deck_15291969 Flashcards
(98 cards)
1
Q
pathogenesis of atherosclerosis
A
- endothelial injury → increased permeability → leukocyte adhesion & macrophage activation
- lipid deposition in damaged intima
- macrophages engulf lipids → lipid accumulation → fatty streaks (EARLY)
- macrophages secrete cytokines and growth factor → ECM synthesis esp collagen
- collagen synthesis forms dense fibrous cap over plaque → white & hard (ESTABLISHED)
- collagenisation affect tunica media → disrupt elastic intima
2
Q
MI – how MI leads to pulmonary & ankle oedema
A
death of heart muscles → LV pump failure
backward failure → LA dilation → pulmonary hypertension → pulmonary congestion → pulmonary oedema
left side fail → RV failure → systemic & portal congestion → ankle oedema
3
Q
complications of MI
A
Myocardial rupture
Congestive heart failure
Fibrosis
Aneurysm
Thrombus
Pericarditis
Ruptured papillary muscle
Arrhythmia
Contractile dysfunciton
4
Q
modifiable risk factors of MI
A
smoking
hyperlipidemia
hypertension
diabetes
5
Q
non-modifiable risk factors of MI
A
age
gender
family history
genetics
6
Q
infective endocarditis (what? cause? symptoms?)
A
infection of valves
- acute: S aureus
- subacute: Viridans strep
form vegetation → destroy tissues
symptoms: fever, chills, heart murmur
7
Q
rheumatic heart disease
A
abnormal immune response (to group A Strep Pharyngitis)
- inflammation & damage to heart valves → stenosis and regurgitation
8
Q
causes of hyperthyroidism
A
primary: Graves, toxic multi nodular goitre, toxic neoplasm
secondary: pituitary hyperfunction
9
Q
causes of hypothyroidism
A
primary: hashimoto (most common), iatrogenic
secondary: pituitary failure
cretinism (congenital in children) – dietary iodine deficiency
10
Q
symptoms + biochemical signs of hyperthyroidism
A
weight loss
hot - heat intolerance
oligomenorrhoea (infrequent period)
diarrhoea
irritable mental state
increased appetites
high T3, T4
low TSH
11
Q
symptoms + biochemical signs of hypothyroidism
A
weight gain
cold intolerance
menorrhagia (heavy period)
constipation
mental slowness
decreased appetite
low T3, T4
high TSH (primary), low TSH (secondary)
12
Q
pathogenesis of graves
A
- autoantibodies bind & activate TSH receptor
- release of T3, T4
- increase cellularity & hyperplasia of gland
13
Q
gross features of graves
A
- diffuse enlargement
- red meaty cut surface
- smooth & soft gland, intact capsule
histology:
- follicular cells tall, columnar, crowded – pseudopapillae
- inflammatory cells
14
Q
gross features of hashimoto
A
- pale
- enlarged
histology:
- lymphoid follicles
- hurthle cell changes
15
Q
which thyroid carcinoma metastasise via bloodstream
A
follicular carcinoma
16
Q
which thyroid carcinoma metastasise via lymphatics (LN)
A
papillary carcinoma
17
Q
medullary carcinoma associated with??
