Pathology Flashcards
1
Q
What is inflammation?
A
The local physiological response to tissue injury
2
Q
Give the 5 cardinal signs of inflammation
A
- ) Rubor/redness
- ) Calor/heat
- ) Tumor/swelling
- ) Dolor/pain
- ) Function laesa/loss of function
3
Q
What is rubor due to?
A
Dilation of small blood vessels in area
4
Q
What is calor due to?
A
Hyperaemia (increased blood flow) and systemic fever
5
Q
What is tumor due to?
A
Oedema and a mass of inflammatory cells migrating to area
6
Q
What is dolor due to?
A
Stretch and distortion of tissues from oedema/pus, and chemical mediators such as bradykinin, serotonin and prostaglandins inducing pain
7
Q
What is functio laesa due to?
A
Movement consciously and reflexively inhibited by pain/tissue and may be immobilised by swelling
8
Q
Give the 3 main inflammatory cells
A
- ) Neutrophil polymorphs
- ) Lymphocytes
- ) Plasma cells
9
Q
What does acute inflammation involve?
A
- ) Tissue macrophages
- ) Lymphatics
- ) Neutrophil polymorphs
10
Q
Give the 3 steps of acute inflammation
A
1) Changes in vessel calibre and flow
2) Increased vascular permeability due to transient chemical mediators and formation of fluid exudate
3) Formation of cellular exudate then emigration of neutrophil polymorphs
11
Q
Give 2 chemical mediators of inflammation
A
- ) Histamine
- ) Bradykinin
- ) NO
12
Q
What is fluid exudate?
A
The leakage of protein rich fluid
13
Q
Give 3 beneficial effects of fluid exudate
A
- ) Dilution of toxins for removal
- ) Entry of antibodies due to increased vascular permeability
- ) Transport of drugs
- ) Fibrin formation
- ) Stimulation of immune response
14
Q
Give 2 harmful effects of fluid exudate
A
- ) Digestion of normal tissue
- ) Swelling leading to airway obstruction
- ) Inappropriate inflammation
15
Q
Give the 4 outcomes of acute inflammation
A
- ) Resolution to normal
- ) Suppuration (pus formation)
- ) Organisation via replacement by granulation tissue
- ) Progression to chronic
16
Q
What is resolution of acute inflammation?
A
Initiating factor is removed, and the tissue is left undamaged or able to regenerate
17
Q
What is pus a mixture of?
A
Living, dying, dead neutrophils/bacteria with cellular debris
18
Q
What is the stimulus for suppuration?
A
Fairly persistent, usually infective
19
Q
What is pus surrounded by once it accumulates?
A
Pyogenic membrane of capillaries, neutrophils and some fibroblasts
20
Q
What does the pus accumulation eventually become?
A
Granulation tissue and leads to scarring
21
Q
What is organisation in acute inflammation?
A
The repair of specialised tissue by the formation of a fibrous scar
22
Q
How do organisation occur?
A
Production of granulation tissue and removal of dead tissue by phagocytosis
23
Q
What is scar tissue made mainly of?
A
Collagen
24
Q
Give 3 causes of acute inflammation
A
- ) Microbial infections
- ) Hypersensitivity reactions
- ) Physical agents
- ) Chemicals
- ) Tissue necrosis
25
What is chronic inflammation?
A prolonged or persistent inflammation marked by new tissue formation (fibrosis)
26
What are the 4 main cell types in chronic inflammation?
- ) Plasma cells
- ) Macrophages
- ) Lymphocytes
- ) Eosinophil polymorphs
27
Give 3 signs of chronic inflammation
- ) Chronic ulcer
- ) Chronic abscess cavity
- ) Fibrosis
- ) Granulomatous inflammation
28
Give 3 causes of chronic inflammation
- ) Resistance of infective agent to killing
- ) Necrotic tissue/foreign material
- ) Autoimmune diseases
- ) IBD/Crohn's
- ) Transplant rejection
- ) Outcome of acute, usually suppurative
29
What is granulomatous inflammation?
A type of chronic inflammation associated with granulomas
30
What is a granuloma?
Aggregate of epithelioid histiocytes (activated macrophages) surrounded by mature lymphocytes
31
Give 2 granulomatous diseases
- ) TB
- ) Crohn's
- ) Leprosy
32
Give a product of epithelioid histiocytes (and thus granulomas)
ACE
33
What is a clot?
A solid mass of blood constituents
34
What is laminar flow?
Cells generally travel in the centre of arterial vessels
35
What is a thrombus?
A clot formed within an intact vascular system during life
36
What is an embolus?
A thrombus that breaks loose and travels to another vessel in the body
37
Give 2 factors which are needed for a thrombus to form
- ) Change in vessel wall
- ) Change in blood constituents
- ) Change in blood flow
38
Give an example of an antiplatelet
Aspirin
39
What do antiplatelets do?
