Pathology Flashcards
(201 cards)
1
Q
What is inflammation?
A
Inflammation is the local physiological response to tissue injury that involves inflammatory cells.
2
Q
What is the likely cause of inflammation that is red? What about if it is red and there is pus?
A
- Virus
2. Bacteria
3
Q
How can inflammation be good? Give two answers.
A
Fight infections
Repair injuries
4
Q
How can inflammation be bad? Give three answers.
A
Autoimmune response
Over-reaction to stimulus
Can cause disease e.g. fibrosis (from chronic) can cause distortion to tissue and alter function
5
Q
What are the classifications of inflammation?
A
Acute and Chronic
6
Q
How would you classify acute inflammation? (3 options)
A
Sudden onset
Short duration
7
Q
What can happen after an acute inflammation? (give 4 options and why they occur)
A
Resolution
Chronic inflammation (caused by persistent causal agent)
Suppuration (e.g. pus forming) form excessive exudate
Organisation and repair (from excessive necrosis)
8
Q
How would you classify chronic inflammation? (4 options)
A
Slow onset (can occur after acute inflammation or on its own without acute)
Long duration
May never resolve
9
Q
What are the inflammatory cells?
A
Neutrophil polymorph Macrophages Lymphocytes Endothelial cells Fibroblasts
10
Q
Describe Neutrophils
A
Short lived, first at scene of acute inflammation, phagocytose bacteria, die at scene of inflammation, release chemicals to attract other inflammatory cells
11
Q
Describe Macrophages
A
Long lived (weeks to months), phagocytic properties, ingest bacteria and debris, carry debris away, if bacterial can’t be ingested they hold it inside them, present antigens of bacteria to lymphocytes
12
Q
Describe lymphocytes
A
Long lived cells (years), produce chemicals to attract other inflammatory cells, immunological memory
13
Q
Describe endothelial cells
A
Line capillaries, grow into areas of inflammation to form new vessels, become more porous to allow more inflammatory cells to leave vessel, become sticky to cause inflammatory cells to stay at site of inflammation and not flow past
14
Q
Describe fibroblasts
A
long lived cells, form collagen to repair
15
Q
Which cells are most prominent in acute vs chronic inflammation?
A
Acute- neutrophil
Chronic- macrophages and lymphocytes
16
Q
List the causes of acute inflammation
A
Microbial infections hypersensitivity physical agents e.g. trauma chemicals bacterial toxins tissue necrosis
17
Q
List the causes of chronic inflammation
A
Primary chronic inflammation
transplant rejection
progression from acute inflammation
recurrent episodes of acute inflammation
18
Q
Describe the appearance of acute inflammation
A
Redness, heat, swelling, pain, loss of function
19
Q
Describe the macroscopic appearance of chronic inflammation
A
Chronic ulcers, chronic abscess cavity, thickening of wall of hollow viscus granulomatous inflammation fibrosis
20
Q
What is an autopsy?
A
History/ scene external examination evisceration internal examination reconstruction
21
Q
What are the types of autopsies?
A
Hospital and medico-legal
22
Q
Describe hospital autopsy
A
occurs at the request of clinician to find out more about cause of death.
have to have consent from family and death certificate
23
Q
Describe medico-legal autopsy
A
occur at request of persona of medical or legal background
24
Q
What are the types of death
A
Presumed natural deaths
presumed iatrogenic deaths
Presumed unnatural deaths
25
Describe a presumed natural death
cause of death not known and/or deceased has not seen doctor in last illness or in last 2 weeks of life
26
describe a presumed iatrogenic death
postoperative, anaesthetic, abortion death, complication of therapy
27
Describe a presumed unnatural death
accidents, industrial deaths, suicide, unlawful killing, neglect, custody deaths, war/industrial pensioners' death
28
Who make referrals?
doctors, registrar at BDM, relatives, police, other properly interested parties
29
Who performs autopsies?
doctors: histopathologists and forensic pathologists
30
what is the role of the coronal autopsy?
to find out who was deceased, when they died, where they died, how they came about their death.
