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Phase 2a > Pathology > Flashcards

Pathology Flashcards

1
Q

Name the 3 processes which occur in acute inflammation

A
  1. Change in vessel calibre - flow
  2. Increased vascular permeability and formation of the fluid exudate
  3. Formation of cellular exudate - emigration of the neutrophil polymorphs into extravascular space
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2
Q

Describe 4 features of neutrophil polymorphs

A
  1. Short lifespan - 2 or 3 days
  2. Polymorph - polylobed nucleus, contain lysosomes - kill and digest phagocytosed bacteria
  3. Arrive first at acute inflammation
  4. Often die at site and phagocytosed by macrophages
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3
Q

Name 4 features of macrophages

A
  1. Lifespan - month to years
  2. Phagocytose debris and bacteria
  3. Transport material to lymphocytes to induce secondary immune response
  4. Name depending on where located in the body
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4
Q

Name 3 features of lymphocytes

A
  1. Long lived - years
  2. Produce chemicals involved in controlling inflammation and antibodies
  3. Immunological memory
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5
Q

What is another name for acute inflammation

A

Neutrophil-mediated inflammation

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6
Q

What is another name for chronic inflammation

A

Macrophage/lymphocyte-mediated inflammation

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7
Q

Name the 4 steps of neutrophil action

A
  1. Margination
  2. Adhesion
  3. Emigration
  4. Diapedesis
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8
Q

When are granulomas present in inflammation

A

Chronic inflammation with collections of macrophages/histocytes surrounded by lymphocytes

e.g. Due to myocardial infection - TB or leprosy

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9
Q

Define resolution

A

Complete restoration of tissue to normal

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10
Q

Define suppuration

A

Formation of pus (living, dying and dead neutrophils and bacteria, cellular debris) as the causative stimulant is still present

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11
Q

Define organisation

A

Replacement of tissues by granulation tissue

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12
Q

Define progression

A

Agent that caused acute inflammation is not removed

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13
Q

Name the 5 cardinal signs

A
  1. Heat - calor
  2. Redness - rubor
  3. Swelling - tumour
  4. Pain - dolor
  5. Loss of function - functio laesa
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14
Q

Define hypertrophy

A

Increase in size of tissue caused by an increase in size of its constituent cells

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15
Q

Where does hypertrophy occur

Name an example

A

Occurs in organs where cells cannot divide

Examples
- Skeletal muscle in athletes/bodybuilders

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16
Q

Describe hyperplasia

A

Increase in size of a tissue caused by an increase in the number of constituents

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17
Q

Where does hyperplasia occur

Name an example

A

Occurs in organs where cells can divide

Examples
- benign prostatic hyperplasia
- endometrial hyperplasia

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18
Q

Define mixed hypertrophy/hyperplasia

A

Increase in the size of an organ due to an increase in size and number of constituent cells

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19
Q

When does mixed hypertrophy/hyperplasia occur

Name an example

A

Occurs in organs where cells can divide

Example

  • Smooth muscle cells of the uterus during pregnancy
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20
Q

Define atrophy

A

Decrease in the size of a tissue caused by a decrease in number of constituent cells or a decrease in their size

(Generic term for decrease in the size of an organ for whatever reason)

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21
Q

Name an example of atrophy

A

Alzheimer’s dementia

Quadriceps muscle following knee injury

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22
Q

Define metaplasia

A

Change in differentiation of a cell from one fully-differentiated type to a different fully-differentiated type

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23
Q

Name an example of metaplasia

A

Bronchial epithelium from ciliated columnar epithelium to squamous epithelium

Barrett’s oesophagus - squamous epithelium to columnar epithelium

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24
Q

Define dysplasia

A

Imprecise term for the morphological changes seen in cells in the progression to becoming cancer

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25
Q

Define carcinogenesis

A

The transformation of normal cells to neoplastic through permanent genetic alterations or mutations

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26
Q

Define oncogenesis

A

Development of a tumour(s) - malignant or benign

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27
Q

Define neoplasms

A

Arise from single cells that have become transformed by cumulative mutational events (clonal proliferations)

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28
Q

Define carcinogens

A

Environmental agents participating in the causation of tumours - act on DNA (mutagenic). Increase the probability of mutational events

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29
Q

Define carcinogenic

A

Cancer causing

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30
Q

Define oncogenic

A

Tumour causing

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31
Q

What is the main risk of exposure to carcinogens

A

Environment - 85%

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32
Q

Name 3 reasons why the identification environmental carcinogens possess a problem

