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Foundations of Disease > Exam 1: Intro to Pathology > Flashcards

Exam 1: Intro to Pathology Flashcards

1
Q

Pathology

Types

A
  1. Anatomic pathology
  2. Clinical pathology
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2
Q

Anatomic Pathology

Subdivisions

A
  1. Surgical pathology
  2. Cytology (“Cytopathology”)
  3. Autopsy pathology
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3
Q

Surgical Pathology

Overview

A
  • Gross examination of tissues for abnormalities
    • From tiny biopsies to large resections
  • Select areas for histological sampling
  • Slides stained with H&E and assessed
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4
Q

Surgical Pathology

Questions

A
  1. Pathologic process present?
  2. Inflammatory, neoplastic, other?
  3. Specific process?
  4. Amount of tissue affected?
  5. Clear resection margins?
  6. Infiltration of surrounding tissue?
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5
Q

Surgical Pathology

Specimen Processing

A
  1. Permanent section
    • Requires overnight processing
    • More accurate and reliable
  2. Frozen section
    • Takes 15-20 minutes
    • Only done when answer needed during surgery ⇒ dx affects management
    • Preliminary only
    • Introduces artifact ⇒ compromises dx somewhat
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6
Q

Surgical Pathology

Adjuncts

A
  1. Immunohistochemistry
  2. Flow cytometry
  3. Electron microscopy
  4. Immunofluorescence
  5. Molecular pathology
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7
Q

Immunohistochemistry

A
  • Tissue incubated with Ab for specific Ag
  • Chromogen added to visualize rxn
  • Gives info about cell products, receptors, or content
  • Serves as a “tumor marker”
    • Used to determine origin of cells
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8
Q

Electron Microscopy

A
  • Rarely used
  • Routinely obtained on kidney biopsies where renal disease suspected
    • Can see electron dense deposits
    • Helps with disease classification
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9
Q

Flow Cytometry

A
  • Process
    • Sample from fresh tissue or fluid specimen
    • Cells tagged with fluorescent dye
    • Cells sorted and counted
  • Applications
    • Measure amount of DNA in a cell
      • Haploid, diploid, polypoid, aneuploid?
    • Test for presence and relative amounts of cells
    • Useful for lymphoma classification
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10
Q

Immunofluorescence

A
  • Process
    • Frozen sections + Ab + fluorescent dyes
    • Visualized under fluorecent microscope
  • Applications
    • Demonstrate immunoglobulin and complement in tissue sections
    • Evaluate immune-mediated diseases
      • Kidneys, blood vessels, skin common
    • See different patterns of distribution
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11
Q

Molecular Diagnostics

A
  • Test specimens for specific markers
    • Use increased over the past 10 years
    • Routine for many conditions
  • Can influence treatment and prognosis
    • Ex. lung cancer & markers like EGFR, KRAS, PDL-1
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12
Q

Cytology

Overview

A
  • Examination of cells
  • Papanicolau stain ⇒ default
  • Uses many similar adjuncts to surgical pathology
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13
Q

Cytology

Cell Sources

A
  1. Exfolative Cytology
    • Cells shed from a surface into fluid or gently scraped from epithelial surface
  2. Fine needle aspiration
    • Cells forcibly removed by aspiration using a small bore needle
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14
Q

Exfoliative Cytology

A
  • Gynecologic ⇒ PAP smears
  • Pulmonary ⇒ sputum, bronchial brush/wash
  • Urinary ⇒ urine, bladder wash, ureter brush/wash
  • Cutaneous ⇒ skin scrape of blister/rash
  • Eye ⇒ conjunctival smear
  • Body fluids ⇒ pleural fluid, pericardial fluid, peritoneal fluid, CSF, joint fluid
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15
Q

Fine Needle Aspiration

(FNA)

A
  • Simple, rapid, accurate, and cost effective
  • Minimal morbidity and mortality
  • Can be applied to virtually any part of the body
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16
Q

Superficial FNA Sites

A

Can be aspirated as an office procedure w/ local or no anesthesia.

