Pathological process of the vasculature in which an artery wall thickens as a result of accumulation of fatty materials such as cholesterol

Answer 23

* Smoking * HTN * DM * Family history * Increased LDL

Answer 24

Small cell v non-smal cell

Answer 25

* Coagulative * Liquefactive * Caseous * Fat * Fibrinoid * Gangrenous

Answer 26

high plasma growth hormone megakaryocytes lodge in peripheral vasculature lead to platelet derived growth factor (PDGF) = increased vascular permeability

Answer 27

Immunohistochemistry

Answer 28

Tyrosine kinase inhibitor (imatinib)

Answer 29

Adenocarcinoma is cancer that forms in mucus-secreting glands throughout the body.

Answer 30

In people with emphysema, the air sacs in the lungs (alveoli) are damaged. Over time, the inner walls of the air sacs weaken and rupture — creating larger air spaces instead of many small ones and reducing surface area for gas exchange

Answer 31

A paraneoplastic syndrome is a syndrome (a set of signs and symptoms) that is the consequence of a tumor in the body (usually a cancerous one).[1] It is specifically due to the production of chemical signaling molecules (such as hormones or cytokines) by tumor cells or by an immune response against the tumor.[2]

Answer 32

**endocrine** - Cushing's - pancreatic cancer - hypercalcaemia - SCC lung, breast, renal **neurological** - myasthenia - bronchocarcinoma **mucocutaneous** - acanthosis nigricans - lung cancer, gastric **hematological** - VTE - all

Answer 33

TB Lung cancer Hodgkin's lumphoma

Answer 34

Sputum - MC&S * Mantoux test * PCR to differentiate mycobacteria tuberculosis from other species * FNAC of lymph node

Answer 35

* Mycobacterium tuberculosis * Mycobacterium avium intracellulare (MAC) → disseminated infection in immunocompromised patients * Mycobacterium bovis

Answer 36

* Solid media: Lowenstein Jensen media, Middlebrook media * Liquid media: BACTEC/MIGT (mycobacteria growth indicator tube)

Answer 37

1 to 8 weeks

Answer 38

necrotic granuloma, histiocytes, giant cells

Answer 39

Multinucleated cells comprising of macrophages often forming granuloma e.g. Langerhans’ giant cells, Reed sternberg cells

Answer 40

1- Notify the consultant in communicable disease control (CCDC) 2- Avoid working in the food factory 3- Use mask during sneezing or coughing 4- DOTS (Directly Observed Treatment, Short-course) anti-TB therapy 5- Contact tracing: the identification and diagnosis of persons who may have come into contact with an infected person

Answer 41

Counselling, screening and treatment of other family members.

Answer 42

A granuloma is an aggregation of macrophages (along with other cells) that forms in response to chronic inflammation. This occurs when the immune system attempts to isolate foreign substances that it is otherwise unable to eliminate

Answer 43

* Leprosy * Schistosomiasis * Sarcoidosis * Crohn’s * Rheumatoid arthritis * TB

Answer 44

Ceaseating - TB Non-ceaseating - Crohn's

Answer 45

speculated mass + microcalcifications

Answer 46

* C1 – inadequate sample * C2 – benign * C3 – equivocal * C4 – suspicious * C5 – malignant

Answer 47

* Type of cancer * Number of positive lymph nodes * Margins status * HER2 receptors status – poor prognosis * ER/PR receptor status – good prognosis * Ki 67 proliferation index – how progressive the cancer is? i.e. the higher its % the higher the progression of the cancer

Answer 48

Most common site is upper outer quadrant as it has more glandular tissue

Answer 49

Invasive duct carcinoma

Answer 50

Oncogene, biomarker, transmembrane Human Epidermal growth factor Receptor 2 and it is overexpressed in 15% of breast cancer cases and associated with bad prognosis.

Answer 51

Immunohistochemistry (IHC) measures the amount of HER2 protein in the cancer cells. Fluorescence in situ hybridization (FISH) looks at the number of copies of the HER2 gene in the cancer cells.

