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Phase 2a Medicine > Pathology and Inflammation > Flashcards

Pathology and Inflammation Flashcards

1
Q

How is inflammation defined into categories?

A

Inflammation is defined by which cells are present, e.g. the presence of neutrophil polymorphs

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2
Q

Name 4 characteristics of acute inflammation

A
  1. Sudden onset
  2. Short duration
  3. Usually resolves
  4. Presence of neutrophil polymorphs
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3
Q

Name 4 characteristics of chronic inflammation

A
  1. Slow onset (or sequel to acute inflammation)
  2. Long duration
  3. May never resolve
  4. Presence of macrophages and lymphocytes
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4
Q

What are the first cells to appear at the site of acute inflammation?

A

Neutrophil polymorphs

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5
Q

What is pus comprised of?

A

Dead neutrophils

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6
Q

Describe three characteristics of neutrophil polymorphs

A
  1. Polymorphic nucleus
  2. Contains cytoplasmic granules containing enzymes which kill bacteria
  3. Short-lived (usually die at the site of inflammation)
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7
Q

Describe five characteristics of macrophages

A
  1. Usually a large cell
  2. Contains cytoplasmic granules with enzymes
  3. Phagocytic properties
  4. Non-descript nucleus
  5. May present antigen to lymphocytes
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8
Q

What are the macrophages in the liver called?

A

Kupffer cells

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9
Q

What are the macrophages in bone called?

A

Osteoclasts

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10
Q

Describe the appearance of a mature lymphocyte

A

The nucleus of a mature lymphocyte fills almost the entire cell

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11
Q

Plasma cells are a subset of lymphocytes. Describe 4 characteristics of plasma cells.

A
  1. Smaller nucleus than mature lymphocytes
  2. Contains lots of ER
  3. Produces a single type of antibody
  4. Can live a long time - years, possibly entire lifetime in some cases
  5. Produce chemicals which attract other inflammatory cells
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12
Q

Why do inflammatory cells adhere to damaged endothelium?

A

Endothelial cells normally express substances on their surface that prevent blood clotting; if this coating is no longer present, inflammatory cells may adhere to the endothelium. If part of the endothelium is removed completely, the underlying collagen is exposed, which platelets bind to readily.

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13
Q

Why does acute inflammation cause erythema?

A

Because the capillaries dilate

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14
Q

Why does acute inflammation cause oedema?

A

Proteins can leak out into the tissues, resulting in a loss of oncotic pressure in the capillaries. Water therefore moves into the tissues, resulting in swelling.

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15
Q

Describe the appearance of fibroblasts

A

Spindle cell shape, lots of ER for production of proteins such as fibrin.

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16
Q

What is the role of fibroblasts in chronic inflammation?

A

Fibroblasts form collagen in areas of chronic inflammation for the purposes of repair

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17
Q

Give an example of an acute inflammation condition

A

Acute appendicitis

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18
Q

Give an example of a chronic inflammation condition

A

Tuberculosis

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19
Q

What happens when single macrophages are unable to phagocytose material such as mycobacteria?

A

They fuse to form multinucleated giant cells

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20
Q

What is a granuloma?

A

A lump of macrophages surrounded by lymphocytes in a specific formation - seen in certain infections such as tuberculosis and Crohn’s disease

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21
Q

Why is ice applied to areas of acute inflammation?

A

Lowering the temperature of the affected area decreases capillary dilation, thereby preventing leakage of fluid into the surrounding tissues and preventing oedema.

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22
Q

Why might mosquito bites be treated with antihistamines?

A

Histamine makes blood vessels more permeable; antihistamines reduce inflammation by blocking this action.

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23
Q

How do NSAIDs reduce inflammation?

A

By inhibiting prostaglandin synthetase. This reduces prostaglandin production (prostaglandins are a mediator of inflammation).

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24
Q

How do corticosteroids reduce inflammation?

A

They bind to DNA to up-regulate inhibitors of inflammation and down-regulate chemical mediators.

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25
Q

Why is it a bad idea to give steroids to a patient with a bacterial infection?

A

Steroids can prevent a person’s immune system from reacting to the bacteria.