31
What are the systemic effects of inflammation? (5 options)
Weight loss, fever, amyloidosis, constitutional symptoms e.g. anorexia, enlargement of lymph nodes
32
Describe the microscopic appearance of chronic inflammation
lots of macrophages and lymphocytes, almost no neutrophils, not a lot of exudate (fluid with proteins), lots of granulation tissue, tissue necrosis
33
What is a granulomatous inflammation?
type of chronic inflammation, a granuloma it is an aggregate of epithelioid histiocytes with sometimes other cells like lymphocytes
34
Describe epithelioid histiocytes
types of macrophages, little phagocytic activities
35
what can cause granulomatous inflammation
necrosis, histiocytes becoming giant cells. in-digestibility of matter by macrophages, beryllium drug traces
36
Describe healing of inflammation (5 things)
```
regeneration of cells
angiogenesis starts
fibroblast proliferate
collagen synthesis
leads to granulation tissue (different from granuloma)
```
37
When does resolution happen?
if the initiating factor is removed
| if the tissue is undamaged or can regenerate
38
what is angiogenesis?
new blood vessels forming
39
when does repair happen?
when the initiating factor is not removed
| when the tissue is damaged and can't regenerate
40
what is repair?
replacement of damaged tissue by fibrous tissue made of collagen.
41
what is regeneration?
process of replacing injured or dead cells.
42
which cells can regenerate? (6 options)
```
hepatocytes
pneumocytes
all blood cells
gut epithelium
skin epithelium
osteocytes
```
43
which cells cannot regenerate? (2 options)
myocardial cells
| neurons
44
what is 1st intention healing?
The incision has caused a gap between two surfaces of skin. If you keep the two surfaces together the gap will be filled by fibrin which over time is turned into collagen by fibroblasts. Squamous epithelium will cover the collagen.
45
what is 2nd intention healing?
The incision has created a gap between two surfaces of skin so large that the two surfaces cannot be brought together. Therefore, repair occurs from bottom up which leaves us with granulation tissue with lots of capillary loops.
46
why does the blood not always clot inside vessels?
Laminar flow
| endothelial cells aren't usually sticky
47
What is a thrombosis?
formation of a solid mass from blood constitutes in an intact vessel in a living person
48
what three factors can lead to a thrombosis?
change in vessel wall, blood flow and/or blood constituents
49
what can occur to a thrombus? (4 things)
resolved by drugs, turn to scar tissue, re-canalised, embolise.
50
What is embolism?
the process of a solid mass in blood being carried through circulation to a place where it gets stuck and blocks a vessel
51
What is ischaemia?
reduction in blood flow
52
what is reperfusion injury?
blood given too quickly after ischaemia so lots of oxygen and lots of radical oxygen species that can kill cells.
53
what is an infarction?
reduction in blood flow that leads to cell death
54
what is a watershed area?
an area with two supplies of blood but both weak, there can be cell death here if there is a drop in blood pressure.
55
What is atheroma?
the condition characterised by the accumulation of lipid in the intima of arteries causing their lumen to narrow, their walls to weaken and predisposing them to thrombosis
56
what is atherosclerosis?
atheroma causes the hardening of the arteries i.e. when the atheroma forms a plaque
57
What is the atherosclerosis plaque made of?
fatty streaks, fibro-lipid plaques, lymphocytes
58
Why do atherosclerosis plaques occur?
endothelial damage theory
59
What are the risk factors for atherosclerosis? (4 things)
cigarette smoking
hypertension
poorly controlled diabetes
hyperlipidaemia
60
How do the risk factors relate to the Endothelial damage theory?
