MRCS B Pathology
Pathology
MRCS Pathology
Sample Data
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| Back | STATION 3:A young lady KCO chronic renal failure developed secondary. Now she developed renal stones. Blood results available.Q1. How hyperparathyroidism is caused in renal failure?- in renal failure there are: 1- Abnormalities in renal tubular absorption of phosphate → Hyperphosphatemia. 2- decrease production of 1,25-dihydroxy vitamin D → hypocalcemia.- Hyperphosphatemia and hypocalcemia >> increase PTH secretion >> secondary hyperparathyroidism.Q2. What is lining epithelium of urinary tract?Stratified transitional epithelium.Q3. What're the types of stones?- Calcium stones [ oxalate and phosphate ]- Struvite stones- Uric acid stones- Cystine stonesQ4. What are the genitourinary complication of stones?1- Obstruction2- Infection (eg: Pyelonephritis)3- Renal cell carcinoma 4- Fistula5- Deterioration of renal functions.6- RuptureQ5. What're the different modalities for management of renal stones?According to its size and location in the urinary tract:1- if Less than 5mm by conservative management: By hydration, analgesic, alpha blocker and antibiotics. [note: should be no signs of obstruction or limitation with single kidney]2- For proximal and mid-ureteral stones that are ≤10 mm, >> ESWL (extracorporeal shock wave lithotripsy) or URS (ureteroscopy).[Note : ESWL is contraindicated in pregnancy and case of abdominal aortic aneurysm.] 3- For proximal and mid-ureteral stones that are >10 mm, >> URS4- For all distal ureteral stones, regardless of size, >> URS5- PCNL [percutaneos nephrolithotomy] for :- renal stones more than 2cm - Complex renal calculi- staghorn calculi- emergency 6- Stone any size + obstructed, infected system >> Urgent decompression (URS with stenting or percutaneous nephrostomy).7- nephrectomy >> affected kidney function is less than 15%.Q6. What are the risk factors for RCC & How can stone cause cancer?A: What are the risk factors for RCC?1- smoking 2- Hypertension3- Obesity4- Stones5- industrial dyes exposure6- chronic kidney diseaseB: How can stones cause cancer?Stones → Chronic infections and inflammation → metaplasia → Dysplasia and DNA damage → cancer.Q7. What is the most common renal cell carcinoma?Clear cell carcinoma.Q8. What is the second most common renal cell carcinoma?Papillary cell carcinoma.Q: What is the most common renal cell carcinoma in patients with acquired cystic kidney disease, renal failure, and dialysis?Papillary cell carcinoma.Q9. What are the macroscopic finding in renal carcinoma (In refence to pathology report)?Clear cell carcinoma macroscopic features :- Arises from proximal convoluted tubules- Unilateral and Solitary- Bright yellow-grey-white spherical masses- Margins are sharply defined and confined within the renal capsule- Prominent areas of cystic softening or of hemorrhagePapillary Carcinoma (PRCC)macroscopic features :- Arises from distal convoluted tubules- Bilateral and multiple- Less vibrantly orange yellow because of their lower lipid content- Papilla formation with fibrovascular cores- Necrosis, hemorrhage and cystic degenerationQ10. What are the microscopic finding in renal carcinoma(in reference to pathology report)?Clear cell carcinoma Microscopic:Rounded or polygonal shape and abundant clear or granular cytoplasm, which contains glycogen and lipidPapillary microscopic features :- Cuboidal or low columnar cells arranged in papillary formations- Interstitial foam cells- Psammoma bodies may be present- Stroma is usually emptyQ11. What is R1?Microscopic residual tumourTHE END OF STATION 3 |
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| Back | Station 9:Stem: A 65-year-old male paient with poor urine stream, urgency and nocturia. PR examination revealed an enlarged, firm, rounded prostate with a preserved median sulcus.Q1: What's the most probable diagnosis?BPHQ: On PR what are the features suggesting a prostate cancer?1-Hard2-Nodular3-Fixed to rectal wall4-obliterated median sulcusQ2: Mention 3 investigations to be performed in the outpatient clinic?- PSA- Mid-Stream Urine analysis- U & E and creatinineQ: What's the most important investigation to confirm or exclude malignancy? How it's done?A: What's the most important investigation to confirm or exclude malignancy? Transrectal ultrasonography guided biopsy B: How it's done?TRUS guided from: mid lobe parasagittal plane at: the apex, the mid gland, and the base, bilaterally and should take more than 10 biopsies Q3: Why there is a need for multiple biopsies to diagnose prostate cancer?Prostatic cancer can be focal, so it’s important to take samples from different sitesQ4: Biopsy showed high grade prostatic neoplastic tissue admixed with rectal glandular tissue, how can prostatic cells be differentiated from rectal cells during pathological analysis?1- Using immunohistochemical marker 2- in rectal cells >> CEA is (+ve) and PSA is (-ve)Q5: What are the gene mutations involved in the pathogenesis of prostate cancer? (BRCA2, BRCA1, ATM, HOXB13, CHEK2, MSH2, MLH1)Q6: Patient underwent TURP for prostate cancer and 6 months later PSA was still raised. What does this signify?- Fall in the level of PSA below detectable levels within 4-6 weeks - High PSA after prostatectomy → recurrence should be consideredQ7: Why PSA is not very reliable?• PSA is organ specific, but not cancer specific.• Although serum levels of PSA are elevated to a lesser extent in BPH than in prostatic carcinomas, there is considerable overlap.