Osce pathology

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Osce pathology

  1. 1. OSCE- Pathology Phase IIIa sienmingoat
  2. 4. Photo- PUD <ul><li>Dx? </li></ul><ul><ul><li>Peptic ulcer disease </li></ul></ul><ul><li>3 abnormalities? </li></ul><ul><ul><li>Microscopic: </li></ul></ul><ul><ul><ul><li>Muscularis mucosa bleached </li></ul></ul></ul><ul><ul><ul><li>4 zone: necrotic, non-specific inflam infiltration, granulation tissue, fibrosis/scarring </li></ul></ul></ul><ul><ul><li>Macroscopic: </li></ul></ul><ul><ul><ul><li>Site: antrum, lesser curvature </li></ul></ul></ul><ul><ul><ul><li>Round to oval punch out ulcer, solitary </li></ul></ul></ul><ul><ul><ul><li>Little overhanging of edge </li></ul></ul></ul><ul><ul><ul><li>Puckering of surrounding, radiating folds </li></ul></ul></ul><ul><li>3 complications? </li></ul><ul><ul><li>Hemorrhage </li></ul></ul><ul><ul><li>Stenosis </li></ul></ul><ul><ul><li>Penetration </li></ul></ul><ul><ul><li>Chronicity/malignancy </li></ul></ul><ul><li>3 precipitating factors? </li></ul><ul><ul><li>Smoking/alcohol </li></ul></ul><ul><ul><li>Helicobacter pylori infection </li></ul></ul><ul><ul><li>Drugs: steroids, NSAIDs </li></ul></ul><ul><ul><li>Stress </li></ul></ul><ul><ul><li>Diet: skipped meal, spicy, betel nut chewing </li></ul></ul>
  3. 5. 40yo man, hematuria Removed kidney
  4. 6. Cross section: RCC <ul><li>Describe? </li></ul><ul><ul><li>macroscopic </li></ul></ul><ul><ul><ul><li>Upper lobe </li></ul></ul></ul><ul><ul><ul><li>Yellow/white mass, large, circumscribed </li></ul></ul></ul><ul><ul><ul><li>Hemorrhage/necrosis (patchy) </li></ul></ul></ul><ul><ul><li>microscopic </li></ul></ul><ul><ul><ul><li>Sheets, tubules or cords of clear/granular cells </li></ul></ul></ul><ul><ul><ul><li>Polygonal-columnar cells with small round nuclei, abundant clear cytoplasm (glycogen/lipid) </li></ul></ul></ul><ul><li>Dx? </li></ul><ul><ul><li>Renal cell carcinoma </li></ul></ul><ul><li>Mode of spread/metastasis? </li></ul><ul><ul><li>Blood: liver, lung, bone </li></ul></ul><ul><ul><li>Lymphatic: regional, para-oartic </li></ul></ul><ul><ul><li>Direct: perinephric/adrenal </li></ul></ul><ul><li>2 extra renal manifestation? </li></ul><ul><ul><li>Polycythemia (erythropoietin) </li></ul></ul><ul><ul><li>Hypertension (renin) </li></ul></ul><ul><ul><li>Hypercalcemia (PTH-like hormones) </li></ul></ul><ul><ul><li>Metastasis (lung, bone) </li></ul></ul>
  5. 8. Gross- Liver cirrhosis <ul><li>Describe? </li></ul><ul><ul><li>Multinodular (micro <3mm, macro >2mm) </li></ul></ul><ul><ul><li>Irregular shape </li></ul></ul><ul><ul><li>Shrunken in size </li></ul></ul><ul><ul><li>Microscopic: parenchymal nodules separated by fibrous septa </li></ul></ul><ul><li>S&S? </li></ul><ul><ul><li>Asymptomatic </li></ul></ul><ul><ul><li>Portal hypertension (caput medusae, anorectal varices) </li></ul></ul><ul><ul><li>Ascites , splenomegaly </li></ul></ul><ul><ul><li>Bleeding tendency </li></ul></ul><ul><ul><li>Infection (SBP) </li></ul></ul><ul><li>Causes? </li></ul><ul><ul><li>Acquired: </li></ul></ul><ul><ul><ul><li>Alcoholic liver dz </li></ul></ul></ul><ul><ul><ul><li>Viral hepatitis (HBV) </li></ul></ul></ul><ul><ul><ul><li>Cryptogenic </li></ul></ul></ul><ul><ul><li>Congenital: </li></ul></ul><ul><ul><ul><li>IEM (hemochromatosis) </li></ul></ul></ul><ul><ul><ul><li>Wilson’s dz </li></ul></ul></ul><ul><ul><ul><li>Alpha-1 antitrypsin deficiency </li></ul></ul></ul>