Answer 52

Monoclonal antibody, (Herceptin) Trastuzumab

Answer 53

1. blocks HER2 receptor 2. antibody mediated destruction of cells overproducing HER2

Answer 54

* Radiotherapy * Chemotherapy * Hormonal therapy: o Premenopausal: Tamoxifen (20mg /d) for 5 years – blocks estrogen receptor o Postmenopausal: Aromatase inhibitors (anastrozole) to prevent peripheral conversion to estrogen

Answer 55

Patient is a carrier and will require decolonization – According to trust protocol * Nose: Mupirocin 2% (Bactroban Nasal®) nasal ointment TDS for 5 days * Skin: Once daily wash with Chlorhexidine 4% (Hibiscrub®) for 5 days * Hair: Wash with Chlorhexidine 4% (Hibiscrub®) on day 1 and day 5

Answer 56

It is caused by the extension of DCIS (ductal carcinoma in situ) up the lactiferous ducts and into the contiguous skin of the nipple, producing a unilateral crusting exudate over the nipple and areolar skin.

Answer 57

Pituitary Pancreatic - insulinomas Parathyroid

Answer 58

Insulinoma

Answer 59

most tumor suppressor genes require both alleles to be inactivated, either through mutations or through epigenetic silencing, to cause a phenotypic change

Answer 60

A telomere is a region of repetitive nucleotide sequences at each end of a chromosome, which protects the end of the chromosome from deterioration or from fusion with neighboring chromosomes

Answer 61

An abnormal localised dilatation of a blood vessel to more than 1.5 its normal diameter

Answer 62

Cause - Acquired - Normally caused by atherosclerosis - Traumatic e.g. popliteal aneurysms in horse-riders - Inflammatory - Infective e.g Syphilis - Congenital connective tissue disorders e.g. Marfan’s and Ehlers-Danlos syndromes True vs false (pseudoaneurysm = false aneurysm. This is a haematoma outside the vessel wall formed by a leaking hole) Site: thoracic aorta, abdominal aorta, intracranial Size: giant vs berry aneurysms Shape: fusiform vs saccular

Answer 63

The normal diameter of the infrarenal aorta is 2cm; therefore an aorta that was 3cm or larger would be considered aneurismal

Answer 64

A true aneurysm involves all three layers of the vessel wall, the intima, media and adventitia, whereas a pseudoaneurysm or false aneurysm is bounded by only part of the vessel wall.

Answer 65

Smoking Hypertension Age Family History Hyperlipidaemia Diabetes mellitus Male sex

Answer 66

Atherosclerosis is the commonest cause of abdominal aortic aneurysms. Other causes include infection and trauma, and genetic disposition plays as role. Abdominal aortic aneurysms arise due to failure of the structural proteins involved in the aortic wall, in particular the elastin and collagen in the media. Atherosclerosis results in weakening of the mechanical structure, loss of elastic recoil, and degenerative ischaemic changes due to obstruction of the vasa vasorum.

Answer 67

Smoking Other risk factors include age (>60), male sex, hypertension and family history.

Answer 68

Rupture Thrombosis Embolism Infection Local pressure effects Fistula (e.g. aorto-enteric fistula)

Answer 69

* above 5.5cm in diameter, or growing at a rate of > 1cm per year. * 3-4 cm, annual ultrasound imaging should be used to monitor for further dilatation. * 4-5.4 cm should be evaluated by ultrasound every 6 months, and patients with * All symptomatic aneurysms should be considered for repair.

Answer 70

For an elective non-ruptured AAA, mortality is around 3-5%, usually due to intraoperative rupture, or subsequent myocardial infarction, renal failure or infection.

Answer 71

50% of ruptured AAAs don’t reach hospital, and of those operated on, there is a 50% mortality.

Answer 72

The posterior openings are the exiting lumbar arteries They are a source of back bleeding during open abdominal aortic aneurysm repair

Answer 73

Lumbar artery orifices are normally oversewn to prevent back bleeding from collaterals. At repair there are several orifices you may see. Posteriorly are the lumbar arteries, laterally the renal arteries, which must be preserved, and anteriorly the superior and inferior mesenteric arteries. In suprarenal AAA repair the superior mesenteric artery is normally reimplanted. The inferior mesenteric artery is occluded unless it is patent and not vigorously back bleeding, in which case it is also reimplanted.

Answer 74

Abdominal ultrasound imaging is probably best as it has few complications and measures to within 0.3cm accuracy Men aged 65

Answer 75

Intraoperative complications * rupture of the aneurysm * endoleak Postoperatively early complications * mesenteric ischaemia * renal failure * infection * myocardial infarction

Answer 76

Aortic dissection is the forceful separation of the layers of the aortic wall due to a tear in the intima. Blood penetrates the space in between the intima and media causing them to be separated.