• Other factors such as prostatitis, infarction of nodular hyperplasia, instrumentation of the prostate, and ejaculation also increase serum PSA levels.Q8: What's the name of the grading system for prostate cancer?Gleason score Q: How it is calculated?1- we take 2 biopsies from Prostate cancer 2-then the pathologist allocates them a number from 1 - 5 for the most common histological pattern in the specimen, then does the same for the second most common pattern.3- then The sum of these two numbers gives the Gleason score.4- It grades prostate tumors from 2 – 10, 2 is well differentiated and 10 being the most abnormal and therefore the most likely to spread. Q: Name of staging system of prostate cancer ? TNM09: If a patient with prostate cancer developed back pain and CT showed increased density in the lumbar spine, what's your diagnosis?Lumber spine metastasis Q: Mention one laboratory test to exclude bony metastasis? Alkaline phosphataseQ: What's the type of these metastasis? Why?A: What's the type of these metastasis?ScleroticB: Why?Due to increased bone deposition due to increased osteoblastic activityQ10: Post TURP the patient developed fever, confusion, dysuria and dusky red urine. Why?UTIQ: Which investigations would you request? - Blood investigation [ CBC, Inflammatory markers (ESR and CRP) ]- Urine analysis - Culture and sensitivity for urine Q: What's the colonies number in urine analysis indicating sepsis? more than one thousandQ11: Which of the blood components would rise?WBC's - neutrophilsQ12: What's the primary stimulus of prostate growth during life? Androgen Q13: In the past bilateral orchidectomy was used as a treatment for cancer prostate. What was the rationale behind that? - Androgen deprivation , So reducing the rate of cancer growth.- The growth and survival of prostate cancer cells depends on androgens, which bind to the androgen receptor (AR) and induce the expression of pro-growth and pro-survival genes.Q14: apart from surgery, what are the other treament modalities of prostatic cancer?TURP and medication of androgen deprivation Q: Do we still have orchidectomy for treating prostate cancer?Yes, we have medical orchidectomy.THE END OF STATION 9 |
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| Back | Station 3:Stem:Middle-aged (diabetic) Chinese male with an ulcer in the nasopharynx. on recent (chemo and radiotherapy).Q1.Risk factors for nasopharyngeal carcinoma?Non-modifiable:- Gender: more in male males• Genetic factors• Family history- Ethnicity and race: common in southern China, Singapore, Vietnam, Malaysia.Modifiable: • Infection with the Epstein-Barr virus• Tobacco and alcohol use.• Diet: consumption of salted fish containing carcinogenic volatile nitrosaminesQ2: Define carcinoma?Carcinoma is a type of cancer that develops from epithelial cells.Q3: Differential diagnosis?1- Tumors: - lymphoma - Angiofibroma - Rhabdomyosarcoma2-Adenoid hypertrophy3- infection: abscess4- HematomaQ4: What are other non-epithelial tumors can be here?- Lymphoma (usually non-Hodgkin)>> ( 🧨 waiting for this in the exam)- Rhabdomyosarcoma- AngiofibromaQ5. If palpable lymph nodes, how to assess? (what simple pathological investigation assist in assessing the nodal status?)I will start by FNAC >> then I may need also to do Excisional biopsy Q6: What is Cytology vs histology?Cytology >> is the study of cellular structure and function.Histology >> is the study of tissue under the microscopeQ7. Scale of radiation dose? (What the SI unit measurement is commonly used in Measurement of radiation dose?)GrayQ8: If swab grows hyphae, what do you think it is?Fungal infection mainly CandidaQ9: pattern of spread?1- Lymphatic spread 2- and local invasion Q: Explain the local invasion?1- sphenoid sinus2-cavernous sinus3- oropharynx4- C1 vertebrae 5- base of skull6- nasal and para nasal cavity 7- orbital invasion 8- lateral para pharyngeal space 9- middle ear cavityQ10: if this patient has an infection and a swab showed fungal infection. from the stem what is the predisposing factors to this infection? 3 marks 🧨1- Diabetic2- Immunosuppressant from chemotherapy 3- Dead tissue from the pharynx due to radiotherapy ulceration which is more prone to fungal infection.Q11: how is radiotherapy Act against malignant tumor?1- Direct: Deliver high energy to Tumor’s DNA causing direct damage to the DNA 2- Indirect: by the generation of free radicals causing further cell damage.Q12: What are steps are needed for the malignant tumors to spread from nasopharynx to the cervical lymph nodes? (4 marks🧨)1- The tumor growes in nasopharynx without feedback or control2- Then the tumor cells penetrate or invade the local soft tissue.3- Then the tumor enter the lymphatic and embolisis to distal nodes 4- then the tumor grow in the nodesQ13 :How is IHC confirm this is carcinoma?By antigen antibody recognition [ Use antibodies to bind to epithelial cells then visualized under microscope ]Q14: In simple wards define frozen section?- It’s a pathological laboratory procedure - to perform rapid microscopic analysis of a specimen.Q15: Can you explain more the steps?1- the surgeon take a small piece from a tissue or tumor and send it for analysis 2- the pathologist freeze it and section it and immediately cut it3- the section will be stained and reported immediately when the results come outQ16 if you are scrubbed in surgery and waiting for the results of frozen section. how they will tell you the results?By telephone.THE END OF STATION 3 |