Cigarette smoke has nicotine, free radicals, CO which damage the endothelial cells
hypertension puts pressure on the cells
poorly controlled diabetes causes an increase in superoxide anions and glycosylation products which damage endothelial cells
hyperlipidaemia directly damages the endothelial cells
61
in what type of arteries do atherosclerosis plaques form?
large and middle arteries (with high pressure)
62
Describe the development of an atherosclerosis plaque in a young person compared to an old person
young person- fatty streaks
older person- plaques (asymptomatic until thrombus causes full blockage or until sudden event e.g. low blood pressure from bleeding)
63
Greater/ lower depravity = greater/lower cases of ischaemic heart disease= greater/lower cases of atherosclerosis plaque
Greater depravity = greater cases of ischaemic heart disease= greater cases of atherosclerosis plaque
64
what are the complications of atherosclerosis plaques? (6 things)
```
cerebral infarction
carotid atheroma
myocardial infarction
aortic aneurysm
peripheral vascular disease
gangrene
```
65
What is apoptosis?
the physiological cellular process in which a programmed sequence of intracellular events leads to the death of a cell without the release of products harmful to surrounding cells. (programmed cell death)
66
how does apoptosis occur?
by activating non-lysosomal endogenous endonuclease which digest nuclear DNA into smaller DNA fragments. The death of scattered single cells which form membrane-bound bodies which are eventually phagocytosed by the surrounding cells including macrophages.
67
What can lead to apoptosis? (3 things)
DNA damage (detected by p53 protein)
ionising radiation
free radicals
68
What are caspases?
enzymes that carry out apoptosis
69
What enzyme will carry out apoptosis?
Caspase
70
what is necrosis?
traumatic dell death where large qualities of cells die unexpectedly i.e. not programmed
71
what are the characteristics of necrosis?
bioenergetics failure
| loss of plasma membrane integrity
72
what can cause necrosis? (3)
ischaemia, metabolic problems, trauma
73
Give 4 examples of necrosis
frostbite necrosis
cerebral infarction
avascular necrosis of bone
caseous necrosis
74
what is caseous necrosis as strong indication of?
TB
75
What are chromosomal abnormalities?
missing, extra, irregular portion of chromosomal DNA.
76
Describe congenital defects
abnormalities present at birth, can be inherited or acquired
77
What causes an inherited abnormality?
caused by inherited genetic abnormality
78
what causes an acquired abnormality?
non-genetic environmental factors
79
What is hypertrophy?
increase in size of tissue caused by an increase in size of constituent cells, increase of cell size without cell division
80
to grow larger, what would a non-dividing cell do?
hypertrophy
81
what is ploidy?
increase in DNA content
82
give two examples of hypertrophy
muscle hypertrophy in athletes where skeletal muscle of limb increase in size.
hypertrophy of arterial smooth muscles in arterial walls in hypertension
83
what is hyperplasia?
Increase in size of tissue caused by increase in number of constituent cells, increase in cell number by mitosis without increase in cell size. decrease in cell loss by apoptosis is a component.
84
give three examples of hyperplasia
bone marrow cell hyperplasia in people living in high altitude leads to increase in number of red blood cells
hyperplasia of breast tissue in puberty
endometrial of uterus hyperplasia due to too much oestrogen compared to progesterone
85
can hyperplasia and hypertrophy occur together?
yes
86
give an example of co-existence of hyperplasia and hypertrophy
enlargement of uterine smooth muscle in pregnancy
87
what is atrophy?
decrease in size of tissue/organ/cell caused by decrease in number of constituent cells and/or decrease in cell size, not just a cessation of growth
88
what causes atrophy generally?
decreased requirement of body for the function of a particular cell or organ
89
what is used to cause atrophy to occur?
apoptosis
90
give three examples of atrophy
atrophy of muscle in disused limb
tissue hypoxia leads to atrophy
in Alzheimer's dementia there is brain atrophy
91
what is metaplasia?
change in differentiation of a cell from one fully differentiated type to a different fully differentiated type
92
why does metaplasia occur?
change in cellular environment, the new cells can better withstand the new environment
93
what risk does metaplasia increase?
risk of cancer
94
give two examples of metaplasia
1. metaplasia in smoker's bronchus from ciliated respiratory epithelial cells to non-ciliated squamous cells
2. in vitamin A deficiency transitional and columnar epithelium are replaced by squamous epithelial cells
95
what is dysplasia
morphological changes seen in cells in the progression to becoming cancerous
96
what are the characteristics of dysplasia? (3)
increased cell proliferation
presence of atypical morphology
reduction in differentiation
97
what can cause dysplasia?
chronic physical or chemical damage, if not removed then early dysplasia cannot be reversed
98
What stops dividing cells from living forever?
telomeres limit number of divisions
99
what are telomeres
found at the end of chromosome DNA and start replication, get shorter with every replication so limit number of divisions
100
the length of the telomere is passed down genetically from mother or father?
father
101
Whats stops non-dividing cells from living forever?
accumulation of damage (e.g. DNA damage, free radicals)
102
what is dermal elastosis?
the accumulation of abnormal elastin in the skin
103
how does dermal elastosis occur?
