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Pathology Flashcards

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1
Q

Diaphragm innervation at this cervical vertebrae

A

C3

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2
Q

Two types of heart block

A

Type 1- PR interval same

Type 2- PR interval increasing

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3
Q

What antibody is measured in people with Strep infection and for RF?

A

ASOT

and AntiDNAseB

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4
Q

Diseases caused by Strep (GAS)

A
  • Pharyngitis
  • Septicaemia
  • Cellulitis
  • Scarlet fever
  • Streptococcal shock syndrome
  • Rheumatic fever
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5
Q

Acute rheumatic fever

A

Abnormal immune response to GAS infection

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6
Q

Features of ARF (Jones criteria)

A 
JONES
Joints- Polyarthritis
O- Heart- Carditis (pancarditis)
N- Subcutaneous nodules
E- Erythema marginatum
S- Chorea

Minor- Fever, arthralgia, acute phase reactants, prolonged PR interval

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7
Q

Treatment for RF

A

Benzathine Penicilin

**Glucocorticoids for severe RF
And symptom control

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8
Q

Three main epicardial coronary arteries

A

1) Left coronary artery (anterior 2/3 of IV septum, apex, anterior wall of LV)
2) Right coronary artery (posterior 1/3 of IV septum, inferior/posterior LV)
3) Left circumflex artery (lateral LV)

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9
Q

Structure of a valve

A

Endothelium
Dense collagenous core
Central loose CT core
Elastin fibres

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10
Q

Three forms of valvular heart disease

A

1) Valvular stenosis (narrowing with failure to open completely)
2) Valvular incompetence
3) Functional regurgitation

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11
Q

What does valvular insufficiency lead to?

A

Volume overload

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12
Q

Acquired valve disease

A

Mitral and aortic stenosis is 2/3 of all

Mitral stenosis
Mitral regurgitation
Aortic stenosis
Aortic regurgitation

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13
Q

Mitral stenosis

A

Rheumatic fever is the major cause

Clinical features:

  • Atrial fibrillation
  • Haemoptysis
  • Pulmonary congestion
  • Right ventricular hypertrophy

Opening snap

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14
Q

Mitral valve incompetence

A

LA enlargement
Acute LV failure
Chordae rupture causing atrial fibrillation

Systolic murmur

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15
Q

Mitral valve prolapse

A

Ballooning/hooding of mitral valve leaflets

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16
Q

Aortic valve stenosis

A

Small pulse, LV hypertrophy
LV failure
Sudden death

Ejection systolic murmur

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17
Q

Streptococci in RHF

A

B haemolytic

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18
Q

Rheumatic fever

A

Connective tissue disorder characterised by fibrinoid necrosis, inflammation and fibrosis

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19
Q

Aschoff bodies

A

Nodules in the hearts of RF patients- granulomatous structure with fibrinoid change, lymphocytic infiltration

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20
Q

Anitschow cells

A

Enlarged macrophages within Achoff bodies

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21
Q

Pancarditis

A

Endocarditis
Pericarditis
Myocarditis

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22
Q

Three features of chronic rheumatic fever

A

Fusion of valve commissure
Thickening and fibrosis of valve cusps
Thickening of chordae tendineae

