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Year 2 EMS GiM > Pathology 1 > Flashcards

Pathology 1 Flashcards

1
Q

What is the difference between aetiology and epidemiology?

A 
Epidemiology = How common? What sort of people get it? How does it spread?
Aetiology = Basic causes eg. microorganisms, molecular defects
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2
Q

What is meant by the prefix ANA?

A

Absence

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3
Q

What is meant by the prefix DYS?

A

Disordered

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4
Q

What is meant by the prefix HYPER?

A

Excess over normal

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5
Q

What is meant by the prefix HYPO?

A

Deficiency below normal

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6
Q

What is meant by the prefix META?

A

Change from one state to another

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7
Q

What is meant by the suffix -ITIS?

A

Inflammatory process

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8
Q

What is meant by the suffix -OMA?

A

Tumour

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9
Q

What is meant by the suffix -OSIS?

A

State or condition

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10
Q

What is meant by the suffix -OID?

A

Bearing a resemblance to

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11
Q

What is meant by the suffix -PENIA?

A

Lack of

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12
Q

What is meant by the suffix -CYTOSIS?

A

Increase number of cells

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13
Q

What is meant by the suffix -ECTASIS?

A

Dilation

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14
Q

What is meant by the suffix -PLASIA?

A

Disorder of growth

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15
Q

What is meant by the suffix -OPATHY?

A

Abnormal state lacking specific characteristics

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16
Q

What did Virchow say about cell injury and disease?

A

Injury to the smallest unit in the body, the cell, is the basis of all disease

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17
Q

What are the 4 things needed to maintain a steady state in a cell?

A

1) Preservation of genetic integrity
2) Normal enzyme content
3) Intact membranes and transmembrane proteins
4) Adequate supply of substrates and oxygen

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18
Q

What is the definition of cell injury?

A

Biochemical and/or morphological changes which occur when the steady state of a cell is perturbed by adverse influences

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19
Q

What is one of the ways that a cell copes with stress and how can this lead to cell injury?

A

Cell adaptation

If cell has an inability to adapt to this stress then cell becomes injured

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20
Q

Once a cell becomes injured one of 2 things can happen, what are they?

A

1) If the injury is mild then the cell can recover and the injury is reversible
2) If the injury is severe/progressive then the cell becomes irreversibly injured and dies - either by apoptosis or necrosis

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21
Q

What is the difference between hyperplasia and hypertrophy?

A

Hypertrophy - No increase in number but cells themselves actually get bigger leading to tissue getting bigger
Hyperplasia - an increase in the number of cells

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22
Q

What are the 3 ways in which a cell can adapt to stress?

A

1) Increased cellular activity - hypertrophy/hyperplasia
2) Decreased cellular activity - atrophy
3) Change in cell morphology

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23
Q

Give an example of how a cell of the adrenal gland adapts to the stress of changes in the pituitary axis with the use of exogenous steroids?

A

Decrease in cell activity - adrenal gland atrophies

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24
Q

Give an example of how myocytes adapt to cope with increased systemic resistance?

A

Hypertophy of the myocytes - bigger heart muscle to pump harder and overcome resistance

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25
Q

What are the 5 main types of cell injury?

A

1) Lack of oxygen availability - ischaemia
2) Physical trauma - includes thermal and mechanical
3) Chemical agents - acid/alkali balance altered/drugs
4) Infectious organisms
5) Irradiation

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26
Q

Other than the 5 main types of cell injury what are the 4 other common types?

A

1) Immunological
2) Lack of essential vitamins/nutrients
3) Genetic disorders
4) Ageing - being old leads to inefficiency in some cell processes

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27
Q

What is the difference between hypoxia and anoxia?

A

Hypoxia - insufficient oxygen

Anoxia - absence of oxygen

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28
Q

What is ischaemia?

A

Lack of blood flow (ie. ischaemia often causes hypoxia/anoxia)

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29
Q

What is infarction?

A

Cell death due to lack of oxygen

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30
Q

Other than ischaemia, for what 2 other reasons may hypoxia occur?

A

1) Not enough oxygen in blood to start off whit

2) Cells might not be able to use available oxygen eg. cyanide poisoning

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31
Q

Why can reoxygenation of hypoxic/anoxic tissue lead to further cell injury in some cases?