UV-B light strikes proteins in skin and causes them to cross link
104
what is a cataract?
clouding of lens in the eye reducing vision
105
what causes cataracts?
UV-B light striking proteins in eye causing them to cross link
106
what is sarcopaenia?
loss of muscle
107
Define carcinogenesis
transformation of normal cells to neoplastic cells via permanent genetic alterations or mutations
108
What type of neoplasm does carcinogenesis refer to?
Malignant neoplasms
109
What type of neoplasm does oncogenesis refer to?
Benign and malignant neoplasms
110
How many steps is carcinogenesis?
multi step, minimum two mutations to same cell
111
What are carcinogens?
agents known or suspected to cause neoplasms, to cause carcinogenesis.
112
What type of of neoplasms do carcinogens cause?
malignant
113
what type of agent causes any neoplasm?
oncogenic agent
114
what do carcinogens act on to cause carcinogenesis?
DNA, they are mutagenic
115
x% of cancer are due to environment and y% is inheritance
```
x= 85
y= 15
```
116
why is it difficult to identify carcinogens?
long latent interval
complex environment
ethical issues of testing directly on humans
117
how can we identify carcinogens through experiments? (4)
1. tests on mice, bacteria, cells
2. epidemiological evidence
3. occupational risk factors
4. direct evidence from accidents
118
how many classes of carcinogens are there? List them.
5
| chemical, viral, radiation, biological agents, miscellaneous
119
do chemical carcinogens act directly or indirectly?
Both!
Directly (doesn't matter where contact is, will cause mutation)
Indirectly (procarcinogens need to be activated into ultimate carcinogens)
120
How does the type of enzyme affect where a cancer occurs in relation to a chemical carcinogen
pro-carcinogens need an enzyme to activate them to ultimate carcinogens. If the enzyme is universal then mutation will occur at contact, but if enzyme is in a specific organ, mutation will occur at organ
121
give four examples of chemical carcinogens and what cancer they cause
1. polycyclic aromatic hydrocarbons in tar cause skin cancer and if absorbed lung cancer
2. aromatic amines cause bladder cancer
3. nitrosamines cause gut cancer
4. alkylating agents cause leukaemia (small risk)
122
give two examples of viral carcinogens and what cancer they cause
1. human papillomavirus causes cervical cancer
| 2. Hep B and C cause hepatocellular cancer
123
Give four examples of how radiation can cause cancer
1. UVA and UVB lead to skin cancer (basal cell carcinoma, squamous cell carcinoma, melanoma)
2. radiographers - skin cancer
3. uranium miners - lung cancer
4. Ukrainian children - thyroid cancer
124
give the four types of biological carcinogens
hormones
mycotoxins (from fungi)
parasites
bacteria
125
Give two examples of hormone carcinogens and the cancer they cause
1. oestrogen increase leads to mammary or endometrial cancer
| 2. anabolic steroid increase leads to hepatocellular carcinoma
126
give an examples of a mycotoxin carcinoma
aflatoxin b1 causing hepatocellular carcinoma
127
give two examples of parasites that cause cancer
1. chlonorchis sinensis causing cholangiocarcinoma
| 2. shistosoma causing bladder cancer
128
Give an example of a bacterial infection that can cause cancer
helicobacter pylori that can cause gastric lymphomas
129
What do we mean by miscellaneous carcinogens?
those that we don't understand their method of action
130
give two examples of miscellaneous carcinogens
1. asbestos - lung and pleura cancer
| 2. nickel- cancer of mucosal lining of nose and lungs
131
What host factors can increase risk of cancer (5)
race, diet, constitutional, premalignant lesions, trans-placental exposure
132
give two examples of a race host factor that could affect risk of cancer
1. black people have more melanin so protected against skin cancer
2. SE asia and India they do reverse smoking so more oral cancer
133
why do dietary factors affect carcinogenesis?
