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Pathology Flashcards

1
Q

Diaphragm innervation at this cervical vertebrae

A

C3

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2
Q

Two types of heart block

A

Type 1- PR interval same

Type 2- PR interval increasing

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3
Q

What antibody is measured in people with Strep infection and for RF?

A

ASOT

and AntiDNAseB

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4
Q

Diseases caused by Strep (GAS)

A
  • Pharyngitis
  • Septicaemia
  • Cellulitis
  • Scarlet fever
  • Streptococcal shock syndrome
  • Rheumatic fever
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5
Q

Acute rheumatic fever

A

Abnormal immune response to GAS infection

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6
Q

Features of ARF (Jones criteria)

A 
JONES
Joints- Polyarthritis
O- Heart- Carditis (pancarditis)
N- Subcutaneous nodules
E- Erythema marginatum
S- Chorea

Minor- Fever, arthralgia, acute phase reactants, prolonged PR interval

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7
Q

Treatment for RF

A

Benzathine Penicilin

**Glucocorticoids for severe RF
And symptom control

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8
Q

Three main epicardial coronary arteries

A

1) Left coronary artery (anterior 2/3 of IV septum, apex, anterior wall of LV)
2) Right coronary artery (posterior 1/3 of IV septum, inferior/posterior LV)
3) Left circumflex artery (lateral LV)

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9
Q

Structure of a valve

A

Endothelium
Dense collagenous core
Central loose CT core
Elastin fibres

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10
Q

Three forms of valvular heart disease

A

1) Valvular stenosis (narrowing with failure to open completely)
2) Valvular incompetence
3) Functional regurgitation

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11
Q

What does valvular insufficiency lead to?

A

Volume overload

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12
Q

Acquired valve disease

A

Mitral and aortic stenosis is 2/3 of all

Mitral stenosis
Mitral regurgitation
Aortic stenosis
Aortic regurgitation

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13
Q

Mitral stenosis

A

Rheumatic fever is the major cause

Clinical features:

  • Atrial fibrillation
  • Haemoptysis
  • Pulmonary congestion
  • Right ventricular hypertrophy

Opening snap

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14
Q

Mitral valve incompetence

A

LA enlargement
Acute LV failure
Chordae rupture causing atrial fibrillation

Systolic murmur

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15
Q

Mitral valve prolapse

A

Ballooning/hooding of mitral valve leaflets

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16
Q

Aortic valve stenosis

A

Small pulse, LV hypertrophy
LV failure
Sudden death

Ejection systolic murmur

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17
Q

Streptococci in RHF

A

B haemolytic

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18
Q

Rheumatic fever

A

Connective tissue disorder characterised by fibrinoid necrosis, inflammation and fibrosis

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19
Q

Aschoff bodies

A

Nodules in the hearts of RF patients- granulomatous structure with fibrinoid change, lymphocytic infiltration

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20
Q

Anitschow cells

A

Enlarged macrophages within Achoff bodies

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21
Q

Pancarditis

A

Endocarditis
Pericarditis
Myocarditis

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22
Q

Three features of chronic rheumatic fever

A

Fusion of valve commissure
Thickening and fibrosis of valve cusps
Thickening of chordae tendineae

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23
Q

Infective endocarditis

A

Damage of heart valves by a microbe by formation of vegetations

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24
Q

Three complications of IE

A

Valve perforations
Myocardial abscess
Septic emboli

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25
Q

Cardiomyopathy

A

Abnormality in the myocardium- cardiac disease of unknown or unusual cause with pathological processes within myocardium or endocardium or both

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26
Q

Classification of cardiomopathy

A

1) Aetiological (primary or secondary)

2) Clinico-pathological (Dilated, hypertrophic, restrictive)

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27
Q

Primary cardiomyopathy three causes

A

Familial
Idiopathic
Endomyocardial fibrosis

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28
Q

Secondary cardiomyopathy three causes

A

Infective
Metabolic
Connective tissue disorders

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29
Q

Histological abnormalities of DCMP

A

Enlarged heart upto 3x
Dilated, flabby heart

Hypertrophied cells
Endocardial and interstitial fibrosis

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30
Q

Hypertrophic myopathy

A

Left ventricular hypertrophy of a non-dilated chamber without obvious cause
Marked hypertrophy of heart muscle without ventricualr dilation

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31
Q

Restrictive cardiomyopathy

A

Abnormal diastolic function due to rigid left ventricular wall

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32
Q

Clinical manifestations of cardiomyopathy

A

Angina
Dyspnoea
Fatigue
Syncope

Can lead to:
Heart failure
Sudden death
Stroke
Atrial fibrillation
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33
Q

What is a common complication of all cardiomyopathy?