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26
Q

What is the difference between resolution and repair?

A

In resolution, the tissue is able to regenerate and goes back to normal.
In repair, the body “patches up” the damaged tissue - regeneration is not possible.

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27
Q

Name 6 types of cells that can regenerate

A
  1. Hepatocytes
  2. Pneumocytes
  3. All blood cells
  4. Gut epithelial cells
  5. Skin epithelial cells
  6. Osteocytes
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28
Q

Name 2 types of cells that can’t regenerate

A
  1. Myocardial cells

2. Neurones

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29
Q

Why does liver cirrhosis lead to death?

A

In this case, the liver is continuously being damaged and is unable to regenerate. This can lead to fibrosis of the liver, which can in turn prevent blood from flowing properly.

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30
Q

How does long covid sometimes result in permanent lung damage?

A

A massive inflammatory reaction can result in fibrosis of the lungs as the lungs are repaired but not regenerated.

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31
Q

Why do skin abrasions normally heal quickly?

A

The bottom layer of squamous cells is usually not removed and regeneration is therefore possible.

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32
Q

What is healing by first intention?

A

The edges of the wound are brought together and held in position (with e.g. sutures or staples). Fibrin joins the edges together, fibroblasts produce strong collagen (sutures can be removed at this point) and epithelium grows over the top.

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33
Q

What is healing by secondary intention?

A

In larger wounds, the skin edges cannot be brought together. Fibroblasts and capillaries grow across the wound (granulation tissue), which then allows epithelium to regrow over the top.

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34
Q

What are the disadvantages of healing by secondary intention as opposed to first intention?

A
  1. Takes longer to heal
  2. Larger scar
  3. Scar tends to be paler due to a lack of melanocytes
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35
Q

Describe how injury to endothelial cells can cause a thrombus to form inside a blood vessel.

A

If the endothelial cells lining the blood vessel become damaged, the collagen underneath is exposed and laminar flow is disrupted. Platelets stick to the collagen and positive feedback results in platelet aggregation. Some red blood cells can also become trapped, forming a thrombus.

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36
Q

Describe how fibrin can affect thrombus formation

A

Fibrinogen in the blood becomes activated and polymerises to form fibrin. Fibrin deposition triggers a positive feedback loop, resulting in further fibrin deposition, which increases the size of the thrombus.

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37
Q

What is the definition of thrombosis?

A

A solid mass of blood constituents formed within an intact vascular system during life.

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38
Q

What are the three factors that can precipitate thrombosis?

A
  1. A change in the vessel wall (e.g. endothelial injury)
  2. A change in the blood flow (e.g. laminar to turbulent flow)
  3. A change in the blood constituents (e.g. clotting factors)
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39
Q

Why are patients in hospital vulnerable to thrombosis?

A

Lack of mobility results in a change in blood flow.

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40
Q

Give three reasons why a thrombus may be more likely to form in a vein as opposed to an artery

A
  1. Blood flow is not laminar so blood cells are more likely to make contact with the endothelium.
  2. Blood flow is slower, which means the clot forms more slowly but is less likely to be broken up.
  3. Endothelial cells are less likely to receive sufficient oxygen, meaning that they can no longer produce the surface that prevents adhesion of platelets to the vessel walls.
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41
Q

Why is aspirin sometimes given to prevent blood clots?

A

Aspirin inhibits platelet aggregation, therefore endothelial cell injury is less likely to lead to thrombus formation.

42
Q

How does Covid-19 trigger thrombus formation?

A

An inflammatory reaction to the virus (increased cytokines, clotting factors and fibrinogen levels) can trigger disseminated vascular coagulation, which results in the formation of small thrombi all over the body, including the lungs.

43
Q

What is an embolus?

A

A mass of material in the vascular system, which is able to become lodged within a vessel and block it.

44
Q

Why can recreational drug use cause emboli?

A

Drugs are often cut with other substances, which if injected into the bloodstream, can cause blockages.

45
Q

How are blood clots prevented following surgery?

A

Through the use of compression stockings and low dose heparin

46
Q

Why is deep vein thrombosis so dangerous?

