Pathology and Medicine Flashcards
What does acute mean?
What does chronic mean?
A rapid onset disease, (but not always followed by rapid resolution)
May follow an acute initial episode and have a prolonged course lasting months or years
What do these prefixes mean?
- ana
- dys
- hyper
- hypo
- meta
- neo
Absence
Disordered
Excess over normal
Deficiency below normal
Change from one state to another
New
What do these suffixes mean?
- itis
- oma
- osis
- oid
- plasia
- opathy
Inflammatory process
Tumour
Abnormal increase
Bearing resemblance to
Disorder of growth
Abnormal state lacking specific characteristics
What are disease classifications based on?
Causes (aetiology) and underlying mechanisms (pathogenesis)
Classification of a disease is commonly based on?
A) The on-set of a disease
B) The reversibility of a disease
C) The name of the doctor who discovered it
D) The mechanism of a disease
E) None of the above
D)
What is a congenital disease?
What is the other type of disease classification?
Initiated before or during birth, may not manifest until adult life. Can be genetic or non-genetic
Acquired
What is the pathogenesis of a disease?
The mechanism through which the aetiology (cause) operates to produce the pathological and clinical manifestations
What is a symptom?
What is a sign?
What the patient feels/ complains about
What the doctor is looking for
What is a syndrome?
An aggregate of signs and symptoms or a combination of lesions without which the disease cannot be recognised or diagnosed
What is morbidity?
The disease state of an individual, or the incidence of illness in a population - the proportion of patients with a particular disease during a given year per given unit of population
What is mortality?
The probability death will be the end result of that disease
What is prevalence?
The total number of cases of a given disease in a specified population at a designated time (morbidity and incidence refer to new cases)
What is a prospective study?
What is a retrospective study?
What are cross-sectional studies?
Subjects are followed over time
Looking back over a period of time
Prevalence between different populations at a particular time
What happens if cytosolic calcium levels increase?
It can cause irreversible damage and cells death
What are the four types of necrosis? Describe them.
Coagulative necrosis - most common form, occurs in all tissues except brain
Liquefactive/colliquative necrosis - affects cells in the CNS, complete digestion of dead cells results in tansformation of tissue into a liquid viscous mass
Caseous necrosis - found in tuberculosis infection, tissue architecture is completely obliterated
Fat necrosis - occurs during pancreatitis, result of rereleased active pancreatic lipases
What are some of the characteristics of apoptotic cells? (There are 6)
Degradation of the cytoskeletal framework
Fragmentation of DNA
Loss of mitochondrial function
Nucleus shrinks (pyknosis) and fragmentation (karyorrhexis)
Cell shrinks but retains intact plasma membrane (which induces phagocytosis)
Apoptotic bodies
Name three components/ processes involved in haemostasis.
Vascular wall
Platelets
The coagulation cascade
Name and briefly describe three predisposing factors of thrombosis.
Endothelial injury - exposure of underneath ECM, adhesion of platelets and release of tissue factor
Stasis or turbulence of blood flow - turbulence occurs in arteries and stasis occurs in veins
Blood hypercoagulability - in some individuals clotting factors are hyperactive
Name seven risk factors for thrombosis.
Prolonged bed rest or immobilisation - causes stasis
Myocardial infarction - activates clotting factors and releases TF
Atrial fibrillation - ventrical can’t pump enough blood causing stasis
Prosthetic cardiac valves - valves different shape so create turbulence
Tissue injury, surgery, fracture, burn - releases tissue factor
Cancer - tumours release TF and cytokines that promote coagulation
Increased age - reduced activity causes stasis
What are the common sites where thrombosis forms?
Coronary cerebral and femoral arteries
Venous thrombosis can cause pulmonary infarction true or false?
True
In reference to thrombosis what is an embolism?
Where part of the thrombus dislodges and travels to other parts in the vasculature
What are the usually consequences of arterial embolisms?