Often performed by the pathologist.

  • Subcutaneous masses
  • Palpable lymph nodes
  • Thyroid
  • Breast
  • Soft tissue masses
17
Q

Deep FNA Sites

A

Sampled by interventional radiologist under radiologic guidance.

Pathologist there to assess adequacy of sample.

  • Lung ⇒ transbronchial or transthoracic
  • Mediastinal mass
  • Hilar lymph nodes
  • Retroperitoneal mass
  • Liver
  • Pancreas
  • Pelvic mass
  • Kidney
  • Adrenal
  • CNS
  • Bone ⇒ lytic lesions
18
Q

Autopsy Pathology

Overview

A
  1. Medical autopsies ⇒ hospital-based
    • Performed on individuals who died of “natural causes”
    • Permission from next of kin required
  2. Forensic autopsies
    • Performed on individuals who are known/suspected to have died in another manner
      • Homicide, suicide, accidents
    • Medical examiner/coroner allowed by law to conduct autopsy for manner and cause of death
19
Q

Clinical Pathology

Subdivisions

A

“Laboratory medicine”

  1. Clinical chemistry
  2. Hematology
  3. Immunology and serology
  4. Microbiology
  5. Blood bank and transfusion medicine
  6. Histocompatibility
  7. Cytogenetics and molecular pathology
20
Q

Lab Medicine

Locations

A
  1. Hospitals labs and POC
  2. Reference labs
  3. Specialized labs
    1. Endocrine lab
    2. Forensic labs
  4. Drug testing
  5. Insurance companies
  6. Physician offices
  7. Home testing
21
Q

Clinical Chemistry

A
  • Most testing done on blood or urine samples
  • Commonly performed assays
    • BGL
    • Electrolyte measurements
    • Enzymes
    • Troponin
    • Liver enzymes ⇒ AST, ALT
    • Pancreatic enzymes ⇒ amylase, lipase
    • Hormones ⇒ cortisol, TSH, ACTH
    • Lipids ⇒ cholesterol, LDL, HDL, TAGs
    • Metabolic products
    • BUN, creatinine, uric acid
    • Proteins ⇒ total, albumin, globulins
    • Toxicology ⇒ drug levels and toxins
22
Q

Hematology

A
  • Blood counts
    • WBC, RBC, platelet, H&H, indices (MCV, MCH, MCHC)
  • Coagulation testing
    • PT, PTT, INR
    • Coagulation factors, inhibitors, etc
  • Bone marrow biopsy
  • Aspirate examination
23
Q

Immunology and Serology

A
  • Measure Ig
  • Measure Rh factor
  • Auto-Ab
  • Complement
24
Q

Microbiology

A
  • Can be done on any body fluid, tissue fragment, foreign objects (lines, implants, caths)
  • From cultures to analysis of genetic make-up of organisms
  • Divided into sections by types of specimens
    • Respiratory, wound, blood, GU, etc
25
Q

Transfusion Medicine

&

Blood Banking

A
  • Blood donations
  • Immunohematology ⇒test blood for Ab
  • Blood management ⇒ safety, quality, inventory, usage
  • Therapeutic apheresis ⇒ materials removed from plasma
  • Stem cell collection and infusion
26
Q

Histocompatibility

A
  • HLA typing ⇒ transplant/donors
  • Ab testing s/p blood product exposure
  • HLA typing for specific diseases
27
Q

Cytogenetics

&

Molecular Pathology

A
  • Dx of chromosomal disorders
    • Prenatal, blood, bone marrow, tumors, etc
  • Important in dx, prognosis, and treatment
28
Q

Pathologist

Pathway

A
  1. Graduate medical school
  2. Residency in Anatomic and Clinical Pathology (4 yrs)
    • Can do just one but most do both
    • Rotate through all areas discussed
    • Learn about lab management, bioinformatics, digital pathology, telepathology
  3. Can do fellowships in any special lab area discussed
    • Most are 1 year

Foundations of Disease (46 decks)

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