A

Mural thrombus

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34
Q

Myocarditis

A

Inflammation of the myocardium with lymphocytic infiltration
Can cause sudden cardiac death or cardiac failure

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35
Q

Three main causes of myocarditis

A

1) Infections
2) Immune mediated
3) Others (e.g. sarcoidosis, amyloidosis)

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36
Q

Tumours of the heart

A

Primary tumours- Myxomas, fibromas, lipomas

Secondary

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37
Q

Myxomas

A

Most common primary tumour of the heart in adults
Commonly located in the left atrium
Most common site is fossa ovalis in the atrial septum

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38
Q

Carney’s complex

A

10% of people with myxoma have this

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39
Q

Rhabdomyoma

A

Primary tumour of the heart in infants and children

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40
Q

Three classifications of pericarditis

A

Effusive
Constrictive
Adhesive

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41
Q

Obstructive disease

A

Increase in resistance to airflow due to partial/complete obstruction

Chronic bronchitis, emphysema, bronchiectasis, asthma

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42
Q

Restrictive disease

A

Reduced expansion of lung parenchyma and decreased total lung capacity

Fibrosis, pneumonia,

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43
Q

Chronic bronchitis

A

Clinical diagnosis
75 ml of sputum everyday
Caused by chronic irritation

**Goblet cell metaplasia and increased mucous production

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44
Q

Complications of chronic bronchitis

A

Infective exacerbation
Pneumonia
Right heart failure

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45
Q

Emphysema

A

Abnormal permanent enlargement of airspaces distal to terminal bronchiole ACCOMPANIED by destruction to their walls without fibrosis

*Just enlargement is not emphysema

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46
Q

Clinical features of emphysema

A

Barrel chest
Progressive dyspnoea
Wheezing
Decreased exercise tolerance

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47
Q

Types of emphysema

A 
Centriacinar- involves the upper lobe (smokers)
Panacinar- all zones (a-antitrypsin deficiency)
Distal acinar (distal portion of acinus)
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48
Q

Protease-antiprotease theory of emphysema

A

Smoking causes accumulation of macrophages and neutrophils in respiratory bronchioles. Anti-protease (a1 antitrypsin) is found in the bronchial mucus. Smoking inhibits this.

*Constant protease- antiprotease imbalance leads to emphysema

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49
Q

Bronchiectasis

A

Permanent and abnormal dilatation of bronchi and bronchioles as a result of bronchial obstruction

Causes- tumour, foreign body obstruction

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50
Q

Clinical features of bronchiectasis

A

Constant infection in dilated bronchi
Persistent cough
Foul smelling sputum
Haemoptysis

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51
Q

Asthma

A

Hyperactive airways which go into a state of reversible bronchoconstriction due to increased responsiveness to various stimuli

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52
Q

Main cells in asthma and histological features

A

Focal necrosis of epithelium with eosinophilic infiltration
Hypertrophy of mucous glands
Hypertrophy of smooth muscle of bronchial wall

Eosinophils
Charcot-Leyden crystals
Curschmann spirals

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53
Q

Chronic interstitial disease

A

Heterogenous group of disorders characterised predominantly by inflammation and fibrosis of the pulmonary connective tissue

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54
Q

UIP

A

Usual interstitial pneumonia

Fibroblastic foci- patchy interstitial fibrosis and inflammation

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55
Q

Pneumoconiosis

A

Pulmonary fibrosis due to inhaled dust
“Coal workers”
“Asbestosis”