Infarction or gangrene
On examination of a heart after autopsy, a myocardial infarct can usually be recognised 2 hours after coronary artery occulsion, true or false?
False
How many litres of blood does the healthy 70kg adult male’s body contain?
5 litres
What are the four clinical signs of inflammation?
What is the 5th sign added by laesa?
Redness, swelling, heat and pain
Loss of function
What is a oedema?
An excess of watery fluid collecting in cavities or tissues of the body
What are the main phagocytic cells involved in acute inflammation?
Neutrophils
What is hyperplasia?
An increase in the number of cells in an organ or tissue (resulting in increased volume of the organ or tissue)
What is hypertrophy?
An increase in the size of cells due to synthesis of more structural components (can result in an increase in size of the organ)
What is atrophy?
The shrinkage (reduced size) of an organ or tissue from a decrease in cell size or number
What is anaplasia?
Lack of differentiation, a hallmark of malignant transformation
What is neoplasia?
The process of new growth
The two types of benign epithelial tumours are papillomas and adenoids, where are they found?
Papillomas - in skin
Adenomas - in glands
What are malignant epithelial tumours called?
What are malignant connective tissue tumours called?
Carcinomas
Sarcomas
What is dysplasia?
Disordered growth (loss in uniformity of individual cells)
What are the names of the four valves in the heart?
Pulmonary valve
Aortic valve
Tricuspid valve
Mitral valve
What side of the heart does systemic hypertension affect?
What side of the heart does pulmonary hypertension affect?
Causes left heart hypertrophy
Causes right heart hypertrophy
What is cardiomyopathy?
When should it be diagnosed?
A heart muscle disease of uncertain cause.
Only when all other causes of cardiac failure e.g. hypertension, ischemic heart disease etc have been excluded
Which of the following is a compensatory mechanism for cardiac dysfunction?
A) cardiac hypertrophy
B) release of noradrenaline
C) activation of the renin-angiotensin-aldosterone system
D) release of atrial natriuretic peptide
E) all of the above
Answer E
What are the diastolic and systolic pressures that indicate hypertension?
A diastolic pressure greater than 89mm Hg
A systolic pressure greater than 139mm Hg
What is the equation for blood pressure?
BP = Cardiac output X peripheral resistance
What is an aortic dissection?
When blood goes into the media to form a blood-filled channel within the aortic wall
Aortic desiccation, true or false?
A) is a complication of atherosclerosis
B) often commenses distal to the aortic arch
C) is associated with systemic hypertension
D) can occur in patients with inherited connective tissue disorders
E) is usually fatal
A) true B) false C) true D) true E) true
What is atherosclerosis characterised by?
Intimal lesions (atheromatous or fibrofatty plaques) which protrude into and obstruct vascular lumens
What on an ECG indicates a myocardial infarction?
What indicates a past myocardial infarction?
ST-elevation
A large q wave
What percentage of blood is made of plasma?
What percentage is composed of cells?
55%
40-45%
Where does hematopoesis occur in the first 6wks - 6months of life?
Where does it occur after 6 months?
Liver and spleen
Bone marrow
What is the precursor cell of erthrocytes called?
Reticulocyte
What are the three essential dietary constituents required for haematopoesis?
Iron
Vitamin B12
Folic acid
What is the most common cause of anemia?
Iron deficiency
What is megaloblastic anaemia characterised by?
What causes it?
Large immature red blood cells (megaloblasts)
Vitamin B12 and folate deficiencies or metabolism problems. Other defects of DNA synthesis
Which of the following is a cause of anaemia? A) suppression of red cell proliferation B) maturation defect in red cells C) chronic haemorrhage D) haemolysis E) all of the above
E
What effects do cytokines have on the liver?
How does this impact red cell production?
In what type of disease are cytokines released?
Act on the liver to increase hepcidin synthesis
Reduces iron release, inhibits erythropoietin synthesis, causes an overall reduction in RBC synthesis
Chronic inflammatory/neoplastic diseases
What are the clinical features of aplastic anaemia?