A
MEN (multiple endocrine neoplasia)
- younger patient
18
Q
diagnosis for single thyroid nodule
A
follicular adenoma
follicular carcinoma
papillary carcinoma
anaplastic carcinoma
medullary carcinoma
19
Q
features of papillary carcinoma
A
- nuclear features: finely dispersed chromatin, nuclear grooves, pseudo inclusions
- papillae with fibrovascular cores
- psammoma bodies
20
Q
MEN 1 associated with which gene mutation
A
MENIN gene mutation
21
Q
MEN 2 associated with which gene mutation
A
RET gene mutation
22
Q
MEN 1 clinical feature
A
PHAIG
prolactinoma - excessive breast milk production
hyperparathyroidism - hypercalcemia
adrenal adenoma – cushing syndrome
insulinoma
gastrinoma - gastric ulceration
23
Q
MEN 2B clinical feature
A
- mucosal neuroma syndrome (growth around nerves of mucous membranes)
- marfanoid syndrome (long limbs, loose joints, curved spine)
24
Q
role of PTH
A
increase Ca levels by
- ↑ bone resorption by osteoblasts
- ↑ renal tubular absorption
- ↑ intestinal absorption (mediated by Vit D, PTH ↑ its synthesis)
25
causes of hyperparathyroidism
primary
- parathyroid adenoma (MOST COMMON) / carcinoma -- 1 gland enlarged
- parathyroid hyperplasia -- >1 glands enlarged
secondary
- renal failure (kidney too much phosphate reabsorption => form insoluble calcium phosphate => ↓ serum Ca2+ => ↑ PTH)
26
effects/consequences of parathyroidism
- renal & urinary calculi
- osteitis fibrous cystica
- hypertension
- pancreatitis
- peptic ulcer
- metastatic calcification
27
causes of hypoparathyroidism
iatrogenic (surgery)
autoimmune
28
causes of adrenal hyperfunction
primary
- adrenal adenoma/carcinoma
- adrenal hyperplasia
secondary
- pituitary adenoma
29
Cushing syndrome clinical features
cushing is due to increase in cortisol
1. adrenal tumour/hyperplasia
2. moon face, buffalo hump, obesity
3. hyperglycaemia
4. hypertension
5. osteoporosis
6. thin wrinkled skin, abdominal striae
7. muscle weakness
8. emotional disturbance
9. skin ulcers (poor wound healing)
10. amenorrhea
30
causes of adrenal hypofunction
primary
- iatrogenic (surgery)
- autoimmune
- haemorrhage (blood vessels in adrenal gland rupture)
- infections: TB, histoplasmosis
- metastatic tumours
secondary
- pituitary disease
31
effects of adrenal hypofunction
- weight loss
- muscle weakness
- low BP
- poor immune response
32
polycythaemia
too much RBCs
- associated with hypoxia -- living at high altitudes
33
causes of anaemia
too few RBC
- decrease production: iron/B12/folate deficiencies
- bleeding
- increased destruction: Hb defects (sickle cell / thalassaemia), enzyme defects (G6PD)
34
symptoms of anaemia
pallor
weakness
dizziness/syncope
palpitation, chest pain, shortness of breath
35
leukocytosis -- following associated with what
- neutrophilia
- eosinophilia
- monocytosis
- lymphocytosis
- neutrophilia: infection, tissue necrosis
- eosinophilia: allergies, parasitic infection
- monocytosis: chronic infections (eg. TB), autoimmune disease
- lymphocytosis: viral infections, TB
36
thrombocytosis -- what? and causes
too many platelets
primary: neoplastic
secondary:
- hemorrhage
- splenectomy
- infections
- inflammatory conditions (autoimmune disease)
37
effects of thrombocytosis
thrombosis
bruising
bleeding
38
thrombocytopenia
too few platelets
caused by
- bone marrow damage (Chemo/radiotherapy),
- autoimmune disease
- hypersplenism (splenomegaly)
- increased consumption (shock, burns, sepsis)