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56
Q

Asbestos

A

Localised pleural plaques
Pleural effusions
Asbestosis

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57
Q

Pressure versus volume overload

A

Pressure- increased systolic pressure- PARALLEL addition- CONCENTRIC hypertrophy

Volume- increased diastolic pressure- SERIES addition- ECCENTRIC hypertrophy

**In both pressure and volume overload there is increase in weight and size of the heart

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58
Q

Congestive heart failure

A

End stage chronic heart disease- failure of the pump

Forward failure- diminished cardiac output, reduced tissue perfusion

Backward failure- pooling of blood in the venous system, oedema

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59
Q

High pressure left to right shunt- what heart failure

A

Right heart failure

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60
Q

Five clinical manifestations of left heart failure

A 
Dyspnoea
Orthopnoea
Paroxysmal nocturnal dyspnoea
Fatigue and weakness
Cachexia
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61
Q

Five clinical manifestations of right heart failure

A 
Peripheral oedema
Splenomegaly
Hepatomegaly
Jaundice
Abdominal symptoms
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62
Q

Hypertension- left vs right

A

Left sided- Systemic hypertension

Right sided- Pulmonary hypertension

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63
Q

Systemic hypertension

A

Concentric left ventricular hypertrophy

Eventually left heart backward failure, lung congestion, pulmonary oedema

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64
Q

Pulmonary hypertension

A

Elevation of pulmonary artery pressure due to pulmonary vascular disease

Can lead to right ventricle enlargement- cor pulmonale

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65
Q

Cor pulmonale

A

Cor pulmonale is defined as an alteration in the structure and function of the right ventricle (RV) caused by a primary disorder of the respiratory system. Pulmonary hypertension is often the common link between lung dysfunction and the heart in cor pulmonale

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66
Q

3 causes of pulmonary hypertension

A

Mitral regurgitation
LV diastolic dysfunction
Pulmonary arterial hypertension

67
Q

Sequelae of right ventricular failure from lung disease

A

Chronic lung disease –> Reduction in pulmonary vascular bed –> Pulmonary hypertension –> Hypertrophy of right ventricle –> Right ventricular failure

68
Q

Types of ischaemic heart disease

A

Angina pectoris
MI
Heart failure
Sudden cardiac death

69
Q

Pathogenesis of MI

A

Atherosclerotic plaques –> Fissuring and ulcerations –> Adhesion, activation and aggregation of platelets –> Thrombus formation

70
Q

Transmural

A

Full thickness necrosis in a territory supplied by a single coronary artery STEMI

71
Q

Subendocardial

A

Circumferential necrosis around 1/3 to 1/2 of the ventricular wall and may extend beyond the territory supplied by a single coronary artery NSTEMI

72
Q

Extent of infarction in MI

A
  • Size of occlusion
  • Site of occlusion
  • Rate of development
  • Duration
  • Myocardial demand
73
Q

Three clinical features

A

Troponin- I and T
Creatinine kinase
Lactate dehydrogenase

74
Q

Complications of MI

A

Sudden death
Arrhythmias
Left ventricular congestive heart failure
Cardiogenic shock

75
Q

Atherosclerosis

A

Hardening and thickening of arterial walls due to build up of fatty material

76
Q

Response to injury hypothesis

A

Injury to endothelium due to oxidised LDL cholestrol

Surface adhesion molecules expressed for lymphocytes and other inflammatory cells to bind

Monocytes migrate and T lymphocytes release cytokines

Fibroproliferative response- smooth muscle cells migrate from media to intima to produce collagen

77
Q

Three complications of atherosclerosis

A

1) Calcification
2) Ulceration of the atheroma
3) Rupture of the atheroma

78
Q

Hypertensive vascular disease

A

Caused by hypertension

known causes- renal disease, drugs, pregnancy

79
Q

Malignant hypertension

A

Hypertensive emergency- Severe rise in BP, renal failure, retinal haemorrhages, encephalopathy

80
Q

Hyaline arteriosclerosis

A

Eosinophilic hyaline thickening of tunica media

81
Q

Three consequences of hypertensive disease

A

1) LV hypertrophy
2) Heart failure
3) Arrhythmias

82
Q

Vegetation

A

Platelet thrombus that develops and propagates

83
Q

What is the most common site of vegetation

A

Aortic site

Mitral site

84
Q

Complications of endocarditis

A

Septic emboli
Vasculitis
Severe regurgitation leading to HF

85
Q

Clinical presentation of endocarditis

And common clinical signs

A

Presentation

  • Chills
  • Myalgia
  • Rigors

Clinical signs

  • Splinter haemorrhages
  • Janeway lesions
  • Clubbing
  • Roth’s spots
  • Splenomegaly
86
Q