  6. 9. Male patient, A&E with abd pain & jaundice
  7. 10. Raw specimen- HCC <ul><li>Describe? </li></ul><ul><ul><li>Loss of liver architecture </li></ul></ul><ul><ul><li>Main large nodule/mass over lower R lobe </li></ul></ul><ul><ul><li>Multiple/satellite nodules </li></ul></ul><ul><ul><li>Composed to gallbladder (swollen?) </li></ul></ul><ul><li>Dx/DDx? </li></ul><ul><ul><li>Hepatocellular carcinoma </li></ul></ul><ul><ul><li>Liver abscess, adenoma/hemangioma? </li></ul></ul><ul><li>Causes? </li></ul><ul><ul><li>Infection: viral hepatitis </li></ul></ul><ul><ul><li>Toxins: alcohol, drugs (methotrexate), aflatoxin </li></ul></ul><ul><ul><li>Biliary obstruction: PBC, stricture/stone </li></ul></ul><ul><ul><li>Metabolic: hemochromatosis, Wilson’s, alpha-1 AT deficiency </li></ul></ul><ul><ul><li>Hepatic venous congestion: Budd-chiari </li></ul></ul><ul><li>Ix? </li></ul><ul><ul><li>Serum alpha-fetoprotein </li></ul></ul><ul><ul><li>Liver U/S, CT </li></ul></ul><ul><ul><li>Liver biopsy </li></ul></ul><ul><ul><li>LFT, clotting profile </li></ul></ul>
  8. 12. Slide- fatty liver <ul><li>Describe + Dx? </li></ul><ul><ul><li>Macro + micro vesicular/fatty degeneration </li></ul></ul><ul><li>2 Clinical features? </li></ul><ul><ul><li>Hepatomegaly </li></ul></ul><ul><ul><li>Vague abdominal symptoms: N&V, diarrhea </li></ul></ul><ul><ul><li>Chronic liver disease: parotid swelling, palmar erythema, gynaecomastia, bruises etc </li></ul></ul><ul><li>3 Causes? </li></ul><ul><ul><li>Alcohol </li></ul></ul><ul><ul><li>Diabetes mellitus </li></ul></ul><ul><ul><li>Reye’s symptoms (aspirin) </li></ul></ul>
  9. 14. Specimen- Ca colon <ul><li>Describe? </li></ul><ul><ul><li>Diffuse infiltrating growth </li></ul></ul><ul><ul><li>Annular/papilliferous </li></ul></ul><ul><ul><li>Malignant ulcer </li></ul></ul><ul><li>Etiology? </li></ul><ul><ul><li>Genetic </li></ul></ul><ul><ul><ul><li>Familial adenomatous polyposis </li></ul></ul></ul><ul><ul><ul><li>Hereditary non-polyposis colorectal Ca </li></ul></ul></ul><ul><ul><ul><li>Colorectal adenoma/polyps </li></ul></ul></ul><ul><ul><li>IBD (UC) </li></ul></ul><ul><ul><li>Diet: low fibre/Ca/vit D, high fat, smoking/alcohol </li></ul></ul><ul><li>Complication? </li></ul><ul><ul><li>Intestinal obstruction (L side) </li></ul></ul><ul><ul><li>Perforation (peritonitis, pericolic abscess, fistulae) </li></ul></ul><ul><ul><li>Metastasis to liver (jaundice, hepatomegaly, ascites) </li></ul></ul>
  10. 15. Cyst Zoites
  11. 16. Picture- purple ball (toxoplasmosis) <ul><li>Organism? </li></ul><ul><ul><li>Genus: Toxoplasma </li></ul></ul><ul><ul><li>Species: gondii </li></ul></ul><ul><ul><li>Stage: cyst </li></ul></ul><ul><li>Why hemiparesis? </li></ul><ul><ul><li>Compression of cerebral abscess on internal capsule (contra lateral) </li></ul></ul><ul><li>S&S? </li></ul><ul><ul><li>Focal CNS signs, fits, confusion </li></ul></ul><ul><ul><li>Fever, headache, chorioretinitis </li></ul></ul><ul><li>Rx (2 drugs)? </li></ul><ul><ul><li>Pyrimethamine, sulfadiazine, folinic acid (leucovorin) </li></ul></ul>