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23
Q

Infective endocarditis

A

Damage of heart valves by a microbe by formation of vegetations

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24
Q

Three complications of IE

A

Valve perforations
Myocardial abscess
Septic emboli

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25
Cardiomyopathy
Abnormality in the myocardium- cardiac disease of unknown or unusual cause with pathological processes within myocardium or endocardium or both
26
Classification of cardiomopathy
1) Aetiological (primary or secondary) | 2) Clinico-pathological (Dilated, hypertrophic, restrictive)
27
Primary cardiomyopathy three causes
Familial Idiopathic Endomyocardial fibrosis
28
Secondary cardiomyopathy three causes
Infective Metabolic Connective tissue disorders
29
Histological abnormalities of DCMP
Enlarged heart upto 3x Dilated, flabby heart Hypertrophied cells Endocardial and interstitial fibrosis
30
Hypertrophic myopathy
Left ventricular hypertrophy of a non-dilated chamber without obvious cause Marked hypertrophy of heart muscle without ventricualr dilation
31
Restrictive cardiomyopathy
Abnormal diastolic function due to rigid left ventricular wall
32
Clinical manifestations of cardiomyopathy
Angina Dyspnoea Fatigue Syncope ``` Can lead to: Heart failure Sudden death Stroke Atrial fibrillation ```
33
What is a common complication of all cardiomyopathy?
Mural thrombus
34
Myocarditis
Inflammation of the myocardium with lymphocytic infiltration Can cause sudden cardiac death or cardiac failure
35
Three main causes of myocarditis
1) Infections 2) Immune mediated 3) Others (e.g. sarcoidosis, amyloidosis)
36
Tumours of the heart
Primary tumours- Myxomas, fibromas, lipomas Secondary
37
Myxomas
Most common primary tumour of the heart in adults Commonly located in the left atrium Most common site is fossa ovalis in the atrial septum
38
Carney's complex
10% of people with myxoma have this
39
Rhabdomyoma
Primary tumour of the heart in infants and children
40
Three classifications of pericarditis
Effusive Constrictive Adhesive
41
Obstructive disease
Increase in resistance to airflow due to partial/complete obstruction Chronic bronchitis, emphysema, bronchiectasis, asthma
42
Restrictive disease
Reduced expansion of lung parenchyma and decreased total lung capacity Fibrosis, pneumonia,
43
Chronic bronchitis
Clinical diagnosis 75 ml of sputum everyday Caused by chronic irritation **Goblet cell metaplasia and increased mucous production
44
Complications of chronic bronchitis
Infective exacerbation Pneumonia Right heart failure
45
Emphysema
Abnormal permanent enlargement of airspaces distal to terminal bronchiole ACCOMPANIED by destruction to their walls without fibrosis *Just enlargement is not emphysema
46
Clinical features of emphysema
Barrel chest Progressive dyspnoea Wheezing Decreased exercise tolerance
47
Types of emphysema
``` Centriacinar- involves the upper lobe (smokers) Panacinar- all zones (a-antitrypsin deficiency) Distal acinar (distal portion of acinus) ```
48
Protease-antiprotease theory of emphysema
Smoking causes accumulation of macrophages and neutrophils in respiratory bronchioles. Anti-protease (a1 antitrypsin) is found in the bronchial mucus. Smoking inhibits this. *Constant protease- antiprotease imbalance leads to emphysema
49
Bronchiectasis
Permanent and abnormal dilatation of bronchi and bronchioles as a result of bronchial obstruction Causes- tumour, foreign body obstruction
50
Clinical features of bronchiectasis
Constant infection in dilated bronchi Persistent cough Foul smelling sputum Haemoptysis
51
Asthma
Hyperactive airways which go into a state of reversible bronchoconstriction due to increased responsiveness to various stimuli
52
Main cells in asthma and histological features
Focal necrosis of epithelium with eosinophilic infiltration Hypertrophy of mucous glands Hypertrophy of smooth muscle of bronchial wall Eosinophils Charcot-Leyden crystals Curschmann spirals
53
Chronic interstitial disease
Heterogenous group of disorders characterised predominantly by inflammation and fibrosis of the pulmonary connective tissue
54
UIP
Usual interstitial pneumonia | Fibroblastic foci- patchy interstitial fibrosis and inflammation
55
Pneumoconiosis
Pulmonary fibrosis due to inhaled dust "Coal workers" "Asbestosis"
56
Asbestos
Localised pleural plaques Pleural effusions Asbestosis
57
Pressure versus volume overload
Pressure- increased systolic pressure- PARALLEL addition- CONCENTRIC hypertrophy Volume- increased diastolic pressure- SERIES addition- ECCENTRIC hypertrophy **In both pressure and volume overload there is increase in weight and size of the heart
