Pathology

Question 1

Pathogenesis of Atheroma stages(4)

Answer 1

Primary Endothelial Injury
Accumulation of lipids and macrophages
Migration of smooth muscle cells
Increase in size

Question 2

Atheromatous plaque types and indication (4)

Answer 2

Fatty streak
Fibrofatty plaque
Complicated plague with overlying thrombus
Progression is associated with further loss of luminal patency and arterial wall weakness

Question 3

Atheromatous narrowing of an artery is likely to produce critical disease if (3)

Answer 3

It is the only artery supplying an organ - No collateral circulation
Artery diameter is small
Overall blood flow decreases

Question 4

Atheroma complications (5)

Answer 4

Stenosis
Thrombosis
Aneurysm
Dissection
Embolism

Question 5

Arterial stenosis (3)

Answer 5

The narrowing of arterial lumen
Decreases elasticity and flow in systole
Causes tissue ischaemia

Question 6

Clinical effects of cardiac ischaemia (5)

Answer 6

Reduced exercise tolerance => Stable angina => Unstable angina => MI => Cardiac failure

Question 7

Cardiac fibrosis indication and effects (2)

Answer 7

Loss of cardiac myocytes is replaced by collagen and fibrocytes
Causes contractility loss, decreased elasticity and filling

Question 8

Main arteries affected by arterial stenosis and consequence (4)

Answer 8

Coronary
Carotid - TIA, stroke
Renal - Hypertension, renal failure
Peripheral - Claudication, leg ischaemia

Question 9

Aneurysm definition (2)

Answer 9

Abnormal persistent dilation of arteries due to elastic degeneration in tunica media
Most common in abdominal aorta

Question 10

Aneurysm complications (5)

Answer 10

Rupture (>6 cm)
Thrombosis
Embolism
Pressure erosion to adjacent structures
Infection

Question 11

Arterial dissection (3)

Answer 11

Splitting within media by flowing blood where false lumen forms filled with blood within the media
Common in middle age with/without atheroma
Causes sudden collapse with high mortality

Question 12

Associations with aortic dissection (6)

Answer 12

Atheroma
Hypertension
Trauma
Coarctation
Marfan's syndrome
Pregnancy

Question 13

Embolism (2)

Answer 13

Caused by superadded thrombus and plaque breaking off

Causes cerebral, renal and lower limb infarct

Question 14

Dilated Cardiomyopathy (4)

Answer 14

Big, flabby and floppy
Histology features not specific
Caused by genes mutations encoding heart muscle proteins, toxins, alcohol, infection, pregnancy
Clinical features - SOB, low ejection fraction, poor exercise tolerance

Question 15

Hypertrophic Cardiomyopathy (5)

Answer 15

Big solid heart
Diastolic dysfunction - Heart cant relax
Outflow tract obstruction occurs
Causes are genetic - Beta myosin heavy chain, myosin binding protein C
Features are bulging interventricular septum, LV luminal reduction

Question 16

Restrictive Cardiomyopathy (3)

Answer 16

Cause is lack of compliance - Stiff heart (Poor diastolic function)
Biatrial dilatation from back pressure
Requires biopsy as looks normal - Identifies iron, amyloid, sarcoid, tumours and fibrosis

Question 17

Amyloid (5)

Answer 17

Abnormal deposition of abnormal protein
Tendency to form beta pleated sheets - Body cant get rid of it
Caused by chronic inflammation responses
Looks like waxy pink material with apple green birefringence or Congo red
Resembles restrictive cardiomyopathy

Question 18

Arrhythmogenic Right Ventricular Dysplasia (3)

Answer 18

Rarest cardiomyopathy type
Genetic disease causing syncope, arrhythmias and sudden death
RV largely replaced by fat - Big and floppy

Question 19

Infective Myocarditis characteristics (2)

Answer 19

Thickened ‘beefy’ myocardium

Lymphocytic infiltration from immune response

Question 20

Non-infective Myocarditis features (3)

Answer 20

Mitral stenosis with thickening and fusion of valve leaflets
Short thick chordae tendinae
Myocardium patchily inflammed

Question 21

Purulent pericarditis features (4)

Answer 21

Heart encaged in caseous necrosis - TB
Wavy peeling butter effect - Uraemic
Damaged heart muscle and immune response - Post MI
Dressler’s Syndrome

Question 22

Infectious endocarditis feature

Answer 22

Rheumatic fever - Aschoff bodies (Vegetations)

Question 23

Non infectious endocarditis (2)

Answer 23

Causes are rheumatic fever, SLE, non-bacterial thrombotic endocarditis
Small, multiple vegetation causing embolic and hypercoaguable states

Question 24

Heart tumours (2)

Answer 24

Atrial myxoma is most common

Primary tumours very rare - Myocytes end differentiated

Question 25

Atrial Myxoma (3)

Answer 25

90% in atria and usually left
Causes tumour emboli, endocarditis
Associated with systemic fever and malaise - Due to IL-6 secretion

Question 26

Lupus in heart diseases (3)

Answer 26

Sacks endocarditis
Forms small sterile emboli on under-surface of valves or chords
Often small asymptomatic deposits or significant valvulitis occurs