A
  1. Latent interval may last decades
  2. Complexity of the environment
  3. Ethical constraints
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33
Q

Name the classes of carcinogens

A
  1. Chemical
  2. Viral
  3. Ionising and non-ionising radiation
  4. Biological agents
  5. Miscellaneous carcinogens
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34
Q

Name 3 factors influencing invasion

A
  1. Decreased cellular adhesion
  2. Secretion of proteolytic enzymes
  3. Abnormal or increased cellular motility
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35
Q

Define matrix metalloproteinases and their role

A

Enzymes which are secreted by malignant neoplastic cells

Enables them to digest the surrounding connective tissue

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36
Q

Name the 3 major families of matrix metalloproteinases

A
  1. Interstitial collagenases
  2. Gelatinases
  3. Stromelysins
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37
Q

What do interstitial collagenases degrade

A

Type I, II, III collagen

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38
Q

Define metastasis

A

Process whereby malignant tumours spread from their site of origin (the primary tumour) to form other tumours (secondary tumours) at distant sites

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39
Q

Define carcinomatosis

A

Used to denote extensive metastatic disease

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40
Q

Describe the sequence of metastasis (5)

A
  1. Detachment of tumour cells from their neighbours
  2. Invasion of the surrounding connective tissue to reach conduits from metastasis (blood and lymphatics vessels)
  3. Intravasation into the lumen of vessels
  4. Adherence to endothelium at a remote location
  5. Extravasation of cells from the vessel lumen into surrounding tissue
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41
Q

Define invasive carcinoma

A

Carcinoma which has invaded through the basement membrane and gone into the stroma

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42
Q

Define a microinvasive carcinoma

A

Gone through the basement membrane into the stroma by a little bit (1 to 2 mm) - risk of spreading is very small

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43
Q

Name 3 ways in which the spread of carcinomas are described

A
  1. In situ carcinoma
  2. Micro-invasive carcinoma
  3. Invasive carcinoma
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44
Q

Describe 3 ways in which carcinomas avoid immune system recognition

A
  1. Aggregate with platelets
  2. Shed surface antigens
  3. Clump together - ones in the middle are safer
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45
Q

Name the 5 metastases which travel to bone

A
  1. Lung
  2. Breast
  3. Kidney
  4. Thyroid
  5. Prostate

BLT KP

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46
Q

What is BLT KP

A

Way to remember the metastasis which travel to bone

  1. Breast
  2. Lung
  3. Thyroid
  4. Kidney
  5. Prostate
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47
Q

Name 3 routes of metastasis

A
  1. Haematogenous
  2. Lymphatic
  3. Transcoelomic
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48
Q

What route of metastasis do carcinomas prefer

A

Lymphatic spread

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49
Q

What route of metastasis do sarcomas prefer

A

Haematogenous spread

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50
Q

Define a tumour

A

Abnormal swelling

Can be due to neoplasm, inflammation, hypertrophy, hyperplasia

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51
Q

Define angiogenesis

A

Process by which new blood vessels form from pre-existing ones (essential to growth of tumour cells)

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52
Q

Define neoplasm

A

A lesion resulting from the autonomous or relatively autonomous abnormal growth of cells which persists after the initiating stimulus has been removed

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53
Q

What are neoplasms made up from

A
  1. Neoplastic cells
  2. Stroma
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54
Q

What is the classification of neoplasms

A
  1. Benign
  2. Borderline
  3. Malignant
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55
Q

Name 8 features of benign neoplasm

A
  1. Localised, non-invasive
  2. Slow growth rate
  3. Low mitotic activity
  4. Close resemblance to normal tissue
  5. Circumscribed or encapsulated
  6. Nuclear morphology - normal
  7. Necrosis and ulceration = rare
  8. Growth on mucosal surface usually exophytic
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56
Q

Name 7 features of malignant neoplasm

A
  1. Invasive
  2. Rapid growth rate - increased mitotic activity
  3. Variable resemblance to normal tissue
  4. Poorly defined/irregular border
  5. Hyperchromatic, pleomorphic nuclei
  6. Necrosis and ulceration = common
  7. Growth on mucosal surface and skin often endophytic
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57
Q

Name the benign neoplasm of the non-glandular non-secretory epithelium

A

Papilloma

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58
Q

Name the benign neoplasm of glandular or secretory epithelium

A

Adenoma

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59
Q

Name the malignant epithelial neoplasm

A

Carcinoma

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60
Q

How are benign connective tissue neoplasms named

A

By their site + oma

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61
Q

How are malignant connective tissue neoplasms named

A

By their site + sarcoma

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62
Q

What is the name given when cell type of origin of a neoplasm cannot be determined

A

Anaplastic

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63
Q

What type of prevention is cancer screening

A

Secondary prevention

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64
Q

Name the 3 cancer screening programmes in the UK

A
  1. Breast
  2. Bowel
  3. Cervical

No screening programme for prostate cancer in the UK because the PSA test is not reliable enough

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65
Q

Who can have bowel cancer screening?