may have a lot of carcinogens
may lack protective factors
may affect intestinal transit time
134
what are the three constitutional factors that affect risk of cancer and give some examples
1. inherited predisposition (BRCA1 and BRCA2 on chromosome 17 and 13 increase risk of breast cancer)
2. age (increase age more cancer)
3. gender (female increase risk of breast cancer)
135
what are premalignant lesions?
identifiable abnormalities that are associated with increased risk of cancer at that site
136
give four examples of premalignant lesions
cervical dysplasia
colonic polyps
ulcerative colitis
un-descended testis
137
what is trans-placental exposure?
carcinogen give to mother but affect seen in fetus when it becomes baby/child/adult
138
give an example of a trans-placental exposure
diethylstiboestrol to mother increases risk of child having vaginal adenocarcinoma
139
What is a lesion?
A local abnormality
140
Define a neoplasm
a lesion resulting from autonomous abnormal growth of cells which persists after the initiating stimulus has been removed. it is a new growth.
141
Define a tumour
any abnormal swelling
142
Give 4 examples of tumours
neoplasm, inflammation, hypertrophy, hyperplasia
143
What is a neoplasm made off?
Neoplastic cells
| stroma
144
What type of cells are neoplastic cells derived from?
nucleated cells
145
describe the growth pattern and synthetic activity of a neoplastic cell
the growth pattern will to a variable extent relate to the parent cell. the synthetic activity will also to a variable extent related to that of the parent cell.
146
What is the stroma?
a connective tissue framework that the neoplastic cells are embedded in. Mechanical and nutritional support is offered by the stroma
147
How does a stroma form?
desmoplastic reaction: the induction of connective tissue proliferation by growth factors in immediate tumour environment
148
what does the stroma contain?
blood vessels, fibroblasts, myofibroblasts, lymphocytes
149
How will a carcinoma in situ first appear?
single neoplastic cell will appear, cell grows faster than healthy cells so takes over the area. remains surrounded by basement membrane
150
What is a carcinoma in situ?
a carcinoma, a neoplasm that is surrounded by basement membrane i.e. the basement membrane has not been breached
151
What can happen to a carcinoma in situ?
completely removed surgically or destroyed by body
stays there for long time
turns into micro-invasive carcinoma
152
What is invasion?
if the carcinoma breaches the basement membrane
153
How (and what does it need) does a neoplasm invade past the basement membrane?
digest basement membrane (needs metalloproteinases)
un-attaches from other cells (loss of surface adhesion)
move past basement membrane (needs more cellular motility)
154
what is the difference between a micro-invasive carcinoma and an invasive carcinoma?
micro-invasive: the length of the total cells that have left the basement membrane is less than 1mm
invasive: more than 1mm, need angiogenesis
155
What is metastasis?
process where malignant neoplasm spreads from site of origin to form other tumours at distant site.
156
what does carcinomatosis mean?
extensive metastatic disease
157
describe the steps of metastasis (7)
```
detachment
invasion
intravasion
evasion
arrest
extravasation
growth
```
158
describe intravasion
neoplastic cells enter vessel lumen by using metalloproteinases and motility.
159
Describe evasion
neoplastic cells evade host's defences by
aggregation with platelets
shedding surface antigens
adhesion to other tumour cells
160
describe arrest
neoplasm arrest their movement by adhering to endothelium of vessel at remove location
161
describe extravasion
neoplastic cells leave vessel lumen and enter surrounding tissues, cell motility and metalloproteinases are used
162
what are the routes of metastasis? (4)
haematogenous (blood stream)
lymphatics
transcoelomic (into pleura, pericardia, peritoneal cavities)
implantation routes (surgical accident spilling neoplastic cells)
163
what methods of classification do we use to classify neoplasms?
behavioural and histogenetic
164
What are the options for behavioural classification?