Deficiency in red cells, white cells and platelets, physical findings include bruising, bleeding gums and epistaxis, mouth infections are common
What is the cause of thalassemias?
What is the pathogenesis of thalassemias?
How are thalassemias diagnosed?
Abnormalities of glob in chain (alpha or beta) synthesis
Imbalanced glob in chain production leads to ineffective erythropoiesis and haemolysis
Hemoglobin electrophoresis can diagnose most specifically, can also use blood count and films
In what blood disorder are bite and blister cells found?
Glucose-6-phosphate-dehydrogenase-deficiency
Which of the following is a feature of anaemia of chronic diseases? A) an uncommon anaemia B) stimulated RBC proliferation C) impaired Fe utilisation D) increased haemolysis E) none of the above
C
Clinical presentation of aplastic anaemia includes: A) anaemia B) neutropenia C) thrombocytopenia D) bone marrow hypocellularity E) all of the above
E
What do these definitions of changes in leucocyte counts mean?
- leucocytosis
- leucopenia
- leukaemia
Increase in leukocyte cell numbers
Decrease in leukocyte cell numbers
Neoplasia of leucopoietic tissue with a massive increase in total numbers
Give at least 5 causes of neutrophilia.
Bacterial infection
Inflammation/tissue necrosis
Metabolic disorders
Malignant neoplasia
Drugs (steroids)
Give at least 4 causes of neutropenia.
Viral infection
Severe bacterial infection
Drug induced e.g. Anti inflammatory agents
Autoimmune e.g. Rheumatoid arthritis
As part of pancytopenia
List 4 causes of lymphocytosis.
Acute viral infections e.g. glandular fever
Chronic infections e.g. Tuberculosis
Leukaemia
Non-Hodgkin’s lymphoma
Of the two types of acute leukaemia which one mostly affects children and which one’s incidence increases with age?
Lymphoblastic - mostly in children
Myeloblastic - all age groups, incidence increases with age
What are the two types of chronic leukaemia and what age groups do they affect?
Myeloid/granulocytic - all age groups
Lymphocytic - >50 years age groups
Lymphocytosis occurs in which of the following conditions? A) tissue necrosis B) acute viral infection C) parasitic infestation D) irradiation E) haemorrhage
B
One feature of acute leukaemia is:
A) it only affects children
B) blast cells rarely appear in blood films
C) there is no spleen enlargement
D) Reed-Sternberg cells are present in the lymph nodes
E) blast cells are accumulated in the bone marrow
E
What do these tests of haemostat ice function test for?
- bleeding time
- activated partial thromboplastin time (APTT)
- prothrombin time (PT)
Platelet integrity
Test the intrinsic pathway and several factors (12, 11, 9, 8, 10, 5, 2, 1)
Test for the extrinsic pathway and several factors (7, 10, 5, 2, 1)
Haemolysis results in what type of bilirubin?
Bile duct blockage results in an increase of what type of bilirubin?
What type of bilirubin is released in liver damage?
Unconjugated
Conjugated
Conjugated and unconjugated
What sort of test would you use to investigate hepatitis?
Serum transferase (which has increased levels in hepatitis)
Give at least 4 causes of acute hepatitis.
What is the best test for acute hepatitis?
Viruses (hepatitis viruses)
Non-viral infection
Alcohol
Drugs: anti-TB (isoniazid)
Others: pregnancy etc…
Serum ATL
What is the mechanism of liver damage for hepatitis A?
Cytopathic (virus proliferates in liver cells damaging them) and immunity mediated (by T-cells)
What is the mechanism of liver damage by hepatitis B?
Immunity mediated (by T-cells)
Which type of hepatitis puts you at risk of developing cirrhosis and hepatocellular carcinoma?
Hepatitis C
The spread of hepatitis A is mainly by: A) blood B) vertical transmission C) personal contact D) faecal-oral route E) all of the above
D
Give at least 4 causes of cirrhosis.