A

In reperfusion of tissues you can get generation of oxygen free radicals

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32
Q

In terms of physical trauma causing cell injury, in what 2 main ways can mechanical trauma lead to cell injury?

A

1) Disruption of cell structure

2) Thrombosis leading to ischaemia

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33
Q

Why can mechanical trauma to a tissue cause cell death. by ischaemia?

A

Damage to cells in walls of blood vessels in that tissue due to mechnical trauma can lead to the formation of a thrombus which can cause ischaemia and infarction

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34
Q

In physical trauma in what 2 ways can the extremes of temperature cause cell injury?

A

1) Heat denaturation of proteins

2) Ice crystals

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35
Q

How can fever cause cell injury by physical trauma (ie. extremes of temperature)?

A

It is possible to become pyrexial enough to alter your metabolism and denature proteins

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36
Q

Name 6 kind of chemical agents (chemical agents cause cell death by many different modes of action including damage to macromolecules and metabolism) which can cause cell death?

A

1) Alcohol
2) Tobacco smoke
3) Drugs
4) Poisons
5) Environmental agents
6) Occupational agents (Asbestos)

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37
Q

By what general mechanism do bacteria cause cell death?

A

The production of toxins

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38
Q

What are the 2 kinds of toxins produced by bacteria and how do they differ?

A

1) Endotoxins - released when bacteria die

2) Exotoxins - released by living bacteria

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39
Q

How do viruses cause cell injury?

A

Hijacking of cell machinery and causing lysis

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40
Q

Other than release of toxins by bacteria and invasion of cells by viruses, in what other way can infectious agents lead to cell injury?

A

Collateral damage to surrounding tissue due to inflammatory process

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41
Q

How does irradiation cause cell injury?

A

Ionising - generation of free radicals which cause cell injury and direct damage to macromolecules

42
Q

What kind of tissues are very sensitive to damage by irradiation, give 3 examples?

A

Tissues with high physiological turnover of cells

1) Bone marrow
2) Gonads
3) Intestines

43
Q

Give 3 examples of tissues that have very low sensitivity to irradiation?

A

1) Uterus
2) Pancreas
3) Adrenal

44
Q

Can irradiation induce an inflammatory response? If so, when?

A

It can, several hours after exposure

45
Q

What are the 5 targets of cell injury (ie. the things that tend to be damaged)?

A

1) Mitochondrial function
2) Membrane integrity and function
3) Protein synthesis
4) Cytoskeleton
5) Genetic apparatus

46
Q

When the mitochondria are damaged this leads to reduced ATP, how does this lead to cellular ‘cloudy’ swelling?

A

Less ATP

Activity of ATP driven Na pump is reduced, influx of Na and Ca leading to osmotic gaining of water and cells swells

47
Q

Why do you get lipid deposition in cells with damaged mitochondria?

A

Less ATP
Increased glycolytic pathway which depletes glycogen stores and leads to a build up of lactic acid, lowering cell pH
The low levels of pH and ATP in the cell cause ribosomes to detach from the RER and a reduction in protein synthesis - lipids are transported out of the cell carried by lipoproteins (which aren’t made) so lipid gets deposited in the cell, leading to fatty swelling

48
Q

Why do you get clumping of nuclear chromatin in cells with damaged mitochondria?

A

Less ATP
Increased glycolytic pathway - build up of lactic acid
Lower pH causes clumping of chromatin

49
Q

What are the 7 things that happen in a cell, with damaged mitochondria?

A

1) Cellular swelling
2) Loss of microvilli
3) Blebs
4) ER swelling
5) Lipid deposition

50
Q

Alcohol causes damage to the liver cells, what 2 things occur?

A

1) Cell (cloudy) swelling

2) Fatty change, fat deposition

51
Q

What are free radicals?

A

Highly reactive ions or molecules with single, unpaired electron in their outer orbit

52
Q

In what 2 ways can free radicals cause damage to cells?

A

1) Chain reaction with molecules in membranes to produce additional free radicals
2) Damages proteins and nucleic acids (can cause cells to die by apoptosis)

53
Q

What 2 things detoxify free radicals normally?

A

1) Superoxide dismutase

2) Anti oxidants eg. Vitamin A, C and E

54
Q

When are free radicals used physiologically?