  12. 18. Brain photo- hydrocephalus <ul><li>Dx? </li></ul><ul><ul><li>Hydrocephalus </li></ul></ul><ul><li>2 S&S? </li></ul><ul><ul><li>Raised ICP: headache, vomit, papilloedema </li></ul></ul><ul><ul><li>Childhood: head enlargement, split suture, tense ant. frontanel, sunset eyes </li></ul></ul><ul><li>Causes? </li></ul><ul><ul><li>Primary-communicating </li></ul></ul><ul><ul><ul><li>Meningitis, SAH, head injury </li></ul></ul></ul><ul><ul><ul><li>Choroid plexus papilloma </li></ul></ul></ul><ul><ul><li>Primary- non communicating </li></ul></ul><ul><ul><ul><li>Aqueduct stenosis </li></ul></ul></ul><ul><ul><ul><li>SOL/tumour/hemorrhage/vascular malformation </li></ul></ul></ul><ul><ul><ul><li>4 th ventricle foramina atresia </li></ul></ul></ul><ul><ul><li>Secondary </li></ul></ul><ul><ul><ul><li>Brain shrinkage (compensation) </li></ul></ul></ul>
  13. 20. Photo- Ca breast <ul><li>Describe? </li></ul><ul><ul><li>Ca breast with ulcer </li></ul></ul><ul><ul><li>Edematous, X retracted X discharge </li></ul></ul><ul><ul><li>Dilated superficial veins, forearm swelling </li></ul></ul><ul><li>Staging? </li></ul><ul><ul><li>TNM staging </li></ul></ul><ul><li>Risk factors? </li></ul><ul><ul><li>Age, gender, family hx, previous breast dz, radiation </li></ul></ul><ul><ul><li>Hormonal: early menarche, late menopause, nulliparious, X BF, OCP/HRT </li></ul></ul><ul><li>4 clinical types? </li></ul><ul><ul><li>Tubular </li></ul></ul><ul><ul><li>Mucinous </li></ul></ul><ul><ul><li>Medullary </li></ul></ul><ul><ul><li>Invasive lobular </li></ul></ul><ul><ul><li>In situ (DCIS/LCIS) </li></ul></ul>
  14. 21. <ul><li>59 yo male </li></ul><ul><li>Hemoptysis, dead </li></ul>This is lung
  15. 22. Post-mortem section of lung <ul><li>Describe? </li></ul><ul><ul><li>lower lobes (mainly) + haemorrhagic (dark red) </li></ul></ul><ul><ul><li>vary in size + wedge shaped with the apex pointing towards the hilus of the lung </li></ul></ul><ul><li>Dx? </li></ul><ul><ul><li>Pulmonary infarction 2 nd to p. embolism </li></ul></ul><ul><li>Pathogenesis? </li></ul><ul><ul><li>DVT, embolism, R heart, lungs vasculature, block supply, infarct, respi distress, CO compromised </li></ul></ul><ul><li>If survived, 2 complications? </li></ul><ul><ul><li>Pulmonary HPT </li></ul></ul><ul><ul><li>Cor pulmonale/R heart failure </li></ul></ul>
  16. 24. Specimen- aortic valve vegetation <ul><li>S&S? </li></ul><ul><ul><li>Bacteremia/vasculitis: fever, splenomegaly, clubbing, splinter hemorrhage, Roth spot </li></ul></ul><ul><ul><li>Immune-complex: GN (hematuria), Janeway/Osler lesion/node </li></ul></ul><ul><ul><li>Valvular dysfunction: murmur change, valve destruction/perforation </li></ul></ul><ul><ul><li>Embolism: brain, kidney, intestine, pul vessel </li></ul></ul><ul><li>Complications? </li></ul><ul><ul><li>CARDIAC: valvular destruction, CF/conduction disturbance, abscess, perforation, pericarditis </li></ul></ul><ul><ul><li>EXTRA-CARDIAC: septic embolic, GN </li></ul></ul>

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