FMGE Pathology Flashcards

24 sample cards from the Pathology deck

Sampled from the end of the deck, so these are different cards from the ones shown on the syllabus page.

1. List the major ABO blood groups and the rule of compatibility for transfusion.

   Groups A, B, AB (universal recipient) and O (universal donor for packed RBCs). Individuals have naturally occurring antibodies against absent antigens; donor RBC antigens must not react with recipient plasma antibodies.

2. What is the difference between the direct and indirect Coombs (antiglobulin) test?

   Direct Coombs detects antibodies/complement already bound to the patient's RBCs (e.g., autoimmune hemolytic anemia, hemolytic disease of newborn). Indirect Coombs detects free antibodies in the patient's serum (used in crossmatching and antibody screening).

3. What is the most common cause of fatal acute hemolytic transfusion reaction, and its mechanism?

   ABO incompatibility, usually from clerical/identification error, causing complement-mediated intravascular hemolysis (Type II hypersensitivity) with fever, flank pain, hemoglobinuria, hypotension and DIC.

4. Distinguish stable, unstable and Prinzmetal angina pathophysiologically.

   Stable angina: fixed atherosclerotic stenosis, pain on exertion relieved by rest. Unstable angina: disrupted plaque with non-occlusive thrombus, pain at rest. Prinzmetal (variant) angina: coronary vasospasm, often at rest with ST elevation.

5. Describe the time course of gross and microscopic changes after myocardial infarction.

   0-4 h: none. 4-12 h: wavy fibers, early coagulative necrosis. 1-3 days: neutrophil infiltrate. 3-7 days: macrophages remove dead myocytes. 1-2 weeks: granulation tissue. >2 months: dense collagenous scar.

6. What are the major morphologic types of cardiomyopathy?

   Dilated (systolic dysfunction, four-chamber dilation), hypertrophic (asymmetric septal hypertrophy, diastolic dysfunction, often genetic), and restrictive (impaired filling from stiff myocardium, e.g., amyloidosis).

7. What are the gross and microscopic hallmarks of pulmonary tuberculosis (Ghon complex)?

   A Ghon focus is a subpleural caseating granuloma; the Ghon complex adds hilar lymph node involvement. Microscopy shows caseating granulomas with epithelioid cells, Langhans giant cells, and acid-fast bacilli on Ziehl-Neelsen stain.

8. Differentiate centriacinar from panacinar emphysema and their associations.

   Centriacinar (centrilobular) emphysema affects respiratory bronchioles in upper lobes and is associated with smoking. Panacinar emphysema affects the whole acinus in lower lobes and is associated with alpha-1 antitrypsin deficiency.

9. Contrast small cell and non-small cell lung carcinoma in origin, behavior and treatment.

   Small cell carcinoma: central, neuroendocrine origin, strongly smoking-related, early metastasis, paraneoplastic syndromes (SIADH, ACTH), treated with chemo/radiation (not surgery). Non-small cell (adeno, squamous, large cell): often resectable if localized.

10. What distinguishes Crohn disease from ulcerative colitis pathologically?

    Crohn disease: transmural, skip lesions anywhere mouth-to-anus, non-caseating granulomas, cobblestoning, fistulae, fissures. Ulcerative colitis: mucosal/submucosal, continuous from rectum, crypt abscesses, pseudopolyps, no granulomas.

11. List the morphologic types of cirrhosis and the key complications of cirrhosis.

    Micronodular (alcohol) and macronodular (viral hepatitis) cirrhosis. Complications: portal hypertension (varices, ascites, splenomegaly, caput medusae), hepatic encephalopathy, hepatorenal syndrome, and hepatocellular carcinoma.

12. Differentiate nephrotic from nephritic syndrome.

    Nephrotic syndrome: massive proteinuria (>3.5 g/day), hypoalbuminemia, edema, hyperlipidemia, lipiduria. Nephritic syndrome: hematuria with RBC casts, hypertension, oliguria, azotemia, and mild-to-moderate proteinuria.