A

In bacterial killing by neutrophils and macrophages which depends on the formation of superoxide

55
Q

Name 4 things which can cause damage to cell membranes?

A

1) Bacterial toxins
2) Viral proteins
3) Complement (MAC complex)
4) Cytolytic lymphocytes

56
Q

When membranes are ruptured this leads a breakdown in metabollite gradients, the influx of what ion causes deleterious cellular affects and why?

A

Influx of Ca2+
activates a number of enzymes:
1) ATPase - hastening ATP depletion
2) Phospholipases - Cause membrane damage
3) Proteases - break down membrane and cytoskeletal proteins
4) Endonucleases - responsible for DNA fragmentation

57
Q

What is necrosis?

A

Cell death as a result of lethal cell injury

58
Q

Is necrosis an active or passive process and does it incite an inflammatory reaction?

A

Passive process

Incites an inflammatory reaction

59
Q

What are the 5 distinct morphological types of necrosis?

A

1) Coagulative - most common
2) Caseous - necrosis that occurs in TB
3) Colliquative
4) Gangrene - wet and dry
5) Fat, fibrinoid

60
Q

Coagulative necrosis is typical of what kind of injury?

A

Ischaemic injury - except to brain

61
Q

How is coagulative necrosis characterised? 4

A
  • Denaturation of intracytoplasmic protein
  • Dead tissue becomes swollen and firm
  • Tissue shows retention of microscopic architecture
  • Cellular proteins may leak out into blood
62
Q

How is colliquative necrosis characterised and where does it prinicipally occur?

A

Necrotic tissue is liable to total liquefaction and site is eventually marked by a cyst
Typically occurs in brain injury due to haemorrhage

63
Q

Caseous necrosis is typical of what disease?

A

TB

64
Q

How is caseous necrosis characterised?

A

Cheese like
Cellular detail destroyed in this area, which is surrounded by granulomatous inflammation
Dead tissue lacks any structure

65
Q

Gangrene is a type of what kind of necrosis?

A

Coagulative necrosis

66
Q

Name the 2 types of gangrene, give examples of each?

A

1) Wet - infarct bowel is prone to develop wet gangrene

2) Dry - dry gangrene of the foot in diabetes

67
Q

What is apoptosis, is it active or passive?

A

Programmed cell death

Active, requires energy

68
Q

Name 3 physiological and 3 pathological reasons why apoptosis may occur?

A 
Physiological
1) Embryogenesis
2) Involution (of an organ)
3) Elimination of self reacting lymphocytes
Pathological
1) DNA/Protein damage
2) Viral infections
3) Cell killing by cytotoxic T cells
69
Q

What are the 2 broad pathways of apoptosis and how do they differ?

A

1) Intrinsic - Cell signals itself to undergo apoptosis without outside influence
2) Extrinsic - Something binds to receptors and feeds through the cell and stimulates apoptosis

70
Q

What are caspases?

A

These are the effector molecules of apoptosis

Enzyme cascade, last step in stimulating apoptosis

71
Q

Which 2 molecules normally kept in the mitochondria activate caspases?

A

1) Apoptosis initiating factor (AIF)

2) Cytochrome C

72
Q

What is the P53 molecule, what is its role in cancer?

A

P53 is activated by DNA damage and causes the elimination of damaged cells by apoptosis (by causing release of AIF and Cytochrome C from mitochondria)
Mutations to P53 are very common in tumours, thus allowing cells to accumulate genetic abnormalities and become malignant

73
Q

What is the difference in number of cells killed by apoptosis compared to necrosis?

A

Apoptosis - single cell

Necrosis - Multiple cells

74
Q

What is the difference in cell size in cells that undergo apoptosis compared to necrosis?

A

Apoptosis - Reduced size

Necrosis - Enlarged

75
Q

What is the difference to the plasma membrane in cells that undergo apoptosis compared to necrosis?

A

Apoptosis - intact

Necrosis - Disrupted

76
Q

What happens to the nucleus in a cell that undergoes apoptosis compared to necrosis?

A

Apoptosis - Fragmentation -> apoptotic bodies

Necrosis - Pyknosis -> karyorrhexis -> karyolysis

77
Q

Does apoptosis cause adjacent inflammation?

A

No

78
Q

What is the difference in what happens to the cell contents of cells that undergo necrosis compared to apoptosis?