Duke’s criteria for endocarditis

A

1) Positive blood culture

2) Evidence of endocardial involvement

87
Q

Relevance of segmental anatomy

A

Related to frequency of infection

10 segments

88
Q

Defense mechanisms of the lung

A

Upper:

  • Mucociliary epithelium (to trap particles)
  • Cough reflex

Lower

  • Alveolar macrophages
  • Mucosal associated lymphoid tissue
  • Bronchus associated lymphoid tissue
89
Q

Samples for infection

A 
Sputum
Bronchoalveolar lavage
Bronchial washings
Fine needle aspirate
Lung biopsy
90
Q

Three classifications of pneumonia

A

1) Aetiology/agent
2) Clinical scenario (pneumonia syndromes)
3) Pathology/anatomical

Pneumonia syndromes:

  • Community acquired
  • Health-care associated
  • Hospital acquired
  • Pneumonia in the immunocompromised
91
Q

Lobar pneumonia and bronchopneumonia

A

Parts of community acquired pneumonia
Lobar- affects the whole lobe
Broncho- affects pulmonary lobules

92
Q

Four stages of morphology of acute bacterial pneumonia

A

1) Congestion- parenchyma heavy, congested, boggy, red
2) Red hepatisation- red exudate, red lung
3) Grey hepatisation- lung grey, disintegration of red cells
4) Resolution

93
Q

Presentation of pneumonia

A 
Fever
Rigor
Productive cough
Haemoptysis
Pleuritic chest pain
94
Q

Complications of pneumonia

A 
Organised pneumonia
Fibrosis
Pneumothorax
Pleural effusion
Pericarditis
95
Q

Acintomycosis

A

Persistent chronic suppurative infection with abscess formation

96
Q

Morphology of mycobacterium TB infection

A

Primary TB- Inhaled bacilli, sensitisation develops, Ghon focus)
Active involvement by caseating/noncaseating granulomas

Progression to either:

  • Healing
  • Latency
  • Secondary TB
  • Progressive pulmonary TB
  • Miliary TB
97
Q

Full oxygen carrying capacity of Hb

A

75-80 mmHg

98
Q

Hypoxia versus hypoxaemia

A

Hypoxia- Low O2 in tissues

Hypoxaemia- Low O2 in blood

99
Q

Causes of hypoxaemia

A

1) Low PiO2
2) Hypoventilation
3) Diffusion limitations
4) V/Q mismatch
5) Right to left shunt

100
Q

Causes of hypoxia

A

Anaemia
Blood flow obstruction
Hypoxaemia

101
Q

Peripheral and central respiratory drive

A

Peripheral

  • Low O2
  • High CO2
  • High H+

Central

  • High CO2
  • HIgh H+
102
Q

What can opioids do in terms of respiratory drive

A

Make people insensitive to CO2 concentrations

103
Q

Chronic hypercapnia

A

Desensitises central chemoreceptors to CO2 concentrations and hypoxia drives respiration
PCO2> 50mmHg

If given too much O2, respiratory rate will slow down and lethal CO2 concentrations will accumulate

104
Q

Three pulmonary vascular diseases

A

1) Pulmonary thromboembolism
2) Pulmonary hypertension
3) Diffuse pulmonary haemorrhagic syndromes

105
Q

Causes of pulmonary hypertension

A

Increased pulmonary blood flow
Increased pulmonary vascular resistance
Increased left heart resistance

106
Q

Pulmonary hypertension

A

Mean pulmonary artery pressure >/ 25 mmHg at rest

>/30 mmHg exercise

107
Q

Clinical presentation of pulmonary hypertension

A

Right heart failure (chest pain, abdominal discomfort)

Arrhythmia

108
Q

What is genetic mechanism for pulmonary hypertension

A

Bone morphogenic protein receptor 2 (BMPR2)

109
Q

Histological patterns of pulmonary hypertension

A 
Plexogenic arteriopathy (changes in muscular arteries and arterioles)
Thrombotic arteriopathy (acute thrombi)
Hypoxic arteriopathy
110
Q

