MRCS B > Pathology > Flashcards

Pathology Flashcards

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1
Q

Types of endocarditis

A

IE - vegetations (Duke’s criteria - remember major and minor criteria)
Marantic - setting of cancer
Libman sacks - setting of cancer

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2
Q

Why rheumatic heart and valve replacement patients are more susceptible to IE?

A

Blood usually flows smoothly over valves, when these valves are damaged (as in RH) or in valve replacement, there will
be an increased chance for bacterial colonization on damaged tissues

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3
Q

Rheumatic fever pathophys

A

Acute rheumatic fever results from host immune responses to group A streptococcal antigens that cross-react
with host proteins.
Recurrent inflammation, progressive fibrosis, narrowing and stiffening of the valve leaflets with commissural
fusion, retraction of the leaflet edges, valve thickening, calcification leading to stenosis.

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4
Q

Macroscopic findings of RHD

A

Aschoff nodules
* Fibrinoid necrosis

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5
Q

If IE occurs in tricuspid valve in young people?

A

Right sided heart failure

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6
Q

How does AS occur

A

Lipid accumulation, inflammation, calcification →
valve thickening and stenosis

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7
Q

Why is bicuspid valve at higher risk of IE?

A

Higher risk of stenosis in bicuspid valve and stasis of blood

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8
Q

If we found microscopic branching hyphae on a
removed metallic valve, what’s the cause?

A

Fungal cause such as aspergillus

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9
Q

Commonest bacteria cause of valve infection

A

Staph epidermis, staph aureus

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10
Q

What is GCA, most accurate test and why is there blindness?

A

Granulomatous inflammatory diseases of blood vessels of the head
Temporal artery biopsy
Opthalmic artery involvement

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11
Q

What is osteoporosis?

A

Metabolic bone disease that is characterised by decreased bone mass of normal mineralised bone leading to fractures with minimal trauma

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12
Q

Bence jones proteins

A

MM

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13
Q

CRAB

A

MM

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14
Q

Types of necrosis

A

Coagulative, caseous, liquefactive, fat, fibrinoid,gangrenous

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15
Q

What other tumor metastasis to bone?

A

BLT with kosher pickle

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16
Q

What are giant cells?

A

Multinucleated cells formed by fusion of monocytes/macrophages often forming granuloma

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17
Q

What can you recognize in mammogram?

A

Speculated mass + microcalcifications

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18
Q

What other tests to do for breast Ca?

A

Tissue biopsy (TRU-cut, FNAC or excisional)

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19
Q

FNAC done showed C4 lesion what this mean?

A

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

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20
Q

Breast cancer lab report

A

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

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21
Q

HER2 stands for and testing

A

Human epidermal growth factor receptor 2, immunochemistry and FISH

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22
Q

Hormonal therapy of breast Ca

A

Pre-menopause - Tamoxifen
Post-menopause - anastrazole

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23
Q

Clinical picture of Insulinoma?

A
  • Ectopic production of insulin by certain retroperitoneal fibromas and fibrosarcomas
    Clinical picture of Insulinoma?
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24
Q