Inhibit thromboxane production from platelets to stop new platelet activation and aggregation
40
Give an example of an anticoagulant
Warfarin
41
What do anticoagulants do?
Target clotting factors by competing with vitamin K
42
What clotting factors do anticoagulants inhibit? (4)
- ) II
- ) VII
- ) IX
- ) X
43
What does an atherosclerotic plaque consist of?
- ) Lipid
- ) Necrotic core
- ) Connective tissue
- ) Fibrous cap
- ) Inflammatory cells
- ) Possible calcification
44
Which vessels is atherosclerosis most common in?
High pressure arteries
45
Give 3 risk factors for atherosclerosis
- ) Increasing age
- ) Male sex
- ) Smoking
- ) Obesity
- ) High cholesterol
- ) Fatty diet
- ) DM
- ) High BP
- ) FHx
46
Give the 5 steps of atherosclerosis formation
1) Fatty streaks
2) Intermediate lesions
3) Fibrous plaque
4) Plaque rupture
5) Plaque erosion
47
Give 3 complications of atherosclerosis
- ) MI
- ) Angina
- ) Thrombosis
- ) Embolism
- ) Stroke
- ) Limb ischaemia
- ) Organ infarction
- ) Haemorrhage
- ) Aneurysm
48
Give the 3 parts of Virchow's triad
- ) Hypercoagulability
- ) Blood stasis
- ) Endothelial damage
49
What is a thromboembolism?
Formation of a blood clot in a vessel
50
What is an infarction?
When blood flow to a tissue is obstructed, and the tissue dies to a lack of oxygen
51
Give 3 complications of a MI
- ) Cerebral infarction
- ) Arrhythmia
- ) Cardiogenic shock
- ) Cardiac rupture
52
What is ischaemia?
Inadequate blood flow to tissues
53
Define atrophy
Decrease in size of tissue due to decrease in number of constituent cells/decrease in cellular size
54
Define hypertrophy
Increase in size of tissue due to increase in size of constituent cells
55
Define hyperplasia
Increase in size of tissue due to increase in number of constituent cells, or by lack of apoptosis
56
Dedine dysplasia
Imprecise term for morphological changes in cells in the progression to becoming cancer
57
Define metaplasia
The change in differentiation of a cell from one fully differentiated type to another fully differentiated type
58
Define apoptosis
Progreammed cell death occurring in old/damaged cells so that they aren't replicated
59
What regulates apoptosis?
p53
60
Define necrosis
Traumatic cell death
61
Give 2 causes of necrosis
- ) Infarction
- ) Frostbite
- ) Toxins
62
What is intraepithelial neoplasia?
Potentially premalignant dysplasia of cells
63
What is a neoplasm?
The formation of abnormal and uncoordinated tissue growth that persists after withdrawal of the initiating cause
64
Give 4 features of benign neoplasia that differentiate it from malignant (brackets are malignant)
- ) Slow growing (fast)
- ) Infrequent mitoses (frequent)
- ) Good histological resemblance to normal tissue (poor)
- ) Near normal nuclear morphology (enlarged irregular)
- ) No invasion or mets (occur)
- ) Often well bordered (poorly defined)
- ) No necrosis or ulceration (common)
- ) Exophytic/outward growth (endophytic/inward)
65
What are the 2 ways in which we classify tumours?
- ) Behavioural
| - ) Histogenetic
66
Give 2 benign epithelial tumours
- ) Papilloma
| - ) Adenoma
67
What is a papilloma?
Benign tumour of non-glandular and non-secretory epithelium
68
What is an adenoma?
Benign tumour of glandular or secretory epithelium
69
What are malignant epithelial tumours called?
Carcinomas or adenocarcinomas (glandular)
70
Give 2 benign connective tissue tumours
- ) Lipoma
- ) Leiomyoma
- ) Rhabdomyoma
- ) Chondroma
71
What are malignant connective tissue tumours called?
Sarcomas
72
What are lymphoid/haematopoietic malignant tumours called?
Lymphomas or leukaemias
73
What is Kaposi's sarcoma?
Malignant neoplasm derived form vascular endothelium
74
What is Kaposi's sarcoma associated with?
AIDS
75
What does the grade of neoplasms correlate with?
The amount of histological differentiation (and growing speed)
76
What does T1N1M0 mean?
Small tumour, 1 nodal met, no other mets
77
Give the staging/grading system used for colorectal carcinomas
Duke's ABCD
78
Give the 7 steps of the formation of a metastatic tumour
1) Detachment from other cells
2) Invasion of basement membrane
3) Intravasation
4) Evasion of host defences
5) Arrest by binding to endothelial ligands for adhesion to endothelium
6) Extravasation by integrins
7) Proliferation and vascularisation of tumour
79
How does detachment from other cells occur in the formation of a metastatic tumour?