39
effects of thrombocytopenia
- petechiae
- bruising
- bleeding (nose bleed; internal bleeds)
- prolonged bleeding
40
causes haemophilia (inherited/acquired)
inherited coagulation factor deficiency
- haemophilia A: factor 8
- haemophilia B: factor 9
- Von Willebrand's disease: VW factor
acquired disorders:
- liver disease -- ↓ clotting factor
- Vit K deficiency
41
leukemia types
ALL - acute lymphoblastic leukaemia: C1
CLL - chronic lymphoid leukaemia: A1
AML - acute myeloblastic leukaemia: C2, A1
CML - chronic myeloid leukaemia
42
clinical signs for benign vs malignant LN
BENIGN vs MALIGNANT
tender | non-tender
discrete | discrete/matted
small | large
mobile/bilateral | fixed to underlying structures
43
causes of benign lymphoma
- bacterial
- viral (EBV)
- granulomatous (TB, bartonella hanselae → cat-scratch disease)
- autoimmune disease (SLE)
- sarcoidosis
44
causes of malignant lymphoma
Primary: non-hodgkin lymphoma & Hodgkin lymphoma
secondary: metastasise from NPC, SCC, breast carcinoma
45
Identifying Source of Tumour for Tx
Type:
- Carcinomas tend to spread via lymphatics => LN metastasis more likely
- Sarcomas tend to spread via blood => LN metastasis less likely
Location of LN:
- Upper cervical: upper GIT, nasopharynx
- Supraclavicular: lung, breast
- Inguinal: external genital organs, lower limbs
Immunohistochemistry:
- Detect small deposits of tumour
- Distinguish btw primary & secondary tumours
- Specific markers (antibodies) to identify primary site of metastases
46
which lymphoma associated with EBV
hodgkin lymphoma
47
non-hodgkin lymphoma
- associated with which age group
- histo
- 2 peaks: young adults & elderly
- Reed Sternberg cell (OWL EYES)
48
gross features of SCC
masses of necrosis
ulcers with rolled margins
histo: keratinised growing pattern, atypia at base, irregular stromal invasion
49
risk factors of SCC
smoking, alcohol
tobacco chewing, betel nut chewing
HPV esp type 16
50
causes of chronic gastritis
- H. pylori
- autoimmune: pernicious anemia
- toxic: smoking/alcohol
- post surgical: bile reflux
51
H. pylori associated diseases
chronic gastritis
peptic ulcer
gastric carcinoma
gastric MALT lymphoma
52
pathogenesis of H. pylori
- colonisation damages epithelial and endothelial cells
- bacterial platelet-activating factor → thrombotic occlusion of capillaries
--- produce urease: convert endogenous urea into free ammonia
--- produce peptidase: break down glycoproteins in gastric mucus
--- produce phospholipase: damage epithelial cells → may release bioactive leukotrienes
- attract neutrophils, while releasing myeloperoxidase
- other antigens attract inflammatory cells → inflammation makes mucosa more susceptible to acid injury
- damaged mucosa more permeable → leakage of tissue nutrients → sustain bacteria
53
causes of peptic ulcer
H. pylori
smoking, alcohol
drugs: anti inflammatory and analgesics
54
complications of peptic ulcer
- bleeding: ulcer extended deeper into lining damages larger blood vessels
- perforation: leakage of GIT contents into abdominal cavity → inflammation & infection
- obstruction: oedema → obstruct pyloric canal/duodenum
- malignancy: adenocarcinoma
55
liver failure complications / clinical manifestations
- coagulapathy → easy bruising
- hepatic encephalopathy →impaired hepatic metabolism
- Cholestasis → jaundice
- portal hypertension → ascites, splenomegaly
56
cirrhosis
- what?