Viral (hep B, hep C and hep D)
Alcohol
Autoimmune hepatitis
Wilson’s disease
Other (e.g. drugs, non-alcoholic fatty liver disease)
What type of body is a specific feature for alcohol induced liver damage?
Mallory body
Which of the following statements is not true about cirrhosis?
A) cirrhosis is a histological diagnosis
B) it is the end result of a variety of chronic liver diseases
C) it is a localised and irreversible process
D) there is fibrosis and distortion of normal structure
E) portal vein hypertension is a complication
C (diffuse not localised)
Which of the following statements is correct regarding alcoholic liver disease?
A) it is the most common cause of chronic liver disease in the west
B) it is more common in men but also occurs in women
C) alcohol acts as a hepatotoxin
D) alcoholic fatty liver and alcoholic cirrhosis are major pathological lesions
E) all of the above
E
What are the most frequent diseases in the respiratory tract?
Upper respiratory tract infections
What is the common cause of community acquired pneumonia?
Streptococcus pmeumoniae
What age is most affected by bronchopneumonia?
What age is most affected by lobar pneumonia?
Old age, infancy and patients with debilitating diseases
Typically healthy adults between 20-50yrs
Asthma has the following clinical features except:
A) the patients can be atopic
B) the airways must be hyper-responsive to stimuli
C) occupational exposure to chemicals may play a role
D) the patients may respond to allergens
E) smoking is a aetiological factor
E
Which of the following is true about emphysema:
A) cigarette smoking and atmospheric pollutants are aetiological factors
B) dilation and distruction of the air sacs distal to the terminal bronchioles
C) there is airway obstruction and airflow limitation
D) an alpha-1 antitrypsin deficiency is responsible for some patients
E) all of the above
E
What are the three major components of acute inflammation?
Vascular dilation - to increase blood flow
Structure changes in the microvasculature to allow plasma proteins and leukocytes to leave the circulation
Emigration of the leukocytes from the microvasculature, their accumulation in the injury site and their activation to eliminate the offending agent
What is the dominant cell type activated in acute inflammation?
What is the dominant cell type activated in chronic inflammation?
Neutrophils
Macrophages
In what type of disease is granuloma formed?
What causes granuloma?
Chronic inflammation
Resistance to phagocytosis (macrophage engulfs pathogen but can’t destroy it)
Out of the 5 varieties of leucocytes which three are granulocytes?
Neutrophils
Eosinophils
Basophils
Benign prostatic hyperplasia is
A) a neoplastic enlargement
B) common between 40-60 years old
C) associated with smooth muscle hypertrophy
D) a fibromuscular and glandular hyperplasia
E) mainly a glandular hyperplasia
D
What are the main symptoms of BPH?
Hesitancy in initiation of micturition
Poor stream
Dribbling postmicturition
Frequency and nocturia
Can bladder hypertrophy be associated with BPH?
Yes
Transitional cell carcinomas of the bladder are common in people in their 40s?
False, rare in the under 50s
Out of these which is a risk factor for transitional cell carcinoma of the bladder?
A) smoking
B) exposure to acryilamides
C) drugs (analgesics and immunosuppressive drugs)
D) radiation
E) all of the above
E
What type of cirrhosis is found in alcoholic cirrhosis?
Micronodular cirrhosis
In which type of pneumonia do you find:
A) focal inflammation along airways
B) diffuse inflammation affecting the entire lobe
A) Bronchopneumonia
B) lobar pneumonia
What is the most common cause of COPD?
What are some of the other causes?
Smoking
Atmospheric pollutants and alpha-1-trypsin deficiency
What are the three mediators that induce vessel dilation in acute inflammation?
Histamine, bradykinin and NO
What is extravasation?
The movement of leukocytes from the vessel lumen to interstitial tissue in acute inflammation
Which vascular mediator (involved in the inflammation reaction) is responsible for pain?
Bradykinin
Chronic inflammation is characterised by the 5 signs of acute inflammation?
False
What is the common cause of adenocarcinona in the oesophagus?