A

Every 2 years

Between age of 60-74 yrs

Gradually expanding the programme to invite people aged 50-59

People over 75 can request

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66
Q

Describe the bowel screening test

A

Faecal immunochemical test (FIT) - look for tiny traces of blood in sample of poo

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67
Q

Define a false positive (screening test)

A

Test picks up something - person does not have cancer

68
Q

Define a false negative (screening test)

A

Test misses cancer

69
Q

Who is eligible for breast cancer screening?

A

50 to 70 yrs - every 5 years

70
Q

What does the breast cancer screening test involve?

A

Mammogram (x-ray) - takes two x-rays of each breast

Can help detect breast cancers when they are too small to see or feel

Finds cancer in around 9/1000

71
Q

When would an individual have a breast cancer screening test earlier?

A

Family history - every year in 40s. Younger than 40 = MRI.

Gene mutation - yearly MRI. TP53 - from age of 20. BRAC1/2 - from age of 30.

72
Q

Describe cervical screening

A

Tests for HPV - present with possible cell change

Sample of cells using smear test

73
Q

Who can have cervical screening?

A

25-64 yrs

Every 3-5 years

Under 25 cell changes in cervix = common

74
Q

Describe the HPV vaccination

A

12-13 yrs offered vaccination against HPV before encounter the virus

75
Q

Define Atherosclerosis

A

Accumulation of fibro lipid plaques in systemic arteries (e.g. aorta)

Major course of organ ischaemia

76
Q

Name 4 non-modifiable risks of atherosclerosis

A
  1. Age
  2. Gender
  3. Family history
  4. Radical origin
77
Q

Name 6 modifiable risks of atherosclerosis

A
  1. Lipids
  2. Smoking
  3. Hypertension
  4. Diabetes mellitus
  5. Obesity
  6. Lack of exercise
78
Q

Describe why diabetes is a risk factor of atherosclerosis

A

Due to super oxide and anions present and glycosylation products which both cause oxidative stress and endothelial injury

79
Q

Describe why smoking is a risk factor for atherosclerosis

A

Due to CO, free radicals and nicotine affecting all stages including oxidative stress, endothelial damage, HDL inhibition and increased vulnerability and thrombogenicity of plaques

80
Q

Describe why hypertension is a risk factor of atherosclerosis

A

Due to shearing forces and increased pressure on endothelial cells increasing inflammation and permeability of lipids through endothelium

81
Q

Describe the endothelial damage theory

A
  1. Damage occurs to endothelium
  2. Lipids become trapped under lining. Attracting macrophages taking in the oxidised LDLs and form foam cells
  3. Overtime build up forming fibrous plaque
82
Q

Define primary prevention

A

Measures aimed at preventing disease or its clinical manifestations

83
Q

Define secondary prevention

A

Preventing progression of the disease of recurrent events in patients who already have the disease

84
Q

Define co-benefits

A

Activities or changes people can make that will benefit the management of climate change as well as having positive effects on health

85
Q

Name 5 examples of primary prevention in atherosclerosis

A
  1. Improve diet
  2. Smoking cessation
  3. Increase exercise
  4. Small dose aspiring - 75mg/day to lower BP
  5. Alcohol avoidance
86
Q

Name 5 examples of secondary prevention on atherosclerosis

A
  1. Statins
  2. Diabetes management
  3. Antihypertensives
  4. Diuretics
  5. Antiplatelet therapy
87
Q

Define apoptosis

A

Programmed cell death

Takes place in single cells.

Important in development and cell turnover.