- causes
- histo
scarring/fibrosis of liver
causes:
- viral hepatitis
- DILI
- alcohol liver disease
- bile duct obstruction
histo:
- diffuse transformation of liver to regenerative parenchymal nodules
- surrounded by fibrous bands
- surrounded by variable degree of vascular shunting
57
pathogenesis of portal hypertension
(how cirrhosis → portal hypertension)
1. increased resistance to portal flow
- vasoconstriction by vascular smooth muscles & myofibroblasts
- scarring/parenchymal nodules → disrupt blood flow
- sinusoidal remodelling & arterial-portal shunt (intrahepatic shunt)
2. increased portal venous flow
- due to hyperdynanamic circulation
- arterial vasodilation of splanchnic circulation (blood flow to abdominal GI organs)
58
consequences of portal hypertension
- ascites: increased pressure in peritoneal capillaries → fluid accumulation in peritoneal cavity → abdominal distension
- portosystemic venous shunts (varices) → bleeding
- congestive splenomegaly: back flow of blood into spleen → enlarge spleen
- hepatic encephalopathy: impaired metabolism → shunting of ammonia from GIT into circulation → ammonia alter mental state → asterixis, coma
59
viral hepatitis caused by
HEP A/B/C/D/E, EBV, CMV
- Acute liver failure w submassive/
massive hepatic necrosis
(usually Hep A/B/D, in pregnancy Hep E)
- May progress to cirrhosis
(usually Hep B/C)
60
Symptoms of Acute Hepatitis
- Jaundice, dark-coloured urine
- Fever, fatigue, poor appetite
- Nausea, vomiting, abdominal pain
61
Fatty Liver Disease Causes
- Diabetes, obesity, starvation
- Hypoxia
- Alcoholism
62
consequences of alcoholic liver disease
- Steatosis: accumulation of fat within liver
- Alcoholic hepatitis: inflammation due to fatty change
- Steatofibrosis
- May lead to cirrhosis (10-15%) => HCC (1-6%)
63
pathogenesis of NAFLD
non-alcoholic fatty liver disease
- insulin resistance → dysfunctional lipid metabolism
- increased production of pro inflammatory cytokines
- fat laden cells sensitive to peroxidase products → oxidative injury → liver cell necrosis
64
risk factors for HCC
- viral infection: HEP B/C
- toxin: aflatoxin from Aspergillus flavus
- metabolic diseases
NAFLD
65
hep b & c transmission via
- unprotected sex with infected
- needle prick injury / sharing needles
b: perinatal (transplacentally)
c: haemodialysis without infection control & organ transplant
66
histo for HCC
- trabecular (sinusoidal), pseudoacinar & compact growth patterns
- polygonal cells with, eosinophilic cytoplasm and distance round nucleus
- lack portal tracts, Kupffer cells and cohesive connective tissue framework
67
atelectasis
collapse of lung - inadequate expansion of lung
68
pneumonia
infective inflammation & consolidation of lung
- neutrophils in airspaces
69
risk factors of TB
- chronic lung disease
- HIV, AIDS, acute renal failure, disease
- alcoholism, malnutrition
70
gross features / histo for TB
- caseous necrosis → cavitation
- surrounding fibrosis
71
tuberculosis
chronic pneumonia
- communicable, granulomatous & caused by Mycobacterium TB
72
pneumonitis
inflammation dominated by interstitial inflammation
73
osteoarthritis
- what
- causes
- gross features/histo
chronic progressive degradation of articular cartilage
caused by wear and tear
- genetic abnormalities: familial mutation of type II collagen COL2A1
gross features:
- destruction of articular cartilage → narrowed joint space
- eburnation: loss of cartilage with smooth polished surface
- subchondral cyst formation
- osteophytes: peripheral growth of bone & cartilage
- reactive thickening of synovium
74
rheumatoid arthritis
- what
- causes
- gross features
systemic, chronic inflammatory autoimmune disease
causes:
- genetic predisposition (HLA-DR4)
- autoantibodies against cyclic citrullinated peptides (CCPs)
Gross features:
- synovial inflammation - swelling
- pannus formation - hypertrophied synovium & vascular granulation tissue
- destruction of adj bone (due to pannus)
- formation of rheumatoid nodules: granuloma w central zone of fibrinoid necrosis
75
pathogenesis of osteomyelitis
- bacterial proliferation in bone → acute inflammation & bone necrosis
- bacterial inflammation spread within bone shaft, haversian system & periosteum