Answer 77

sudden severe chest pain, which is maximal at onset, radiating through to the back. It has a high mortality.

Answer 78

The Stanford classification splits aortic dissection into type A and B. A, which also includes DeBakey type I and II, involves the ascending aorta B, only the descending aorta is involved

Answer 79

In general type A aortic dissections require surgical repair whereas type B aortic dissections are managed with aggressive medical therapy.

Answer 80

Parathyroid hyperplasia Medullary thyroid cancer Phaechromocytoma

Answer 81

Hyperparathyroidism Medullary thyroid carcinoma Phaechromocytoma

Answer 82

Plasma: * Free metanephrine * Catecholamines Urine: * Metanephrines * Catecholamines * VMA Imaging: * Ultrasound * CT * MRI * MIBG scintigraphy * PET/CT

Answer 83

MEN2a (hyperparathyroidism, Medullary thyroid carcinoma, Phaechromocytoma) + Marfanoid + Mucosal neuromas

Answer 84

pleomorphic adenoma

Answer 85

Benign tumors that consist of a mixture of ductal (epithelial) and myoepithelial cells, and therefore they show both epithelial and mesenchymal differentiation

Answer 86

Remarkable histologic diversity

Answer 87

* Duct obstruction – salivary calculus, external ductal compression * Neoplasia – benign or malignant * Infective mumps (although bilateral swelling is more common), parotitis

Answer 88

well demarcated adjacent normal salivary glands

Answer 89

* Facial nerve affection * Rapid increase in size * Fixity to underlying tissue * Invasion of the skin * Skin ulcer * Presence of associated nodes

Answer 90

* Increased nuclear size (with increased nuclear/cytoplasmic ratio--N/C ratio). * Variation in nuclear or cell size (pleomorphism). * Lack of differentiation (anaplasia). * loss of normal tissue architecture (loss of polarity) * Increased nuclear DNA content with subsequent dark staining on H and E slides (hyperchromatism). * Prominent nucleoli or irregular chomatin distribution within nuclei. * Increased mitotic rate (especially irregular or bizarre mitoses). * Giant cells some malignant cells may coalese into so-called giant cell * Ischemic necrosis (from tumor cells outgrowing their blood supply)

Answer 91

* The wound should be allowed to bleed under running water and wash with soap * Assess incident risk * Assess source patient o Take history if he has a possibility of any blood borne infection, take a blood sample from the patient if high risk after consent. * I would file an incident report and speak to occupational health for advice. * Documentation Source: https://www.

Answer 92

* 7th CN palsy * Frey’s Syndrome * Salivary fistula * Greater auricular nerve damage -numbness to earlobe

Answer 93

post-operative phenomena following salivary gland surgery resulting in gustatory sweating and facial flushing due to reinnervation of postganglionic fibers to sweat gland and cutaneous blood vessels

Answer 94

Sensitivity is the ability of a test to correctly classify an individual as ′diseased′ (true positive rate) High sensitivity = low number of false negatives

Answer 95

Specificity is the ability of a test to correctly classify an individual as disease-free (true negative rate). High specificity = low number of false positives

Answer 96

passing a needle through a lesion whilst suction is applied to a syringe.

Answer 97

A core biopsy is obtained by use of a spring-loaded gun with a needle passing quickly through the lesion

Answer 98

* Lymphatic (permeation and lymph emboli) * Hematogenous * Trans-celomic (along body cavity to peritoneal surface) * Local invasion

Answer 99

A hypha is a long, branching, filamentous structure of a fungus, oomycete, or actinobacterium. In most fungi, hyphae are the main mode of vegetative growth, and are collectively called a mycelium.

Answer 100

An abscess is a collection of pus surrounded by granulation or fibrous tissue

Answer 101

Slow-growing type of neuroendocrine tumor originating in the cells of the neuroendocrine system.