58
Congestive heart failure
End stage chronic heart disease- failure of the pump Forward failure- diminished cardiac output, reduced tissue perfusion Backward failure- pooling of blood in the venous system, oedema
59
High pressure left to right shunt- what heart failure
Right heart failure
60
Five clinical manifestations of left heart failure
``` Dyspnoea Orthopnoea Paroxysmal nocturnal dyspnoea Fatigue and weakness Cachexia ```
61
Five clinical manifestations of right heart failure
``` Peripheral oedema Splenomegaly Hepatomegaly Jaundice Abdominal symptoms ```
62
Hypertension- left vs right
Left sided- Systemic hypertension | Right sided- Pulmonary hypertension
63
Systemic hypertension
Concentric left ventricular hypertrophy | Eventually left heart backward failure, lung congestion, pulmonary oedema
64
Pulmonary hypertension
Elevation of pulmonary artery pressure due to pulmonary vascular disease Can lead to right ventricle enlargement- cor pulmonale
65
Cor pulmonale
Cor pulmonale is defined as an alteration in the structure and function of the right ventricle (RV) caused by a primary disorder of the respiratory system. Pulmonary hypertension is often the common link between lung dysfunction and the heart in cor pulmonale
66
3 causes of pulmonary hypertension
Mitral regurgitation LV diastolic dysfunction Pulmonary arterial hypertension
67
Sequelae of right ventricular failure from lung disease
Chronic lung disease --> Reduction in pulmonary vascular bed --> Pulmonary hypertension --> Hypertrophy of right ventricle --> Right ventricular failure
68
Types of ischaemic heart disease
Angina pectoris MI Heart failure Sudden cardiac death
69
Pathogenesis of MI
Atherosclerotic plaques --> Fissuring and ulcerations --> Adhesion, activation and aggregation of platelets --> Thrombus formation
70
Transmural
Full thickness necrosis in a territory supplied by a single coronary artery STEMI
71
Subendocardial
Circumferential necrosis around 1/3 to 1/2 of the ventricular wall and may extend beyond the territory supplied by a single coronary artery NSTEMI
72
Extent of infarction in MI
- Size of occlusion - Site of occlusion - Rate of development - Duration - Myocardial demand
73
Three clinical features
Troponin- I and T Creatinine kinase Lactate dehydrogenase
74
Complications of MI
Sudden death Arrhythmias Left ventricular congestive heart failure Cardiogenic shock
75
Atherosclerosis
Hardening and thickening of arterial walls due to build up of fatty material
76
Response to injury hypothesis
Injury to endothelium due to oxidised LDL cholestrol Surface adhesion molecules expressed for lymphocytes and other inflammatory cells to bind Monocytes migrate and T lymphocytes release cytokines Fibroproliferative response- smooth muscle cells migrate from media to intima to produce collagen
77
Three complications of atherosclerosis
1) Calcification 2) Ulceration of the atheroma 3) Rupture of the atheroma
78
Hypertensive vascular disease
Caused by hypertension | known causes- renal disease, drugs, pregnancy
79
Malignant hypertension
Hypertensive emergency- Severe rise in BP, renal failure, retinal haemorrhages, encephalopathy
80
Hyaline arteriosclerosis
Eosinophilic hyaline thickening of tunica media
81
Three consequences of hypertensive disease
1) LV hypertrophy 2) Heart failure 3) Arrhythmias
82
Vegetation
Platelet thrombus that develops and propagates
83
What is the most common site of vegetation
Aortic site | Mitral site
84
Complications of endocarditis
Septic emboli Vasculitis Severe regurgitation leading to HF
85
Clinical presentation of endocarditis | And common clinical signs
Presentation - Chills - Myalgia - Rigors Clinical signs - Splinter haemorrhages - Janeway lesions - Clubbing - Roth's spots - Splenomegaly
86
Duke's criteria for endocarditis
1) Positive blood culture | 2) Evidence of endocardial involvement
87
Relevance of segmental anatomy
Related to frequency of infection | 10 segments
88
Defense mechanisms of the lung
Upper: - Mucociliary epithelium (to trap particles) - Cough reflex Lower - Alveolar macrophages - Mucosal associated lymphoid tissue - Bronchus associated lymphoid tissue
89
Samples for infection
``` Sputum Bronchoalveolar lavage Bronchial washings Fine needle aspirate Lung biopsy ```
90
Three classifications of pneumonia
1) Aetiology/agent 2) Clinical scenario (pneumonia syndromes) 3) Pathology/anatomical Pneumonia syndromes: - Community acquired - Health-care associated - Hospital acquired - Pneumonia in the immunocompromised
91
Lobar pneumonia and bronchopneumonia