- inflammation within periosteum → sizeable subperiosteal abscess "lifting" periosteum → impair blood supply → cause suppurative injury & further segmental sequestrum
- rupture of periosteum → abscess in surrounding soft tissue → form draining sinus
76
sequelae of osteomyelitis
- acute OM to chronic OM
- proliferative periostitis & involucrum
- pathologic fracture with deformities
- spread of inflammation/infection elsewhere
- bone abscess including Brodie's abscess
- secondary amyloidosis (chronic OM)
77
gout
deposition of urate crystals & increased serum uric acid
78
osteosarcoma
produces malignant osteoid
- histo: cytological atypia
79
Ewing sarcoma
malignant
NO production of malignant osteoid
translocation of t(11,22)
80
chondrosarcoma
production of malignant cartilage
histo: cartilage matrix permeates/invades bone, marrow, soft tissue
81
chondroma
benign cartilage
82
osteochondroma
contain benign cartilage and bone
83
giant cell tumour
benign, epiphyseal-metaphyseal region
- abundant giant cell tumour (osteoclastic type)
84
fibro-osseous tumours
- type n comparison
Fibrous Dysplasia (FD) & Ossifying Fibroma (OF)
both: benign bone tumour; contains fibrous tissue & immature bone; same histo
OF vs FD
- FD has GNAS1 mutation
- radiology: OF more circumscribed
- OF higher potential of recurrence
85
clinical manifestations of increase inter cranial pressure (ICP)
- Papilledema (swelling of optic discs)
- cerebralherniation
- headache, nausea/vomiting
- macroencephaly
- altered mental status
- crushing triad: bradycardia, hypertension, repsiratory depression
86
pathogenesis of subdural haemorrhage
tearing of BRIDGING VEINS in subdural space → extravasation of venous blood
- slow progressive neurological deterioration
87
pathogenesis of subarachnoid haemorrhage
increase bp / trauma / spontaneous → rupture of BERRY ANEURYSM
88
pathogenesis of epidural haemorrhage
temporal skull bone fracture / trauma → laceration of MMA → extravasation of arterial blood
lucid for 2-3 hours → lose consciousness
89
intracerebral/intraparenchymal haemorrhage
hypertension → damage blood vessels → formation of micro-aneurysms
symptoms: headache, nausea, coma, fever, vomiting
if rupture → bleed within parenchyma → brain herniation → death
90
cells of innate and adaptive immune system
innate: macrophage, NK cells
adaptive: cell-mediated (T-cells), humoral (B cells & CD4 T cells)
91
alzheimer disease
- region affected, protein inclusions
- brain volume loss
- affects CEREBRAL CORTEX
- formation of protein inclusions
---- extracellular fibrillar Aβ plaques (beta-amyloid)
---- Intracellular neurofibrillary Tau tangles (Tau protein)
92
parkinson disease
- region affected, protein inclusions
- basal ganglia & brainstem
- degeneration of dopinergic neuron
- eosinophilic inclusions (Lewy bodies)
- proteins: α-Synuclein
93
hypertrophy - physiological causes
- sex organs - testosterone & oestrogen during puberty
- cardiac muscles - sustained high outflow (athletes)
- uterine muscles - oestrogen during puberty
- breast tissue - oestrogen & prolactin for lactation
- skeletal muscles - exercise
94
hypertrophy - pathological
- LV cardiac muscle - increased outflow pressure (systemic hypertension, aortic valve disease)
- RV cardiac muscle - increased outflow pressure (pulmonary hypertension, pulmonary valve disease)
arterial smooth muscle - hypertension
95
hyperplasia - physiological
- breast tissue - during puberty, pregnancy & lactations
- thyroid - increased metabolic demand during puberty & pregnancy
- stromal cells in endmetrium: oestrogen during pregnancy
- RBC precursors in bone marrow - erythropoietin at high altitudes
96
hyperplasia - pathological
- thyroid - graves (autoantibodies effect to TSH receptors
- stromal cells in endometrium - may lead to endometrial carcinoma
- skin - persistent trauma (eg corns on feet)
- parathyroid gland: hypocalcemia
- prostate gland
97
metaplasia
ciliated pseudostratified columnar → squamous
- respiratory tract of smokers
- chronic bronchitis
stratified squamous → simple columnar
- barrett's oesophagus, gastro-oesophageal reflux
simple columnar → intestinal
- chronic gastritis
- H. pylori in stomach
98
causes of acute inflammation
- infection
- physical agent: mechanical, heat/cold, ionising radiation
- chemical agent
- ischaemia
- immunological reaction