benign, borderline, malignant (spectrum)
165
Describe benign neoplasms (5)
```
localised
non-invasive
clear borders
slow growth rate
resemble normal tissue with nuclear morphometry
```
166
which type of tumour would you see a lot of necrosis and ulceration?
malignant NOT benign
167
which type of tumour grows in an exophytic manner on mucosal surfaces?
benign
168
how do benign and malignant differ in the way they grow on mucous surfaces?
malignant: endophytic
benign: exophytic
169
how do benign neoplasms cause morbidity and mortality? (5)
```
pressure on adjacent structures
block of flow
production of hormones
transform into malignant tumours
anxiety
```
170
give an example of a borderline tumour
some ovarian lesion
171
describe malignant tumours (5)
```
invasive
irregular border
can metastasise
rapid growth rate-increase mitosis
variable resemblance to normal tissue
nucleus hyperchromatic and pleomorphic
```
172
how can malignant neoplasms cause morbidity and mortality? (7)
```
destruction of adjacent tissues
metastasis
blood loss from ulcers
obstruction of flow
hormone production
anxiety and pain
paraneoplastic effects
```
173
what does histogenetic classification refer to?
the cell of origin of the neoplasm
174
what can we learn from histogenesis?
degree of resemblance to original cell allows grading of tumour (good resemblance low grade so good prognosis)
175
what is the suffix of an epithelial non-glandular neoplasm benign?
papilloma
176
what is the suffix of an epithelial non-glandular neoplasm malignant?
carcinoma
177
what is the suffix of an epithelial glandular neoplasm benign?
adenoma
178
what is the suffix of an epithelial glandular neoplasm malignant?
adenocarcinoma
179
what is the suffix for a benign adipocyte neoplasm?
lipoma
180
what is the suffix for a malignant adipocyte neoplasm?
liposarcoma
181
what is the suffix for a benign cartilage neoplasm?
chondroma
182
what is the suffix for a malignant cartilage neoplasm?
chondrosarcoma
183
what is the suffix for a benign bone neoplasm?
osteoma
184
what is the suffix for a malignant bone neoplasm?
osteosarcoma
185
what is the suffix for a benign vascular neoplasm?
angioma
186
what is the suffix for a malignant vascular neoplasm?
angiosarcoma
187
what is the suffix for a benign nerve neoplasm?
neuoma
188
what is the suffix for a benign straited muscle neoplasm?
rhabdomyoma
189
what is the suffix for a malignant straited muscle neoplasm?
rhabdomyosarcoma
190
what is the suffix for a benign smooth muscle neoplasm?
leiomyoma
191
what is the suffix for a malignant smooth muscle neoplasm?
leiomyosarcoma
192
how do you describe a tumour of unknown cell type?
anaplastic
193
EXCEPTIONS: give 3 tumours that end with "oma" but are not neoplasms
granuloma
mycetoma
tuberculoma
194
EXCEPTIONS: give 3 malignant tumours that don't end with sarcoma or carcinoma
melanoma
mesothelioma
lymphoma
195
EXCEPTIONS: give 4 neoplasms that are named after a person
burkitt's lymphoma
ewings's sarcoma (osteosarcoma)
grawitz tumour (renal cell carcinoma)
kaposi sarcoma (angiosarcoma)
196
EXCEPTIONS: give 4 examples of miscellaneous tumours
teratoma
embryonal tumour (blastoma)
mixed tumour
APUDomas
197
what is grade 0 in duke's staging of cancer?
carcinoma in situ
198
what is grade 1 in duke's staging of cancer and what is the survival rate?
```
no nodal involvment (N0)
no metastases (M0)
tumour invades submucosa (T1)
tumour invades muscularis propria (T2)
90-100%
```
199
what is grade 2 in duke's staging of cancer and what is the survival rate?
N0, M0
tumour invades subserosa (T3)
tumour invades other organs (T4)
75-85%
200
what is grade 3 in duke's staging of cancer and what is the survival rate?
M0, any T
regional lymph nodes involved (N1)
30-40%
201
what is grade 4 in duke's staging of cancer and what is the survival rate?
distant metastases (M1)
any N and any T
less than 5%