Answer 102

Small intestine, appendix (terminal third) and they can also be found in the rectum, stomach and lung

Answer 103

Enterochromaffin (EC) cells in the crypts of Lieberkuhn

Answer 104

serotonin (5-HT), bradykinins, prostaglandins, tachykinins, substance P and histamine

Answer 105

* Periodic abdominal pain * Manifestations of carcinoid syndrome: o Cutaneous flushing o Diarrhea and malabsorption o Cardiac manifestations: Valvular heart lesions, fibrosis of the endocardium o Wheezing or asthma like syndrome: Due to bronchial constriction

Answer 106

* Chromogranin A (CgA) Testing in the blood (protein secreted from carcinoid tumor cells) * 5-Hydroxyindoleacetic Acid (5-HIAA) Testing in 24 h urine (byproduct of serotonin) * Pathological diagnosis: immunohistochemistry stains positive for chromogranin B

Answer 107

tacrolimus mycophenolate

Answer 108

* **Calcineurin inhibitors**, such as cyclosporine or tacrolimus, inhibit T cells by blocking IL2 * **Anti-proliferative agents**, such as mycophenolate mofetil or azathioprine, inhibit nucleotide synthesis * **Corticosteroids**, such as prednisolone or methylprednisolone, anitinflammatory * **Monoclonal antibodies**, such as Basiliximab (IL2 blocking) or Alemtuzumab (lymphocyte depleting) ## Footnote https://teachmesurgery.com/transplant-surgery/core-concepts/immunosuppression/

Answer 109

* Abscess * Toxic megacolon * Malabsorption * Malignancy * Gall stones (due to inhibition of enterohepatic circulation so bile salts will not be absorbed leading to increased amount of cholesterol)

Answer 110

* Aphthous ulcers * Pyoderma gangrenosum * Iritis * Erythema nodosum * Sclerosing cholangitis * Arthritis * Clubbing

Answer 111

**Medical** * Advice from gastroenterology * Steroid, antibiotics, 5-aminosalicylic acid, immunomodulators **Conservative** * Dietary control (low residue diet) **Surgery** * Refractory disease * Intestinal obstruction * Toxic megacolon * Abscess, fistula, perforation, hemorrhage, cancer

Answer 112

**Site** Mouth to anus **Macroscopic** * Cobblestone appearance * Aphthoid ulceration * Linear fissures * Thickened bowel wall * Creeping fat **Depth** Transmural inflammation **Pattern** Patchy, skip lesions **Histology** Granulomas (non caseating epithelioid cell aggregates with Langhans' giant cells) Active colitis * Crypt abscess formation * Mucosal ulceration * Inflammatory pseudo polyps **Cancer ** 1 - 3%

Answer 113

**Site** Rectum and colon (back-wash ileitis) **Macroscopic** * Pseudopolyps * Extensive ulceration * Contact bleeding **Depth** Superficial inflammation **Pattern** Continuous **Histology** Crypt abscesses, Inflammatory cells in the lamina propria Active colitis * Cryptitis * Crypt abscess formation * Mucosal ulceration * Inflammatory pseudo polyps **Cancer** 5 - 25%

Answer 114

Stepwise accumulation of mutations of oncogenes and tumor suppressor genes: 1- Loss of APC (tumor suppressor gene) → hyperplasia 2- K-RAS (oncogene) mutation → dysplasia 3- Loss of p 53 (tumor suppressor gene) → adenocarcinoma

Answer 115

Created by mutation in proto-oncogenes Encode for oncoproteins that promote cell growth in the absence of normal growth producing signals

Answer 116

KRAS - bowel cancer RET - MEN2 MVC - Burkett's lymphoma

Answer 117

Normal function is to inhibit proliferation of cells or promote cell death

Answer 118

APC - bowel cancer, brain, stomach, bone PTEN - breast, thyroid, endometrial STK2 - breast, pancreatic

Answer 119

Subset of tumour supressor Identification and repair of damaged DNA

Answer 120

P53 - breast, sarcoma, bowel VHL - RCC, phaeochromocytoma

Answer 121

a cytokine involved in acute phase reaction

Answer 122

TNF and other immune mediated signals direct epithelia to increase tight junctions permeability which increase the flux of luminal bacterial components which activates innate and adaptive immune responses

Answer 123

* Infliximab * Adalimumab * Certolizumab Monoclonal IgG1 antibody to TNF- α

Answer 124

Autosomal dominant condition characterized by loss of APC tumor suppressor gene leading to development of hundreds of tubular adenomas with 100% risk of cancer by the age of 40 AKA Gardener syndrome

Answer 125

* **Non-neoplastic:** o Hamartomatous o Metaplastic * **Inflammatory:** o Pseudopolyps o Ulcerative colitis * **Neoplastic:** o Villous (40%) o Tubulovillous (20%) o Tubular (5%)

Answer 126

* Mandibular osteoma * Desmoid tumors * Sebaceous cyst

Answer 127

Prophylactic near total colectomy by the age of 25

Pathology 2 Mo's notes Flashcards

(157 cards)