Loss of adhesion molecules
80
What make invasion of the basement membrane and intravasation occur in the formation of a metastatic tumour?
Metalloproteinases
81
Give 3 ways in which malignant tumours cause mortality
- ) Pressure on tissue
- ) Destruction of tissue
- ) Mets
- ) Haemorrhage from ulcerated surfaces
- ) Obstruction of flow
- ) Formation production
- ) Pain
- ) Weight loss
- ) Debility
82
Give 3 ways in which benign tumours cause mortality
- ) Pressure on adjacent tissues
- ) Obstruction of flow
- ) Hormone production
- ) Possible transformation into malignant
83
What is a germline mutation?
Altered gene in gamete that can be passed on
84
Give an example of a germline mutation
BRCA1 mutation
85
What is a somatic mutation?
Genetic mutation that will be present in subsequent cell divisions but will not be in gametes
86
Give an example of a somatic mutation
Philadelphia chromosome
87
Give 3 things carcinogenesis requires
- ) Expression of telomerase to avoid shortening
- ) Loss of tumour suppressor genefunction
- ) Enhanced expression of dominant oncogenes
88
What is Knudson's 2 hit hypothesis?
Cancer is the result of accumulated mutations to a cell's DNA
89
What are the 2 hits in Knudson's hypothesis?
1) Inheritance of defective allele or acquired mutation
| 2) Mutational loss of function of normal allele
90
Define carcinogenesis
The transformation of normal cells into neoplastic cells through permanent genetic alterations or mutations (malignant)
91
Define oncogenesis
The transformation of normal cells into neoplastic cells through permanent genetic alterations or mutations (benign and malignant)
92
Define carcinogen
Agents suspected or known to cause tumours
93
Define carcinogenic
Cancer causing
94
Define oncogenic
Tumour causing
95
Give 2 problems with identifying carcinogens
- ) Long latent interval
- ) Complexity of environment
- ) Ethical constraints
96
How is the location of cancer caused by chemical carcinogens related to that chemical?
Cancer likely localised to where the enzyme that converts the pro-carcinogen to it's active form is
97
Give 3 treatment options for treating cancers
- ) Radiotherapy
- ) Chemotherapy
- ) Surgery
98
Give 2 ways in which conventional chemotherapy works
- ) Bind to mitotic spindles to stop contraction and thus division of cell
- ) Bind to DNA so synthesis is inhibited
- ) Bind to enzymes that are needed for DNA replication
99
What is a problem with conventional chemo?
It also affects normal dividing cells
100
Give 2 ways in which targeted chemotherapy works
- ) Create antibodies to receptors to prevent growth factor
- ) Inhibit receptors inside cells
- ) Antibodies against growth factors
101
Define histogenesis
The specific cell of origin for a tumour
102
Define osteosclerotic
New bone growth
103
Define osteolytic
Holes in bone
104
What do caretaker genes do?
Repair DNA damage
105
What do gatekeeper genes do?
Promote damaged cell death
106
What are oncogenes?
If expressed, they drive the neoplastic behaviour of cells
107
What is the most frequently mutated gene in cancers?
Tumour suppressor gene p53
108
What type of gene is p43?
Gatekeeper gene
109
What does germline mutation of p53 lead to?
Li-Fraumeni syndrome
110
What is Li-Fraumeni syndrome?
Autosomal dominant hereditary disorder that pre-disposes carriers to cancer development
111
What gene gives rise to familiar retinoblastoma when germline mutated?
RB1
112
What type of gene is BRCA1/2?
Caretaker
113
Give the 8 principles of screening
- ) Important condition
- ) Recognisable latent/early stage
- ) Natural course must be understood
- ) Suitable, acceptable test
- ) Case finding should be continuous (repeated tests)
- ) Accepted and available treatment
- ) Agreed policy on who to treat
- ) Cost consideration
114
What must screening be? (5)
Cheap, reliable, acceptable, sensitive, specific
115
What are the 2 main types of autopsy?
Hospital and medico-legal
116
What are the 2 types of pathologists, and what do they each do?
Histopathologist (hospital and coronial), forensic pathologist (coronial)
117
Give 3 questions to answer in an autopsy
- ) Who was the deceased?
- ) When did they die?
- ) Where did they die?
- ) How did they come about their death?
118
What is healing by 1st intention?
Wound heals back together
119
What is healing by 2nd intention?
Wound doesn't heal back together, is filled in by other tissue
120
Define congenital disorders
Present at birth
121
Defined inherited disorders
Caused by inherited genetic abnormality
122
Defined acquired disorders
Caused by non-genetic environmental factors, can be congenital
123
What is dermal elastosis?
Wrinkles in skin due to UV damage
124
Why do cataracts occur?
Cross linking of proteins in lenses due to UV
125
What is sarcopenia?
Loss of muscles mainly due to decreased growth hormone and testosterone
126
Why does deafness occur?
Loss of hair cells in cochlea