Parts of community acquired pneumonia Lobar- affects the whole lobe Broncho- affects pulmonary lobules
92
Four stages of morphology of acute bacterial pneumonia
1) Congestion- parenchyma heavy, congested, boggy, red 2) Red hepatisation- red exudate, red lung 3) Grey hepatisation- lung grey, disintegration of red cells 4) Resolution
93
Presentation of pneumonia
``` Fever Rigor Productive cough Haemoptysis Pleuritic chest pain ```
94
Complications of pneumonia
``` Organised pneumonia Fibrosis Pneumothorax Pleural effusion Pericarditis ```
95
Acintomycosis
Persistent chronic suppurative infection with abscess formation
96
Morphology of mycobacterium TB infection
Primary TB- Inhaled bacilli, sensitisation develops, Ghon focus) Active involvement by caseating/noncaseating granulomas Progression to either: - Healing - Latency - Secondary TB - Progressive pulmonary TB - Miliary TB
97
Full oxygen carrying capacity of Hb
75-80 mmHg
98
Hypoxia versus hypoxaemia
Hypoxia- Low O2 in tissues | Hypoxaemia- Low O2 in blood
99
Causes of hypoxaemia
1) Low PiO2 2) Hypoventilation 3) Diffusion limitations 4) V/Q mismatch 5) Right to left shunt
100
Causes of hypoxia
Anaemia Blood flow obstruction Hypoxaemia
101
Peripheral and central respiratory drive
Peripheral - Low O2 - High CO2 - High H+ Central - High CO2 - HIgh H+
102
What can opioids do in terms of respiratory drive
Make people insensitive to CO2 concentrations
103
Chronic hypercapnia
Desensitises central chemoreceptors to CO2 concentrations and hypoxia drives respiration PCO2> 50mmHg If given too much O2, respiratory rate will slow down and lethal CO2 concentrations will accumulate
104
Three pulmonary vascular diseases
1) Pulmonary thromboembolism 2) Pulmonary hypertension 3) Diffuse pulmonary haemorrhagic syndromes
105
Causes of pulmonary hypertension
Increased pulmonary blood flow Increased pulmonary vascular resistance Increased left heart resistance
106
Pulmonary hypertension
Mean pulmonary artery pressure >/ 25 mmHg at rest | >/30 mmHg exercise
107
Clinical presentation of pulmonary hypertension
Right heart failure (chest pain, abdominal discomfort) | Arrhythmia
108
What is genetic mechanism for pulmonary hypertension
Bone morphogenic protein receptor 2 (BMPR2)
109
Histological patterns of pulmonary hypertension
``` Plexogenic arteriopathy (changes in muscular arteries and arterioles) Thrombotic arteriopathy (acute thrombi) Hypoxic arteriopathy ```
110
Diffuse pulmonary haemorrhage
Patients will present with diffuse haemoptysis Can be localised or diffuse - Diffuse haemoptysis (with or without capillaries) (e.g. Goodpasture's syndrome)
111
Goodpasture's syndrome
Autoimmune- antibodies around collagen | Primarily affects kidneys and lungs
112
Aneursym- definition and classification
Abnormal dilation in a vessel leading to weakness in tunica media of vessel/myocardium Classification - Cause (congenital, inflammatory, trauma) - Morphology (saccular, fusiform) - Anatomical site (aortic, AAA)
113
Clinical features of ruptured aneurysm
Seizures Double vision Vomitting Headaches
114
Complications of aneurysm
1) Rupture 2) Occlusion 3) Mass effect
115
Morphology of aneurysms
- Saccular (berry) | - Fusiform
116
AAA
Fusiform aneurysm located in abdominal aorta below renal arteries and above bifurcation Complications: - Rupture - Peripheral thromboembolism
117
Aortic dissection
Tear in intima due to weakness of tunica media Blood enters here Due to weakening of tunica media- chronic hypertension, Marfan's syndrome Complications - Rupture, massive haemorrhage - Occlusion of other branches Clinical features - Sudden onset excruciating pain - Collapse, shock
118
What causes 90% of pharyngitis
Viral infections - Influenza virus - Rhinovirus - Adenovirus - Coronavirus
119
Causes of bacterial pharyngitis
- Streptococcal pyogenes - H. influenzae - Mycoplasma pneumoniae
120
Complications of Strep pharyngitis
Suppurative - Otitis media - Meningitis - Sinusitis - Peritonsillar abscess "Quinsy" Non-suppurative - Rheumatic fever - Glomerulonephritis
121
Three tests for diagnosis of strep pharyngitis
Throat swab ASOT Blood culture
122
Epiglottitis
Acute inflammation of the epiglottis Haemophilus influenza B (HIB) Treatment- support the airway and Ceftriaxone and Amoxycillin
123
Diptheria
Diptherium bacteria produces toxin that adheres to mucosa to cause cell death and destruction
124
LeMierres disease
Jugular vein phlebitis
125
Croup
A clinical syndrome, not a diagnosis ``` Clinical features- Fever Hoarseness of voice Barking cough Inflammatory obstruction of subglottic area ```
126
Chronic sinusitis