A

Necrosis - Enzymatic digestion - may leak out of cell

Apoptosis - Intact, may be released into apoptotic bodies

79
Q

Name 8 important functions of the liver?

A

1) Glucose metabolism
2) Barrier to sepsis
3) Lipid metabolism
4) Amino acid metabolism
5) Vitamin storage A, B12, D and iron
6) Chemical detoxification and metabolism (alcohol and some drugs)
7) Bilirubin metabolism
8) Production of clotting factors

80
Q

Why is ischaemic injury to the liver very uncommon?

A

It has 2 blood supplies - hepatic artery and portal vein, its unlikely that blood flow from both of these will be stopped

81
Q

What are idiosyncratic hepatotoxins?

A

Drugs that cause injury to a very small number of people who take them

82
Q

What are intrinsic hepatotoxins?

A

Drugs that in high doses cause injury to everyone

83
Q

Why does paracetamol toxicity occur?

A

Paracetemol metabolised by enzyme 1 (Glucuronyl transferase), if thats overwhelmed its metabolised by enzyme 2 (Sulphotransferase) if thats overwhelmed its metabolised by enzyme 3 to make a toxic product NAPQ1 which is mopped up by glutathione but if glutathione is overwhelmed then NAPQ1 binds covalently to cell membrane proteins resulting in necrosis of liver cells

84
Q

What is the first treatment for paracetemol overdose, what does this do?

A

Acetylcysteine - regenerate the glutathione to mop up more NAPQ1

85
Q

Hepatocytes in which part of the liver are most vulnerable to toxins and why?

A

Hepatocytes around the hepatic veins
This is where most of the detoxification takes place
These also have blood with the lowest oxygen concentration so are most vulnerable to injury

86
Q

What kind of cell death does viral hepatitis cause?

A

Apoptosis

87
Q

What kind of cell death occurs in hepatocytes in paracetemol poisoning?

A

Necrosis

88
Q

What are the clinical signs and symptoms seen in liver cell necrosis (in order)? 5

A

1) Raised AST and ALT in blood
2) Jaundice
3) Hepatic encephalopathy (coma)
4) Bleeding tendency
5) Renal failure (hepatorenal failure)

89
Q

Why would raised AST and ALT be seen in the blood in liver necrosis?

A

Released from the hepatocytes as they die

90
Q

Why is jaundice seen in liver cell necrosis?

A

Failure of bilirubin metabolism, mostly conjugated hyperbilirubinaemia

91
Q

Why is hepatic encephalopathy seen in liver cell necrosis?

A

failure of liver to detoxify nitrogenous compounds

Circulation of excitatory amino acids

92
Q

Why is a bleeding tendency seen in liver cell necrosis?

A

Failure to synthesise proteins and thus clotting factors

93
Q

Why is hepatorenal failure seen in liver cell necrosis?

A

Shock causes low glomerular filtration

94
Q

What is shock?

A

a syndrome featuring low blood pressure, a prejudice blood supply to important organs such as the brain and heart and low kidney output

95
Q

What 3 kind of patients have been found to be at higher risk of liver damage after paracetemol overdose?

A

1) Malnourished, or fasting patients
2) Patients who take enzyme inducing drugs
3) Patients who regularly drink alcohol to an excess

96
Q

After paracetemol poisoning patients can start to become irritable, what is this a sign of and what can it lead to?

A

In acute liver failure cerebral oedema can develop quickly, irritability is the initial sign of this and it can quickly lead to patients becoming unconcious

97
Q

Why is it necessary to protect the head of a patient with hyper acute liver failure such as that in paracetemol overdose?

A

Clotting is abnormal - risk of bleeding on the brain

98
Q

What 3 things tell you the most about a patients prognosis after paracetemol poisoning (ie. in acute liver failure)?

A

NOT ALT/AST

1) Clotting - prothrombin time
2) Kidney function
3) Signs of encephalopathy

99
Q

Why can the failure of one organ lead to multi organ failure?

A

One organ failing to perform its function puts extra strain on other organs which in turn can lead to them failing and thus multiple organ failure

100
Q

What is meant by encephalopathy?

A

Any degenerative or non-inflammatory disorder affecting the brain in a widespread manner (ie. effecting brain function)

Year 2 EMS GiM (6 decks)

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