Barrett’s oesophageal
Give 5 factors associated with gastritis in the stomach (inflammation of the gastric mucosa).
NSAIDs
Alcohol and tobacco
Bacterial and viral infection
Severe stress
Chemotherapy
The chronic infection with which microorganism is linked with gastritis?
H. Pylori
In people with peptic ulcers what is the most common complication that leads to death?
Name another complication that can lead to death.
Perforation, release of acid and gut contents into peritoneum (60% of deaths)
Bleeding (25%) of deaths
What are the two types of adenocaecinoma found in gastric cancers? Describe them
Intestinal - develops from precursor lesions, mean age 55yrs, moms common
Diffuse, no precursor lesions, mean age 48yrs
GI cancers have a genetic component?
True
People with dermititis herptiformis cannot get Coeliac disease,true or false?
False they have a 100% chance of getting coeliac disease
What is the name of the protein in gluten that coeliacs are intolerant to?
Gliadin
What is the only 100% accurate method of diagnosis of coeliac disease?
SI biopsy
Chrons disease only affects the small intestine true or false?
False, it can affect any part of the bowel (mouth to anus) but mostly affects the small and large intestines
Which disease of the bowel is characterised by skip lesions? Which disease is characterised by continuous inflammation?
Chrons disease
Ulcerative colitis
What are the two types of epithelial lesions found in tumours of the GI tract?
Adenoma (benign) and adenocarcinoma (malignant)
What are the characteristics of nuclear atypia?
DNA damage, micro satellite instability, defect in DNA repair throughout the entire GI tract
What type of polyp is linked to risk of cancer?
Villous polyps, risk of cancer is proportional to proportion of polyp which is villous
A mutation in what gene is responsible for familial adenomatous polyposis (FAP)?
Adenomatous polyposis coli (APC) gene
Which node is the pacemaker of the heart?
SA node
What is the most important event in the formation of atherosclerosis?
Endothelial injury
What are the clinical manifestations of ischemic heart disease?
Angina
Myocardial infarction
Sudden cardiac death
Heart failure
What is
A) anisocytosis
B) poikilocytosis
C) anisochromasia
Variation in size
Variation in shape
Variation in Hb (change of colour)
What is the pathogenesis of anemia of chronic diseases?
Cytokines driven inhibition of RBC production
In what condition are bite and blister cells found?
Glucose-6-phosphate-dehydrogenase deficiency
What type of leukaemia is due to a chromosomal abnormality between chromosomes 22 and 9?
Chronic leukaemia
What clotting factors require vitamin K for synthesis?
2, 7, 9 and 10
What is a common cause of glomerulonephritis?
Golmerulonephritis can be chronic or acute true or false?
The immune system attacking healthy body tissue
True
What happens in nephrotic syndrome?
Damage to the glomeruli in the kidney causes large molecular weight proteins such as albumin to be excreted in the urine
What are
A) pre-renal
B) intrinsic renal
C) post renal
Causes of acute renal failure?
A) shock, hypovolemia
B) acute tubular necrosis
C) obstruction
What are some of the major causes of chronic renal failure?
Diabetes
Hypertension
Glomerulonephritis
Pyelonephritis
Cystic renal disease
Nephrotoxins
Below what glomerular filtration rate does chronic renal failure stop being asymptomatic?
Above what serum urea level are symptoms of CRF common?
GFR 40mmol/L
Painless heamaturia is a symptom of bladder cancer, true or false?
True
Describe these types of urinary incontinence A) urge incontinence B) stress incontinence C) overflow incontinence D) functional incontinence
A) due to detrusor (smooth muscle of bladder) overactivity secondary to infection or central nervous factors
B) occurs when intra-abdominal pressure is increased (e.g. cough, sneeze), common in women after childbirth
C) leakage of urine from full distended bladder, after spinal injury or prostatic obstruction
D) inability to reach a toilet
Painless haematuria is a symptom of cystitis, true or false?
False