A

A thrombus that forms in the veins of the calf can travel to the inferior vena cava and then block the pulmonary artery, resulting in sudden death.

47
Q

What is ischaemia?

A

A reduction in blood flow

48
Q

What is infarction?

A

A reduction in blood flow which leads to cell death

49
Q

How can ischaemia stop the heart from functioning properly?

A

Cells further away from the capillary receive less oxygen, so myocardial cells in an area of reduced blood flow that are further away from the vessel may stop contracting due to a lack of oxygen.

50
Q

Why are the lungs and liver less likely to die due to a blood clot than most other organs?

A

Instead of having an end artery supply, the lungs and liver are supplied by two vessels, so if one becomes occluded, the organ may still receive some oxygen.

51
Q

How can a carotid endarterectomy be used to treat atherosclerosis?

A

By opening up one of the carotid arteries and scraping out the atherosclerosis

52
Q

What is the usual surgical treatment for atherosclerosis?

A

Stent

53
Q

Give 5 risk factors for atherosclerosis

A
  1. Smoking
  2. Poorly controlled diabetes
  3. Hyperlipidaemia
  4. Social deprivation
  5. Hypertension
54
Q

What 3 things are present in atherosclerotic plaques?

A
  1. Fibrous tissue
  2. Lipids (generally cholesterol)
  3. Lymphocytes
55
Q

Where does atherosclerosis tend to occur?

A

In high pressure systems, such as the aorta and systemic arteries (not low pressure systems such as the pulmonary arteries)

56
Q

What is the current accepted theory as to what causes atherosclerosis?

A

Endothelial damage theory - the endothelial cells are high energy and are easily damaged by e.g. free radicals, nicotine and carbon monoxide from smoking. Damage results in exposure of underlying collagen and therefore platelet aggregation and thrombus formation.

57
Q

What medication can be used to prevent atherosclerosis?

A

Low-dose aspirin, which inhibits platelet aggregation

58
Q

Name 6 potential complications from atherosclerosis

A
  1. Cerebral infarction
  2. Carotid atheroma
  3. Myocardial infarction
  4. Aortic aneurysms
  5. Peripheral vascular disease
  6. Gangrene
59
Q

Why does hypertension increase the risk of atherosclerosis?

A

Shearing forces on endothelial cells can cause damage

60
Q

Where are atherosclerotic plaques most likely to form?

A

At bifurcation of vessels

61
Q

What is apoptosis?

A

Programmed cell death

62
Q

What causes a fully differentiated cell to undergo apoptosis?

A

DNA damage

63
Q

The p53 gene codes for a protein which acts as a “switch” that checks for DNA damage. How can a fault in this protein result in cancer?

A

If the DNA damage is not detected, the cell will divide instead of undergoing apoptosis. The daughter cells will inherit the DNA damage and acquire further DNA damage, which remains unchecked and can therefore lead to cancer.

64
Q

Give an example of apoptosis in fetal development

A

In hand development, fingers are initially webbed, cells in between fingers undergo apoptosis to create web spaces.

65
Q

What is necrosis?

A

Traumatic, unprogrammed cell death - a lot of cells are killed off as a result of e.g. infarction.

66
Q

Give 5 clinical examples of necrosis

A
  1. Toxic spider venom (wipes out skin cells)
  2. Frostbite
  3. Infarction
  4. Avascular necrosis of bone (can be caused by fracture)
  5. Pancreatitis
67
Q

How does HIV affect CD4 T-cells?

A

It wipes them out by causing them to undergo apoptosis

68
Q

Describe what happens to a cell during apoptosis

A

The cell switches on enzymes which destroy the organelles. The cell shrivels up and the remains are cleared by a phagocyte.

69
Q

Why don’t elephants get cancer?

A

They have 20 copies of the p53 gene

70
Q

What is atherosclerosis?

A

The build-up of lipids and other substances in/on the arteries

71
Q

What is the Hayflick limit and how is it determined?

A

The Hayflick limit is the number of times a cell can divide. It is determined by telomere length as telomeres shorten during each cell division.

72
Q

Why does ageing occur in cells that do not need to divide?