>3 weeks of facial pain, postnasal drip and nasal congestion Gram -ve organisms and fungi
127
Otitis media
Follows a viral URTI Congestion of the nasopharyngeal mucosa, inflamm obstruction of the Eustacian tube, followed by fluid trapping and effusion formation in middle ear, ear drum becomes inflamed and bulging Mostly self-limiting, little evidence for other therapy Tympanocentesis specimen collection
128
Otitis externa
Moisture driven ear infection (swimmer's ear)
129
Pertussis
Bordatella pertussis 100 day cough Attaches to nasopharynx, produces toxins and damages trachea/bronchi Catarrhal phase --> Paroxysmal phase --> Convalescent phase
130
Complications of pertussis
Subconjuctival haemorrhage Pneumothorax Rib fractures Hernia
131
Pathophysiology of bronchopneumonia
Microbes access lower respiratory tract ---> Proliferate within alveoli ---> get cleared by macrophages If microbes overwhelm the capacity of the immune system --> inflammatory response initiated --> white cell migration --> leaky membranes --> decreased oxygenation
132
Typical and atypical causes of bacterial pneumonia
Typical- Strep pneum, H influenzae, Staph aureus | Atypical- mycoplasma pneum, legionella, chlamydophila psittaci
133
Pneumococcal pneumonia
Commonest form of pneumonia | Gram +ve diplococci
134
Typical and atypical clinical features of pneumonia
Typical - Rigors - Chills - Productive cough - Pleuritic chest pain - Fever Atypical - Arthralgia - Myalgia - Headache
135
PSI
>50 years (yes/no) Any of these? - Neoplasia - Liver disease - Renal disease - Cerebrovascular disease - Congestive HF Any exam abnormalities (yes/no) - BP <90 mmHg - Resp rate >30 - Temp >40 - Pulse >125/min - Altered mental state Yes- II, II, IV or V No- I
136
CURB-65
Confusion Urea > 7mmol/L Resp rate >30 BP <90 65- Age >65
137
SMART-COP
Age <50 or Age >50 ``` Systolic BP <90 Multilobar CXR involvement Albumin <35 Resp rate >25 >30 Tachycardia >125 ``` Confusion Oxygen stat <93% <90% PH <7.35 Total of 11 points
138
What antibiotic is added to cover atypical pneumonia organisms?
Clarithromycin
139
Three complications of pneumonia
- Respiratory failure - Multi-organ failure - Disseminated intravascular coagulation
140
Four organisms that can cause health-care associated pneumonia
1) ESBL 2) Acintobacter species 3) MRSA 4) Pseudomonas aeruginosa **HAP particularly affects upper lobes
141
MAC pneumonia
Mycobacterium avium and M intracellular complex Environmental, soil and water *Chronic pneumonia in patients with pre-existing conditions
142
Transudate vs exudate
Transudate- imbalance in oncotic and hydrostatic pressures Exudate- Inflammation of pleura or decreased lymphatic drainage
143
Light's criteria to define an exudate
1) Ratio of pleural fluid protein to serum protein >0.5 2) Ratio of pleural fluid LDH to serum LDH >0.6 3) Pleural fluid LDH > 2/3 of upper limit of normal *Transudate if all of the above are absent
144
Empyema
Frank pus in pleural space **Need pre-existing pleural fluid for this to develop
145
Aspergillus infections
Allergic bronchopulmonary aspergillosis Aspergilloma Invasive aspergillosis
146
Probability of TB transmission
Infectiousness of host Environment Virulence Host defences
147
Diagnosis of TB
1) Positive Mantoux test | 2) Positive quantiferon
148
Treatment of TB
Isoniazif | Rifampicin
149
Clinical symptoms of TB
``` Prolonged cough Fever Weight loss Night sweats Pneumonia Haemoptysis ```
150
Conmonest benign tumour of the nasal cavity
Pleiomorphic adenoma
151
Squamous cell carcinoma
Non-keratinising has better prognosis than keratinising
152
Sinonasal adenocarcinoma
Wood dust exposure | Salivary gland poor prognosis
153
Olfactory neuroblastoma
Arise from specialised sensory neuroepithelial cells of olfactory membrane
154
Sinonasal undifferentiated carcinoma
Metastasises to brain, kidney etc
155
Lymphoepithelial carcinoma
EBV infection
156
Nasopharyngeal angiofibroma
Arise from fibrovascular stroma, wall of the roof
157
Nasopharyngeal carcinoma
Strongly associated with EBV
158
Papilloma
Benign tumour of the larynx | HPV associated
159
Clinical symptoms of lung cancer
``` Cough Sputum Haemoptysis Weight loss Chest pain SOB ```
160
Horner syndrome
Occurs in lung cancer | Sympathetic ganglia invasion
161
4 main types of lung cancer
1) Squamous cell carcinoma (Male)- commonest in smokers; central 2) Adenocarcinoma (Female)- commonest in non-smokers; peripheral 3) Small cell carcinoma 4) Large cell carcinoma
162
Carcinoid tumours
Neuroendocrine malignant tumours
163
Three histological types of mesothelioma
Epitheloid Sarcamatoid Biphasic

Cardio-resp (4 decks)

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