88
Q

Define p53

A

Protein in cells which can detect DNA damage and trigger apoptosis

89
Q

Define necrosis

A

Wholesale destruction of large numbers of cells by some external factors

Death of tissues following bioenergetic failure and loss of plasma membrane integrity

90
Q

Define coagulative necrosis

A

In most tissues, firm pale area, with ghost outlines on microscopy

91
Q

Define colliquative necrosis

A

Seen in brain, the dead area is liquified

92
Q

Define caseous necrosis

A

Seen in TB, there is a pale semi-solid material

93
Q

Define gangrene

A

Necrosis with putrefaction, it follows vascular occlusion or certain infections and is black

94
Q

Define fibrinoid necrosis

A

Microscopic feature in arterioles in malignant hypertension

95
Q

Define fat necrosis

A

May follow trauma and cause a mass, or may follow pancreatitis visible as multiple white spots

96
Q

Define ischaemia

A

Result of impaired vascular perfusion, depriving affected tissue of vital nutrients, especially oxygen (reduction of blood flow)

Can be reversible

97
Q

Define infarction

A

Necrosis of tissue as a result of ischemia (reduction in blood flow with subsequent death of cells)

Is irreversible

98
Q

Define shock

A

Pathophysiological - state of circulatory collapse resulting in impaired tissue perfusion

99
Q

Define thrombus

A

A solid mass of blood constituents formed within the vascular system of life

100
Q

Describe the formation of arterial thrombus

A
  1. Atheromatous plaque on intima surface of artery
  2. Plaque becomes enlarged and protrudes lumen (degree of turbulence flow)
  3. Turbulence caused loss of intimal cells - plaque surface presented to blood cells
  4. Turbulence predisposes to fibrin deposition and platelet clumping + bare luminal surface - has exposed and platelets settle
  5. Layers protrude
  6. Thrombi grows in the direction of blood flow = propagation
101
Q

Define an embolus

A

Mass of material in the vascular system able to become lodged within a vessel and block its lumen

102
Q

Describe the different between a venous and arterial thrombus

A

Blood pressure is lower in veins, so atheroma does not occur

Most venous thrombi occurs in valves

103
Q

Name an example of a venous thrombus

A

Pulmonary embolism

104
Q

Name an example of an arterial thrombus

A

Systemic embolism

105
Q

Name the 3 parts of Virchow’s Triangle

A
  1. Change in vessel wall
  2. Change in blood flow
  3. Change in blood constituents
106
Q

Name the 2 steps of primary platelet formation

A
  1. Platelet adhesion
  2. Platelet aggregation
  3. Fibrin generation
107
Q

What are the 3 steps involved in coagulation?

A
  1. Vascular spasm
  2. Formation of a primary platelet plug
  3. Formation of a secondary stable plug
108
Q

What are the 3 steps of to form a primary platelet plug

A

Adhesion
Activation
Aggregation

109
Q

What mechanism is used to form a secondary stable plug

A

Coagulation cascade

110
Q

Describe adhesion in the formation of a primary platelet plug

A
  1. Injury exposed endothelium and collagen
  2. Collagen fibres bind to vWF, then binds to platelets
  3. Exposed fibres trigger the clotting cascade generating thrombin
  4. Thrombin converts fibrinogen to fibrin creating a platelet plug
111
Q

Describe activation in the formation of a primary platelet plug

A
  1. Platelet binds to collagen activating glycoprotein IIb/IIa pathway
  2. Results in secretion of thromboxane and ADP activating other platelets
  3. Results in increased surface area of platelets as prepare for aggregation
112
Q

Describe aggregation in the formation of a platelet plug

A
  1. Platelets express GPIIb/IIIa receptors binding to vWF or fibrinogen
  2. Fibrinogen facilitates the crosslinks between platelets
  3. Aids aggregation to form a platelet plug
113
Q

What is the extrinsic pathway of the coagulation cascade triggered by

A

External trauma which causes blood to escape the circulation

114
Q

What is the intrinsic pathway of the coagulation cascade triggered by

A

Interna damage to the vessel wall

114
Q

Thrombosis

Name 3 factors which affect the vessel wall

A

Atheroma formation - think of everything which can cause this

Inflammatory response

Direct trauma

114
Q

Thrombosis - name a factor which affects change in blood flow

A

Recent immobilisation

Most common is DVT

115
Q

Thrombosis - Name 4 factors that can result in a change of blood constituents

A
  1. Smoking
  2. Sepsis
  3. Malignancy
  4. Inherited blood disorders
116
Q

What cancer does polycyclic aromatic hydrocarbons cause?

Where are people exposed to there?

A

Lung cancer
Skin cancer

Smoking
Mineral oils

117
Q

What cancer do aromatic amines cause?

Where would you be exposed to these?

A

Bladder cancer

Rubber/dye workers

118
Q

What cancer do nitrosamines cause?

