Pathology

Question 1

List factors and substances that can damage cells of the CNS

Answer 1

Lack of oxygen (hypoxia)
Trauma
Toxins
Metabolic disturbance
Malnutrition
Infection
Ageing
Genetic mutations

Question 2

Which component of the CNS is most vulnerable to hypoxia?

Answer 2

Neurones

Question 3

Which cells are the “macrophage cells” of the CNS?

Answer 3

Microglia

Question 4

Axonal injury involves a reaction in which part of the neurone?

Answer 4

Reaction within cell body

Question 5

In which direction does the axon damage in response to injury?

Answer 5

Anterograde degeneration of axon distal to site of injury

Question 6

Which process do astrocytes initiate in response to injury?

Answer 6

Reactive proliferation - gliosis - where cells undergo hyperplasia and hypertrophy

Question 7

Which process if the most important histopathological indicator of CNS injury, regardless of cause?

Answer 7

Gliosis

Question 8

Which cells line the ventricular system?

Answer 8

Ependymal cells

Question 9

The brain receives how much of the cardiac output?

Answer 9

15%

Question 10

What is the response of vasculature to the brain in hypotension and hypertension?

Answer 10

Constricts in hypertension

Dilates in hypotension

Question 11

What are the two main sets of arteries supplying blood to the brain?

Answer 11

Branches of internal carotid + vertebral arteries (form anterior + posterior circulations)

Question 12

Lack of blood supply in the anterior cerebral artery is associated with which dysfunctions?

Answer 12

Frontal lobe dysfunction
Contralateral sensory loss in foot + leg
Paresis of arm + foot

Question 13

Lack of blood supply in the middle cerebral artery is associated with which dysfunctions?

Answer 13

Hemiparesis
Hemisensory loss
Aphasia/dysphasia
Apraxia

Question 14

Lack of blood supply in the posterior cerebral artery (vertebrobasilar) is associated with which cerebellar dysfunctions?

Answer 14

Ataxia
Nystagmus
Intention tremor
Pendular reflexes

Question 15

Lack of blood supply in the posterior cerebral artery (vertebrobasilar) is associated with which occipital lobe dysfunctions?

Answer 15

Homonymous hemianopia with macular sparing

Question 16

When does gliosis occur following a cerebral infarct?

Answer 16

1-2 weeks

Question 17

What is the most common cause of a subarachnoid haemorrhage?

Answer 17

Spontaneous rupture of a saccular aneurysm (Berry aneurysm)

Question 18

List diseases that have increased incidence of Berry aneurysms

Answer 18

Polycystic kidney disease
Fibromuscular dysplasia
Coarctation of aorta

Question 19

Most berry aneurysms occur where?

Answer 19

90% = arterial bifurcations near internal carotid cartery
10% = vertebrobasilar circulation

Question 20

At which diameter do berry aneurysms have greatest risk of rupture?

Answer 20

6-10mm

If over 25mm, risk of rupture decreases

Question 21

Lacunar infarcts can be present in hypertensives. What are they?

Answer 21

Small cavities up to 10mm in diameter found in basal ganglia, thalami in pons

Question 22

What is demyelination?

Answer 22

Destruction of myelin sheath surrounding an axon, either due to breakdown or abnormal production

Question 23

What disease comes under primary demyelination?

Answer 23

Multiple sclerosis

Question 24

What is the female:male affected ratio for MS?

Answer 24

2:1

Question 25

The external appearance of the brain and spinal cord in MS is usually normal. True/False?

Answer 25

True

Question 26

MS is a grey matter disease. True/False?

Answer 26

False | MS is a white matter disease

Question 27

Describe the morphology of MS

Answer 27

Well-demarcated plaques in white matter in a non-anatomical distribution

Question 28

Describe the colour of MS plaques

Answer 28

Acute lesions: soft pink | Chronic lesions: firm pearl-grey

Question 29

What structures do MS plaques commonly affect?

Answer 29

``` Optic nerve Periventricular white matter Corpus callosum Brainstem Spinal cord ```

Question 30

Where do chronic inactive MS plaques typically occupy?

Answer 30

Situated around lateral ventricles

Question 31

Dementia is always pathological. True/False?

Answer 31

True | Neurodegenerative disorder, not just part of ageing!

Question 32

List diseases classified as primary dementias

Answer 32

Alzheimer's disease Huntington's disease Pick's disease Lewy body dementia

Question 33

What is the female:male ratio for Alzheimer's disease?

Answer 33

2:1

Question 34

List the genes the can be involved in Alzheimer's disease

Answer 34

Amyloid precursor protein (c21) Presenilin 1 (c14) Presenilin 2 (c1) ApoE (allele e4)

Question 35

Describe the morphology of Alzheimer's disease on the brain

Answer 35

Cortical atrophy Widened sulci Narrowed gyri Dilated ventricles

Question 36

Which lobes are particularly affected in Alzheimer's disease?

Answer 36

Frontal Temporal Parietal

Question 37

Which protein forms plaques in Alzheimer's disease?

Answer 37

A-beta amyloid plaques

Question 38

What colour does amyloid protein stain?

Answer 38

Congo red

Question 39

Which protein in the brain can become tangled and defective in Alzheimer's disease?

Answer 39

Tau protein

Question 40

Which area of the brain is affected in Lewy body dementia (Parkinson's)?

Answer 40

Substantia nigra

Question 41

Which protein, when stained, can help detect Lewy bodies?

Answer 41

Ubiquitin

Question 42

What happens to the caudate nucleus in Huntington's disease?

Answer 42

Caudate atrophy with loss of neurons

Question 43

What are the histopathological landmarks of Pick's disease dementia?

Answer 43

``` Swollen neurons (Pick's cells) Filamentous inclusions (Pick's bodies) ```

Question 44

Which lobes does Pick's disease usually affect?

Answer 44

Frontal | Temporal

Question 45

What is the most common type of secondary dementia?

Answer 45

Vascular (infarct) dementia