13. What are the characteristic glomerular findings in post-streptococcal glomerulonephritis?

    Diffuse proliferative GN with subepithelial 'humps' on electron microscopy, granular IgG and C3 immunofluorescence, hypercellular glomeruli, and low serum C3, typically 1-3 weeks after streptococcal infection.

14. What are the most common renal stones and their urinary associations?

    Calcium oxalate/phosphate (most common, hypercalciuria), struvite (magnesium-ammonium-phosphate, urease-producing organisms, 'staghorn' calculi, alkaline urine), uric acid (acidic urine, gout, radiolucent), and cystine stones.

15. Differentiate the histologic types of diabetes mellitus pancreatic and the diagnostic Whipple criteria are not asked; instead, list the four common thyroid carcinomas and one key feature each.

    Papillary (Orphan Annie nuclei, psammoma bodies, best prognosis), follicular (capsular/vascular invasion), medullary (calcitonin, amyloid stroma, MEN2), and anaplastic (highly aggressive, elderly).

16. How are breast carcinomas classified and what is the most common type?

    Invasive ductal carcinoma (no special type) is most common, forming a hard, gritty desmoplastic mass. Invasive lobular carcinoma shows single-file 'Indian file' cells with loss of E-cadherin. Receptor status (ER, PR, HER2) guides therapy.

17. Name the most common primary brain tumors in adults and children.

    Adults: glioblastoma multiforme (supratentorial, pseudopalisading necrosis), meningioma (psammoma bodies, whorls). Children: pilocytic astrocytoma (Rosenthal fibers) and medulloblastoma (cerebellar, Homer-Wright rosettes).

18. Differentiate osteosarcoma, Ewing sarcoma and giant cell tumor of bone.

    Osteosarcoma: metaphysis of long bones (knee), young, malignant osteoid, Codman triangle/sunburst. Ewing sarcoma: diaphysis, children, t(11;22), 'onion-skin' periosteum, small round blue cells. Giant cell tumor: epiphysis, 'soap-bubble', osteoclast-like giant cells.

19. What casts in urine indicate which renal conditions?

    RBC casts: glomerulonephritis. WBC casts: pyelonephritis/interstitial nephritis. Granular ('muddy brown') casts: acute tubular necrosis. Fatty casts: nephrotic syndrome. Waxy/broad casts: chronic renal failure. Hyaline casts: nonspecific/normal in concentrated urine.

20. How is a pleural/ascitic fluid classified as transudate vs exudate (Light's criteria principle)?

    An exudate meets any of: fluid-to-serum protein ratio >0.5, fluid-to-serum LDH ratio >0.6, or fluid LDH greater than two-thirds the upper normal serum limit. Failing all suggests a transudate.

21. What are the principles and main advantage of fine-needle aspiration cytology (FNAC)?

    FNAC uses a fine needle to aspirate cells for cytologic examination; it is rapid, inexpensive, minimally invasive and OPD-based, but assesses cytomorphology only (individual cells/clusters) and cannot evaluate tissue architecture/invasion like histopathology.

22. Match these special stains to their target: PAS, Congo red, Prussian blue, Ziehl-Neelsen, reticulin.

    PAS: glycogen, fungi, basement membranes. Congo red: amyloid (apple-green birefringence). Prussian blue (Perls): iron/hemosiderin. Ziehl-Neelsen: acid-fast bacilli (TB, leprosy). Reticulin: reticulin/type III collagen framework.

23. What is immunohistochemistry and name common markers for epithelial, mesenchymal, lymphoid and melanocytic tumors.

    IHC uses antibodies against specific antigens to identify cell lineage. Epithelial: cytokeratin, EMA. Mesenchymal: vimentin. Lymphoid: LCA/CD45. Melanocytic: S-100, HMB-45, Melan-A.

24. What is the difference between autolysis, putrefaction and an autopsy's purpose?

    Autolysis is sterile self-digestion by the body's own enzymes after death; putrefaction is bacterial decomposition. An autopsy (necropsy) is a systematic post-mortem dissection to establish cause/manner of death and correlate clinical with pathologic findings.

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