Pathology

Question 1

Which component of the CNS is most vulnerable to hypoxia?

Answer 1

Neurones

Question 2

Which cells are the “macrophage cells” of the CNS?

Answer 2

Microglia

Question 3

Axonal injury involves a reaction in which part of the neurone?

Answer 3

Reaction within cell body

Question 4

In which direction does the axon damage in response to injury?

Answer 4

Anterograde degeneration of axon distal to site of injury

Question 5

Which process do astrocytes initiate in response to injury?

Answer 5

Reactive proliferation - gliosis - where cells undergo hyperplasia and hypertrophy

Question 6

Which process if the most important histopathological indicator of CNS injury, regardless of cause?

Answer 6

Gliosis

Question 7

Which cells line the ventricular system?

Answer 7

Ependymal cells

Question 8

The brain receives how much of the cardiac output?

Answer 8

15%

Question 9

What is the response of vasculature to the brain in hypotension and hypertension?

Answer 9

Constricts in hypertension
Dilates in hypotension

Question 10

What are the two main sets of arteries supplying blood to the brain?

Answer 10

Branches of internal carotid + vertebral arteries (form anterior + posterior circulations)

Question 11

Lack of blood supply in the anterior cerebral artery is associated with which dysfunctions?

Answer 11

Frontal lobe dysfunction
Contralateral sensory loss in foot + leg
Paresis of arm + foot

Question 12

Lack of blood supply in the middle cerebral artery is associated with which dysfunctions?

Answer 12

Hemiparesis
Hemisensory loss
Aphasia/dysphasia
Apraxia

Question 13

Lack of blood supply in the posterior cerebral artery (vertebrobasilar) is associated with which cerebellar dysfunctions?

Answer 13

Ataxia
Nystagmus
Intention tremor
Pendular reflexes

Question 14

Lack of blood supply in the posterior cerebral artery (vertebrobasilar) is associated with which occipital lobe dysfunctions?

Answer 14

Homonymous hemianopia with macular sparing

Question 15

When does gliosis occur following a cerebral infarct?

Answer 15

1-2 weeks

Question 16

What is the most common cause of a subarachnoid haemorrhage?

Answer 16

Spontaneous rupture of a saccular aneurysm (Berry aneurysm)

Question 17

List diseases that have increased incidence of Berry aneurysms

Answer 17

Polycystic kidney disease
Fibromuscular dysplasia
Coarctation of aorta

Question 18

Most berry aneurysms occur where?

Answer 18

90% = arterial bifurcations near internal carotid cartery
10% = vertebrobasilar circulation

Question 19

At which diameter do berry aneurysms have greatest risk of rupture?

Answer 19

6-10mm
If over 25mm, risk of rupture decreases

Question 20

Lacunar infarcts can be present in hypertensives. What are they?

Answer 20

Small cavities up to 10mm in diameter found in basal ganglia and pons

Question 21

What is demyelination?

Answer 21

Destruction of myelin sheath surrounding an axon, either due to breakdown or abnormal production

Question 22

What disease comes under primary demyelination?

Answer 22

Multiple sclerosis

Question 23

What is the female:male affected ratio for MS?

Answer 23

2:1

Question 24

The external appearance of the brain and spinal cord in MS is usually normal. True/False?

Answer 24

True

Question 25

MS is a grey matter disease. True/False?

Answer 25

False MS is a white matter disease

Question 26

Describe the morphology of MS

Answer 26

Well-demarcated plaques in white matter in a non-anatomical distribution

Question 27

Describe the colour of MS plaques

Answer 27

Acute lesions: soft pink Chronic lesions: firm pearl-grey

Question 28

What structures do MS plaques commonly affect?

Answer 28

Optic nerve Periventricular white matter Corpus callosum Brainstem Spinal cord

Question 29

Where do chronic inactive MS plaques typically occupy?

Answer 29

Situated around lateral ventricles

Question 30

Dementia is always pathological. True/False?

Answer 30

True Neurodegenerative disorder, not just part of ageing!

Question 31

List diseases classified as primary dementias

Answer 31

Alzheimer's disease Huntington's disease Pick's disease Lewy body dementia

Question 32

What is the female:male ratio for Alzheimer's disease?

Answer 32

2:1

Question 33

List the genes the can be involved in Alzheimer's disease

Answer 33

Amyloid precursor protein (c21) Presenilin 1 (c14) Presenilin 2 (c1) ApoE (allele e4)

Question 34

Describe the morphology of Alzheimer's disease on the brain

Answer 34

Cortical atrophy Widened sulci Narrowed gyri Dilated ventricles

Question 35

Which lobes are particularly affected in Alzheimer's disease?

Answer 35

Frontal Temporal Parietal

Question 36

Which protein forms plaques in Alzheimer's disease?

Answer 36

A-beta amyloid plaques

Question 37

What colour does amyloid protein stain?

Answer 37

Congo red

Question 38

Which protein in the brain can become tangled and defective in Alzheimer's disease?

Answer 38

Tau protein

Question 39

Which area of the brain is affected in Lewy body dementia (Parkinson's)?

Answer 39

Substantia nigra

Question 40

Which protein, when stained, can help detect Lewy bodies?

Answer 40

Ubiquitin

Question 41

What happens to the caudate nucleus in Huntington's disease?

Answer 41

Caudate atrophy with loss of neurons

Question 42

What are the histopathological landmarks of Pick's disease dementia?

Answer 42

Swollen neurons (Pick's cells) Filamentous inclusions (Pick's bodies)

Question 43

Which lobes does Pick's disease usually affect?

Answer 43

Frontal Temporal

Question 44

What is the most common type of secondary dementia?

Answer 44

Vascular (infarct) dementia

Question 45

Examples of acetylcholine esterase inhibitors used to treat dementia?

Answer 45

Donepezil Galantamine Rivastigmine

Question 46

Name the NMDA receptor antagonist used to treat Alzheimer's?

Answer 46

Memantine