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BLOCK A - Molecules to Global Health > Pathology > Flashcards

Pathology Flashcards

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Organic Chemistry 101 flashcards
1
Q

how does anatomic pathology relate to laboratory medicine?

A

lab medicine = general pathology (ANATOMIC pathology + clinical pathology)

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2
Q

what is included in anatomic pathology? (4)

A
  1. autopsy pathology
  2. surgical pathology
  3. cytopathology
  4. speciality labs (immunohistochemistry, immunofluorescence, electron microscopy)
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3
Q

what is included in clinical pathology? (3)

A
  1. clinical biochemistry
  2. microbiology
  3. laboratory hematology
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4
Q

what is surgical pathology?

A

any tissue removed or biopsied at surgery or radiology gets sent to pathology

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5
Q

what are the surgical procedures in surgical pathology? (5)

A
  1. core (needle) biopsies (remove long narrow piece)
  2. incisional biopsies (large mass)
  3. excisional biopsies (lymph node)
  4. resection
  5. exenteration (entire content)
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6
Q

explain a pathologist’s OR consultation

A
  1. can be macroscopic or microscopic examinations
  2. if light microscopy required: freeze tissue cut on cryostat and stain with H&E
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7
Q

what are the advantages and drawbacks to pathologist OR consultations?

A

advantage: fast (takes 5-15min)

disadvantage: since freezing, cannot use for all specimens and is small diagnostic error rate

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8
Q

what changes in the procedure of small vs large pieces in macroscopy?

A

small pieces are fixed directly to prevent degradation

large pieces have sample representative sections

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9
Q

what are the steps of biopsies? how long does each step take?

A
  1. fixation (min. few hrs, often 24-48hr)
    (STEPS 2-4 OVERNIGHT)
  2. dehydration
  3. clearing
  4. infiltration by wax
    (STEPS 5-6 TAKES A FEW HOURS)
  5. embedding
  6. cutting
    (STEPS 7-8 AUTOMATED)
  7. staining
  8. distribution to pathologist
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10
Q

what fixation agent is used?

A

10% formalin in water

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11
Q

what is the fixation step?

  1. fixation (min. few hrs, often 24-48hr)
    (STEPS 2-4 OVERNIGHT)
  2. dehydration
  3. clearing
  4. infiltration by wax
    (STEPS 5-6 TAKES A FEW HOURS)
  5. embedding
  6. cutting
    (STEPS 7-8 AUTOMATED)
  7. staining
  8. distribution to pathologist
A

preserves (fixes) structures by cross linking proteins (NH2 groups), inactivating proteolytic enzymes

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12
Q

the (slower/faster) the tissue is fixed, the better

A

faster

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13
Q

explain steps 2-4:

  1. fixation (min. few hrs, often 24-48hr)
    (STEPS 2-4 OVERNIGHT)
  2. dehydration
  3. clearing
  4. infiltration by wax
    (STEPS 5-6 TAKES A FEW HOURS)
  5. embedding
  6. cutting
    (STEPS 7-8 AUTOMATED)
  7. staining
  8. distribution to pathologist
A

step 2: dehydration with graded alcohols

step 3: use xylene (organic solvent) miscible to clear it

step 4: infiltrate with paraffin wax

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14
Q

explain steps 5-6:

  1. fixation (min. few hrs, often 24-48hr)
    (STEPS 2-4 OVERNIGHT)
  2. dehydration
  3. clearing
  4. infiltration by wax
    (STEPS 5-6 TAKES A FEW HOURS)
  5. embedding
  6. cutting
    (STEPS 7-8 AUTOMATED)
  7. staining
  8. distribution to pathologist
A

step 5: place tissue in the correct orientation and mold with paraffin, cassette and let harden

step 6: cut sections on microtome at thickness of 3-5um for light microscopy and put on glass slide

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15
Q

explain step 7:

  1. fixation (min. few hrs, often 24-48hr)
    (STEPS 2-4 OVERNIGHT)
  2. dehydration
  3. clearing
  4. infiltration by wax
    (STEPS 5-6 TAKES A FEW HOURS)
  5. embedding
  6. cutting
    (STEPS 7-8 AUTOMATED)
  7. staining
  8. distribution to pathologist
A

use routine hematoxylin and eosin OR other special stains

  1. since hematoxylin is aqueous, remove wax: remove wax (heat, xylene) -> dehydration (alcohol) -> water -> stain with hematoxylin
  2. differentiate (destaining) using weak alcohol
  3. apply eosin
  4. dehydrate (alcohol) -> clear (xylene)
  5. mounting medium, coverslip
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16
Q

what stains are simple acid base reactions?

A

hematoxylin and eosin

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17
Q

describe hematoxylin (color, what, where)

A
  • blue/purple
  • basic (binds to basophilic substances like ACIDS, NUCLEIC ACIDS)
  • in the nucleus
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18
Q

describe eosin (color, what, where)

A
  • red/pink
  • acidic (binds to acidophilic substances like BASIC proteins)
  • in the cytoplasm
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19
Q

sometimes, eosin needs to be used for more intense staining. in what two cases does this happen?

A

necrosis and apoptosis

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20
Q

what is masson trichrome used for?

A
  • collagen and fibrosis
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21
Q

what color are the following stained with masson trichrome:

  1. collagen
  2. nuclei
  3. muscle
  4. cytoplasm
A
  1. blue
  2. dark blue
  3. red
  4. light red/pink
22
Q

what is the Prussian blue stain for? what color does it stain?