Diffuse pulmonary haemorrhage

A

Patients will present with diffuse haemoptysis
Can be localised or diffuse
- Diffuse haemoptysis (with or without capillaries)
(e.g. Goodpasture’s syndrome)

111
Q

Goodpasture’s syndrome

A

Autoimmune- antibodies around collagen

Primarily affects kidneys and lungs

112
Q

Aneursym- definition and classification

A

Abnormal dilation in a vessel leading to weakness in tunica media of vessel/myocardium

Classification

  • Cause (congenital, inflammatory, trauma)
  • Morphology (saccular, fusiform)
  • Anatomical site (aortic, AAA)
113
Q

Clinical features of ruptured aneurysm

A

Seizures
Double vision
Vomitting
Headaches

114
Q

Complications of aneurysm

A

1) Rupture
2) Occlusion
3) Mass effect

115
Q

Morphology of aneurysms

A
  • Saccular (berry)

- Fusiform

116
Q

AAA

A

Fusiform aneurysm located in abdominal aorta below renal arteries and above bifurcation

Complications:

  • Rupture
  • Peripheral thromboembolism
117
Q

Aortic dissection

A

Tear in intima due to weakness of tunica media
Blood enters here
Due to weakening of tunica media- chronic hypertension, Marfan’s syndrome

Complications

  • Rupture, massive haemorrhage
  • Occlusion of other branches

Clinical features

  • Sudden onset excruciating pain
  • Collapse, shock
118
Q

What causes 90% of pharyngitis

A

Viral infections

  • Influenza virus
  • Rhinovirus
  • Adenovirus
  • Coronavirus
119
Q

Causes of bacterial pharyngitis

A
  • Streptococcal pyogenes
  • H. influenzae
  • Mycoplasma pneumoniae
120
Q

Complications of Strep pharyngitis

A

Suppurative

  • Otitis media
  • Meningitis
  • Sinusitis
  • Peritonsillar abscess “Quinsy”

Non-suppurative

  • Rheumatic fever
  • Glomerulonephritis
121
Q

Three tests for diagnosis of strep pharyngitis

A

Throat swab
ASOT
Blood culture

122
Q

Epiglottitis

A

Acute inflammation of the epiglottis
Haemophilus influenza B (HIB)

Treatment- support the airway and Ceftriaxone and Amoxycillin

123
Q

Diptheria

A

Diptherium bacteria produces toxin that adheres to mucosa to cause cell death and destruction

124
Q

LeMierres disease

A

Jugular vein phlebitis

125
Q

Croup

A

A clinical syndrome, not a diagnosis

Clinical features- 
Fever
Hoarseness of voice
Barking cough
Inflammatory obstruction of subglottic area
126
Q

Chronic sinusitis

A

> 3 weeks of facial pain, postnasal drip and nasal congestion

Gram -ve organisms and fungi

127
Q

Otitis media

A

Follows a viral URTI
Congestion of the nasopharyngeal mucosa, inflamm
obstruction of the Eustacian tube, followed by fluid trapping and effusion formation in middle
ear, ear drum becomes inflamed and bulging

Mostly self-limiting, little evidence for other therapy

Tympanocentesis specimen collection

128
Q

Otitis externa

A

Moisture driven ear infection (swimmer’s ear)

129
Q

Pertussis

A

Bordatella pertussis
100 day cough
Attaches to nasopharynx, produces toxins and damages trachea/bronchi

Catarrhal phase –> Paroxysmal phase –> Convalescent phase

130
Q

Complications of pertussis

A

Subconjuctival haemorrhage
Pneumothorax
Rib fractures
Hernia

131
Q

Pathophysiology of bronchopneumonia

A

Microbes access lower respiratory tract —> Proliferate within alveoli —> get cleared by macrophages

If microbes overwhelm the capacity of the immune system –> inflammatory response initiated –> white cell migration –> leaky membranes –> decreased oxygenation

132
Q

Typical and atypical causes of bacterial pneumonia

A

Typical- Strep pneum, H influenzae, Staph aureus

Atypical- mycoplasma pneum, legionella, chlamydophila psittaci

133
Q

Pneumococcal pneumonia

A

Commonest form of pneumonia

Gram +ve diplococci

134
Q

Typical and atypical clinical features of pneumonia

A

Typical

  • Rigors
  • Chills
  • Productive cough
  • Pleuritic chest pain
  • Fever

Atypical

  • Arthralgia
  • Myalgia
  • Headache
135
Q

PSI

A

> 50 years (yes/no)

Any of these?