A

Gut cancer

119
Q

What cancer do alkylating agents cause?

A

Leukaemia

120
Q

What is the associated cancer of human herpes virus 8

What type of virus is it

A

Kaposi sarcoma

DNA virus

121
Q

What is the associated cancer of Epstein Barr Virus (2)

What type of virus is it

A

Burkitt lymphoma
Nasopharyngeal carcinoma

DNA virus

122
Q

What is the associated cancer of hepatitis B virus

What type of virus is it

A

Hepatocellular carcinoma

DNA virus

123
Q

What is the associated cancers of human papillomavirus virus

What type of virus is it

A

Squamous cell carcinomas of the cervix, penis, anus, head and neck

DNA virus

124
Q

What is the associated cancer of Merkle cell polyomavirus

What type of virus is it

A

Merkle cell carcinoma

DNA virus

125
Q

What is the associated cancer of human T-lymphotropic virus

What type of virus is it

A

Adult T-cell leukaemia

RNA virus

126
Q

What is the associated cancer of hepatitis C virus

What type of virus is it

A

Hepatocellular carcinoma

RNA virus

127
Q

Exposure to UVA or UVB radiation increases the risk of what cancers

A

Basal cell carcinoma
Squamous cell carcinoma
Melanoma

128
Q

Increased hormone oestrogen increases the risk of which cancers

A

Mammary/endometrial cancer

129
Q

Mycotoxins are associated with which cancer

A

Hepatocellular carcinoma

130
Q

Parasite - chlonorchis sinensis is associated with which cancer

A

Cholangiocarcinoma

131
Q

Parasite - shistosoma - is associated with which cancer

A

Bladder cancer

132
Q

Name a malignant cell of melanocytes

A

Melanoma

133
Q

Define melanoma

A

malignant cell of melanocytes

134
Q

Name a malignant neoplasm of mesothelial cells

A

Mesothelioma

135
Q

Define mesothelioma

A

malignant neoplasm of mesothelial cells

136
Q

Name a malignant neoplasm of lymphoid cells

A

Lymphoma

137
Q

Define lymphoma

A

malignant neoplasm of lymphoid cells

138
Q

Name a benign connective tissue neoplasm of adipocytes

A

Lipoma

139
Q

Define lipoma

A

benign connective tissue neoplasm of adipocytes

140
Q

Name a benign connective tissue neoplasm of cartilage

A

Chondroma

141
Q

Define chondroma

A

benign connective tissue neoplasm of cartilage

142
Q

Name a benign connective tissue neoplasm of bone

A

Osteoma

143
Q

Define osteoma

A

benign connective tissue neoplasm of bone

144
Q

Name a benign connective tissue neoplasm of vascular

A

angioma

145
Q

Define angioma

A

benign connective tissue neoplasm of vascular

146
Q

Name a benign connective tissue neoplasm of straited muscle

A

Rhabdomyoma

147
Q

Define rhabdomyoma

A

benign connective tissue neoplasm of striated muscle

148
Q

Name a benign connective tissue neoplasm of smooth muscle

A

Leiomyoma

149
Q

Define leiomyoma

A

benign connective tissue neoplasm of smooth muscle

150
Q

Name a benign connective tissue neoplasm of nerves

A

Neuroma

151
Q

Define neuroma

A

benign connective tissue neoplasm of nerves

152
Q

Name a malignant connective tissue neoplasm of adipose tissue

A

Liposarcoma

153
Q

Define liposarcoma

A

malignant connective tissue neoplasm of adipose tissue

154
Q

Name a malignant connective tissue neoplasm of striated muscle

A

Rhabdomyosarcoma

155
Q

Define rhabdomyosarcoma

A

malignant connective tissue neoplasm of straited muscle

156
Q

Name a malignant connective tissue neoplasm of smooth muscle

A

Leiomyosarcoma

157
Q

Define leiomyosarcoma

A

malignant connective tissue neoplasm of smooth muscle

158
Q

Name a malignant connective tissue neoplasm of cartilage

A

Chondrosarcoma

159
Q

Define chondrosarcoma

A

malignant connective tissue neoplasm of cartilage

160
Q

Name a malignant connective tissue neoplasm of bone

A

Osteosarcoma

161
Q

Define osteosarcoma

A

malignant connective tissue neoplasm of bone

162
Q

Name a malignant connective tissue neoplasm of blood vessels

A

Angiosarcoma

163
Q

Define angiosarcoma

A

malignant connective tissue neoplasm of blood vessels

Phase 2a (15 decks)

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