A
  • for iron
  • stains blue
23
Q

what is ziehl-neelsen used for?

A

acid fast bacilli

24
Q

what is grocott used for?

A

fungal organisms

25
Q

place the correct term with the stain type (hematoxylin or eosin):

  1. nuclear staining
  2. cytoplasmic staining
A
  1. hematoxylin
  2. eosin
26
Q

how is nuclear staining used to make a diagnosis? (3)

A
  • reflects DNA (genetic material)
  • regulator of proliferation and metabolic activities
  • susceptible to mutations
27
Q

how is cytoplasmic staining used to make a diagnosis (2)

A
  • reflects effort proteins (i.e., enzymes)
  • reflects phenotype of the cell
28
Q

how does immunohistochemistry work?

A

use of antibodies to check for certain antigens (markers) in a sample of tissue

29
Q

what are the steps to immunohistochemistry?

A
  1. inject protein to generate the specific AB
  2. apply AB to histologic sections along with chromogen to detect it
  3. look for presence/absence of AG, intensity and location
30
Q

what are CD molecules in immunohistochemistry?

A

cluster of differentiation number assigned to group/cluser of ABs that recognize a specific cell surface molecule

31
Q

what type of immunohistochemistry can be used as predictive factor?

A

CD molecules: if cell X is stained with ab against Y, it predicts a response to anti-Y

32
Q

what can immunohistochemistry stain for? (4)

A
  • cell surface proteins
  • cytoplasmic proteins
  • nuclear proteins
  • infectious agents
33
Q

how does immunofluorescence compare to immunohistochemistry?

A

also uses AG and AB but stained with fluorescein-labeled AB and examined with UV microscopes

34
Q

what do we use electron microscopy for in pathology? (2)

A
  • used for very high resolution
  • diagnostic for renal glomerular diseases and virology
35
Q

T/F: to get the ultra thin sections needed for electron microscopy, we cut them the same way as regular biopsies

A

FALSE: embed them in epoxy resin and cut on diamond knifes

36
Q

what is cytopathology and what are its 2 sections?

A

looks at whole cells (individual or sheets) rather than sections of tissues

  1. gynecologic (PAP smears)
  2. non-gynecologic (fine needle aspirates, exfoliative)
37
Q

how is the procedure for cytopathology different/similar to surgical pathology?

A

difference:
- uses smears and cytocentrifuge
- does not use immunohistochemistry/fluorescence UNLESS in cell blocks

similar:
- if there’s enough tissue, make cell blocks that are processed the same as surgical pathology

38
Q

what is a syndrome?

A

Set of symptoms (history) and/or signs (physical examination) that occur together

39
Q

what is pathology and how is it divided?

A
  • scientific study of diseases from molecules to patients
  • general pathology and organ-based pathology (systemic)
40
Q

what is the current concept and practical application of pathology?

A
  • Diagnosis of diseases
  • Determination of prognostic and predictive factors
41
Q

how do we classify diseases?

A

systematic arrangement of diseases in categories according to criteria or common features

42
Q

describe the epidemiology and predisposing/risk factors approach to disease (4)

A
  • Incidence and prevalence
  • Age, gender, racial differences
  • Geographic/global distribution and epidemics
  • Relation to occupational, environmental, social aspects
43
Q

describe the etiological/cause approach to disease (2)

A
  1. Known: Genetic vs acquired vs multifactorial
  2. Unknown: Idiopathic
44
Q

describe the pathologenesis (HOW) approach to disease (2)

A
  • Mechanism where the etiological agent results in the pathological alteration of the disease
  • Once you have this, you have targetable intervention for therapy
45
Q

where can we see pathological alterations (5)?

A
  • Macroscopic (gross)
  • Light microscopic
  • Histochemical (special stains) and immunohistochemical stains
  • Ultrastructural (electron microscopy)
  • Molecular
46
Q

describe the pathophysiology and effects approach to disease (2)

A
  • functional consequences of the pathologic/structural alterations
  • Levels –> cells/molecules, organs, patient
47
Q

describe the clinical manifestations approach to disease (3)

A
  • Symptoms via history
  • Signs via physical examination
  • Imaging and laboratory data
48
Q

describe the diagnosis approach to disease (4)

A
  • History and physical exam
  • Imaging, lab data
  • Pathological examination (macro and micro)
  • Need to think about differential diagnosis
49
Q

describe the complications approach to disease (2)

A
  • Events that aren’t related to signs/symptoms of the disease
  • Certain overlap with side-effects
50
Q

what are prognostic factors?

A
  • things affecting patient outcome and survival
  • i.e., performance status, severity, histological type of lesion, etc.
51
Q

what are predictive factors?

A
  • predict potential response to specific therapies
  • i.e., molecule that predicts the response of a drug
52
Q

explain the pathway from ethology to outcome

A
  1. predisposing factors affect etiology
  2. pathogenesis and predisposing factors affect how etiology leads to pathological alterations
  3. mild pathological alterations lead to asymptomatic symptoms while severe alterations lead to clinical manifestations (affected by pathophysiology)
  4. to catch early diagnoses, want to screen for asymptomatic symptoms, but if you have clinical manifestations, you can just diagnose it
  5. once a diagnosis is reached, we can apply therapy (which is affected by predictive factors)
  6. prognostic factors will affect the outcome

BLOCK A - Molecules to Global Health (5 decks)

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