  • Neoplasia
  • Liver disease
  • Renal disease
  • Cerebrovascular disease
  • Congestive HF

Any exam abnormalities (yes/no)

  • BP <90 mmHg
  • Resp rate >30
  • Temp >40
  • Pulse >125/min
  • Altered mental state

Yes- II, II, IV or V
No- I

136
Q

CURB-65

A

Confusion
Urea > 7mmol/L
Resp rate >30
BP <90

65- Age >65

137
Q

SMART-COP

A

Age <50 or Age >50

Systolic BP <90
Multilobar CXR involvement
Albumin <35
Resp rate >25                            >30
Tachycardia >125

Confusion
Oxygen stat <93% <90%
PH <7.35

Total of 11 points

138
Q

What antibiotic is added to cover atypical pneumonia organisms?

A

Clarithromycin

139
Q

Three complications of pneumonia

A
  • Respiratory failure
  • Multi-organ failure
  • Disseminated intravascular coagulation
140
Q

Four organisms that can cause health-care associated pneumonia

A

1) ESBL
2) Acintobacter species
3) MRSA
4) Pseudomonas aeruginosa

**HAP particularly affects upper lobes

141
Q

MAC pneumonia

A

Mycobacterium avium and M intracellular complex
Environmental, soil and water

*Chronic pneumonia in patients with pre-existing conditions

142
Q

Transudate vs exudate

A

Transudate- imbalance in oncotic and hydrostatic pressures

Exudate- Inflammation of pleura or decreased lymphatic drainage

143
Q

Light’s criteria to define an exudate

A

1) Ratio of pleural fluid protein to serum protein >0.5
2) Ratio of pleural fluid LDH to serum LDH >0.6
3) Pleural fluid LDH > 2/3 of upper limit of normal

*Transudate if all of the above are absent

144
Q

Empyema

A

Frank pus in pleural space

**Need pre-existing pleural fluid for this to develop

145
Q

Aspergillus infections

A

Allergic bronchopulmonary aspergillosis
Aspergilloma
Invasive aspergillosis

146
Q

Probability of TB transmission

A

Infectiousness of host
Environment
Virulence
Host defences

147
Q

Diagnosis of TB

A

1) Positive Mantoux test

2) Positive quantiferon

148
Q

Treatment of TB

A

Isoniazif

Rifampicin

149
Q

Clinical symptoms of TB

A 
Prolonged cough
Fever
Weight loss
Night sweats
Pneumonia
Haemoptysis
150
Q

Conmonest benign tumour of the nasal cavity

A

Pleiomorphic adenoma

151
Q

Squamous cell carcinoma

A

Non-keratinising has better prognosis than keratinising

152
Q

Sinonasal adenocarcinoma

A

Wood dust exposure

Salivary gland poor prognosis

153
Q

Olfactory neuroblastoma

A

Arise from specialised sensory neuroepithelial cells of olfactory membrane

154
Q

Sinonasal undifferentiated carcinoma

A

Metastasises to brain, kidney etc

155
Q

Lymphoepithelial carcinoma

A

EBV infection

156
Q

Nasopharyngeal angiofibroma

A

Arise from fibrovascular stroma, wall of the roof

157
Q

Nasopharyngeal carcinoma

A

Strongly associated with EBV

158
Q

Papilloma

A

Benign tumour of the larynx

HPV associated

159
Q

Clinical symptoms of lung cancer

A 
Cough
Sputum
Haemoptysis
Weight loss
Chest pain
SOB
160
Q

Horner syndrome

A

Occurs in lung cancer

Sympathetic ganglia invasion

161
Q

4 main types of lung cancer

A

1) Squamous cell carcinoma (Male)- commonest in smokers; central
2) Adenocarcinoma (Female)- commonest in non-smokers; peripheral
3) Small cell carcinoma
4) Large cell carcinoma

162
Q

Carcinoid tumours

A

Neuroendocrine malignant tumours

163
Q

Three histological types of mesothelioma

A

Epitheloid
Sarcamatoid
Biphasic

Cardio-resp (4 decks)

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