A

Due to accumulated damage, e.g. damage to cross-linking of proteins and DNA, damage to mitochondrial DNA

73
Q

Why does caloric restriction have an anti-ageing effect?

A

Fewer cell divisions occur as a result of caloric restriction, so the telomeres do not shorten as quickly.

74
Q

What is osteoporosis?

A

Loss of bone matrix

75
Q

What causes osteoporosis?

A

Increased resorption and decreased bone formation, mostly caused by a lack of oestrogen.

76
Q

What causes cataracts?

A

UVB light affects protein cross-linking in the eye

77
Q

Name 5 conditions associated with ageing.

A 
Dermal elastosis
Cataracts
Senile dementia
Sarcopenia
Deafness
78
Q

Approximately what proportion of people over 80 have dementia?

A

20%

79
Q

What are the three things that cause sarcopenia?

A
  1. Decreased growth hormone
  2. Decreased testosterone (in both sexes)
  3. Increased catabolic cytokines
80
Q

Why is hearing loss associated with ageing?

A

People are born with a limited number of hair cells in the cochlea. As these are damaged, they are not replaced, leading to a loss in hearing.

81
Q

What is hypertrophy?

A

An increase in tissue size caused by increase in size of the constituent cells.

82
Q

What is hyperplasia?

A

An increase in tissue size caused by an increase in the number of constituent cells.

83
Q

What is atrophy?

A

A decrease in tissue size, which can be caused by either a decrease in size of the constituent cells or a decrease in number of constituent cells.

84
Q

What is metaplasia?

A

Change in differentiation of a cell from one fully-differentiated cell type to another.

85
Q

How does metaplasia in the bronchi of a smoker result in a smoker’s cough?

A

When the ciliated columnar epithelium in the bronchi are exposed to cigarette smoke, they die. The stem cells regenerate the epithelium, but start to produce more robust squamous epithelium instead. The squamous epithelium is not ciliated, meaning that mucus and debris cannot be cleared from the lungs as effectively, resulting in a cough.

86
Q

What is dysplasia?

A

An imprecise term for morphological changes seen in the cells in the progression of cancer

87
Q

Is the increase in the size of the uterus in pregnancy due to hyperplasia or hypertrophy?

A

Trick question - it’s both

88
Q

What causes endometrial hyperplasia?

A

Oestrogen/progesterone imbalance - too much oestrogen and too little progesterone

89
Q

Why can hyperplasia occur in some tissues and not others?

A

As hyperplasia is caused by an increased number of cells, it can only occur in tissues capable of regeneration

90
Q

What are the 3 types of spina bifida?

A
  1. Spina bifida occulta
  2. Meningocele - outpouching of the meninges
  3. Myelomeningocele - outpouching of the meninges and cauda equina
91
Q

Name 3 congenital conditions caused by structures not fusing properly

A

Spina bifida
Cleft lip/palate
Ventricular septal defect

92
Q

Give two examples of congenital disorders that are NOT influenced by genetics

A

Club foot

Fetal alcohol syndrome

93
Q

Give 4 examples of conditions that are associated with trisomy 21

A
  1. Hearing problems
  2. Cataracts
  3. Early onset dementia
  4. VSD
94
Q

Polygenic inheritance accounts for most inherited disease. What is it?

A

When many genes act together as a group - these may be spread over different chromosomes - not just a fault with one particular gene/chromosome.

95
Q

What is thought to be the cause of fetal alcohol syndrome?

A

Fetal alcohol syndrome may be due to the effects of alcohol on homeobox genes.

96
Q

What are the effects of congenital growth hormone deficiency?

A

Short stature

97
Q

What causes excess growth hormone production?

A

Usually a benign pituitary adenoma

98
Q

What happens as a result of excess growth hormone before puberty?

A

Gigantism

99
Q

What happens as a result of excess growth hormone after puberty?

A

Acromegaly. The growth plates have fused, so only the extremities (such as the jaw, hands and feet) are able to grow further.

100
Q

How does Huntington’s disease cause early onset dementia?

A

A fault in the Huntingtin gene causes the protein to accumulate in the brain.

Phase 2a Medicine (13 decks)

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