Biochemical tests for insulinoma

A

High insulin-to-glucose ratio
High C-peptide

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25
Dose exposure unit of radiotherapy
Gray
26
Define abscess?
Abscess is focal collection of pus that may be caused by seeding of pyogenic organisms into a tissue or by secondary infections of necrotic foci.
27
Structure of the abscess?
Abscess typically has a central, largely necrotic region rimmed by a layer of preserved neutrophils, with a surrounding zone of dilated vessels and fibroblast proliferation indicative of attempted repair
28
How neutrophils migrate to the site of inflammation?
The neutrophils first roll, then become activated and adhere to endothelium, then transmigrate across the endothelium, pierce the basement membrane, and migrate toward chemoattractants emanating from the source of injury
29
What is carcinoid tumor
Slow-growing type of neuroendocrine tumor originating in the cells of the neuroendocrine system
30
What cells do carcinoid tumours arise from
Enterochromaffin (EC) cells (also known as Kulchitsky cells) in the crypts of Lieberkuhn
31
What do carcinoid tumours release
Notably: serotonin (5-HT), bradykinins, prostaglandins, tachykinins, substance P and histamine
32
Diagnosis of carcinoid syndrome
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
33
UC complications?
Abscess Toxic megacolon Cancer
34
Extraintenstinal manifestations of UC
Apthous ulcers Uveitis Episcleritis Erythema nodosum Arthritis
35
Crohns vs UC
Crohn's: Skip lesions Transmural inflammation Cobblestone appearance Granulomas Mouth to anus UC: Continous Superifical inflammation Crypt abscesses Mucosal ulceration Rectum and anus
36
Cancer cell formation
Loss of APC - hyperplasia Loss of K-RAS - dysplasia Loss of p53 - adenocarcinoma
37
K-Ras MOA
GTPase causing cells to proliferate
38
p53 MOA
Arrest at G1
39
APC MOA
Promotes formation of complex that degrades B-catenin
40
TNF MOA
Pro-inflammatory cytokine secreted from macrophages
41
Define Abscess?
Collection of pus surrounded by granulation or fibrous tissue
42
Define Pus?
collection of neutrophils plus dead or dying micro organisms
43
Define Ulcer?
a lesion in the mucous membrane or the skin resulting from the gradual disintegration of surface epithelial cells
44
1o hyperparathyroidism
Increased PTH and Ca2, reduced phosphate. Solitary adenoma
45
2o hyperparathyroidism
Increased PTH, decreased Ca2, renal failure
46
3o hyperparathroidism
Increased PTH, normal or Ca2 and phosphate, correction of renal disorder
47
What is dumping syndrome
Loss of the reservoir function of the stomach (e.g. following gastrectomy) results in the rapid transit of highly osmotically active substances into the duodenum following meals and may cause ‘dumping syndrome’.
48
4 types of melanoma
Lentigo maligna Superficial spreading Desmoplastic Acral Nodular
49
What is a satellite lesion?
It is a form of local spread of malignant melanoma by contiguity and continuity leading to pigment spreading to the surrounding area. They are found within 2 cm of the primary tumor.
50
BCC lesion
Pearly papule with a central ulcer, with granulation tissue on base and with rolled in (inverted) edges with surrounding telangiectasia
51
MRSA treatment
Isolate, inform infection control, Abx as per micro but vanc/linezolid, decolonise using mupriocin or chlorhexadine
52
Mechanism of lymphatic spread?
Malignant tumors release growth factors such as VEGF-C to induce lymphatic vessel expansion (lymph angiogenesis) in primary tumors and in draining sentinel LNs, thereby promoting LN metastasis
53
Define cryptorchidism
Cryptorchidism is a complete or partial failure of the intra-abdominal testes to descend into the scrotal sac and is associated with testicular dysfunction and an increased risk of testicular cancer
54
Post-operative developed hematoma, mention stages of hematoma resolution?
Lysis of the clot by macrophages (about 1 week) * Growth of fibroblasts from into the hematoma (2 weeks) Hyalinezed tissue formation
55
Protein deposition in chronic OM
Amyloid AA
56
Gout vs Pseudogout
Gout - Negative birefringent needle-shaped, monosodium urate Pseudogout - Weakly positive, rhomboid shaped, calcium pyrophosphate
57
Which thyroid cancer will show no response to iodine uptake?
Medullary thyroid cancer as its origin is from parafollicular C cells so it is not of a follicular origin
58
Intrisnic pathway activation and blood test
Intrinsic pathway is activated by vessel injury which will lead to activation of factor 12 (tested by APTT)
59
Extrinsic pathway activaton and blood test
Extrinsic pathway is activated by tissue thromboplastin released by damaged cells (tested by PT)
60
Hep C transmission
IVDU/needlestick (parentral transmission)
61
What is R1?
R0 – No residual tumor * R1 – microscopic residual tumor * R2 – macroscopic residual tumor
62
Which layer is affected in pseudoaneurysm?
Sub-intimal layer
63
Sequence of clotting?
njury to blood vessels → Platelets aggregation → Platelet plug → activation of intrinsic pathway
64
What are the borders of the inguinal canal?
Anterior – External oblique aponeurosis, internal oblique in lateral third Posterior – Transversalis fascia + conjoint tendon medially. Roof – Internal oblique Floor – Inguinal ligament.
64
What is the anatomical distinction between direct and indirect inguinal hernias?
In a direct inguinal hernia, the hernia neck lies medial to the inferior epigastric vessels, whereas in an indirect hernia it lies lateral to the same vessels.
65
How could you tell clinically between a direct and indirect inguinal hernia?
Reduce the hernia, place a finger over the deep inguinal ring (1cm above the midpoint of the inguinal ligament) and ask the patient to cough. The hernia will return if it is a direct hernia, whereas an indirect hernia will remain reduced.
66
What are the borders of Hesselbach’s triangle?
Lateral – inferior epigastric vessels Inferior – inguinal ligament Medial – lateral border of rectus abdominis.
67
What are the borders of the femoral ring?
Anterior – inguinal ligament Posterior – pectineal ligament Medial – Lacunar ligament Lateral – medial wall of femoral vein
68
Explain the process of primary intention healing.
Occurs when wound edges (specifically dermal edges) are well opposed. Process: Haemostasis Inflammation – migration of phagocytes resulting in the removal of wound debris Proliferation – involves cells such as fibroblasts and myofibroblasts, resulting in the formation of granulation tissue and collagen. Remodelling – ongoing process of collagen formation and breakdown, providing strength to the resulting scar.
69
Describe the two phases of acute inflammation.
Vascular phase – vasodilatation and increased capillary permeability secondary to cytokine release. Cellular phase – recruitment of neutrophils to the affected area, resulting in phagocytosis of offending material
70
Outline the process by which neutrophils leave the blood and enter the interstitial fluid.
Margination Rolling Adhesion Emigration
71
How are macrophages involved in the activation of the adaptive immune system in chronic inflammation?
Can form antigen presenting cells (APCs), presenting antigens to the adaptive immune system, stimulating production of antigen-specific antibodies.
72
What is a granuloma?
Aggregation of macrophages around a foreign insult, in an attempt to ‘wall off’ from the surrounding tissues as opposed to phagocytose.
73
What enzyme is predominantly activated in apoptosis?
Caspase – both initiator and finally executor types.
74
Explain the two pathways by which apoptosis is activated.
Intrinsic pathway – internal stimuli e.g. DNA damage, biochemical abnormalities. Extrinsic pathway – external stimuli, activation of receptors resulting in caspase enzyme activation.
75
Which specific mediator results in the inhibition of apoptosis?
Bcl-2
76
MRCS B
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