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PATH2420 > Week 1 > Flashcards

Week 1 Flashcards

1
Q

Define pathology

A

the study of disease

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2
Q

Define disease

A

very simply, a change in normal body function/structure that leads to abnormal function

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3
Q

Define sign

A

clinical sign that can be objectively observed or measured by a physician or nurse

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4
Q

Define symptom

A

subjective complaint described by the patient (ex. dizziness, nausea, chest pain)

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5
Q

Define etiology

A

study of the causes of disease

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6
Q

Define pathogenesis

A

mechanism of disease
-The sequence of cellular events that take place from the initial contact with the etiologic agent until the expression of disease

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7
Q

Define pathological and morphological manifestations

A

changes in structure and function of tissues, organs, and systems

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8
Q

Define prognosis

A

anticipated course of the disease and final outcome

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9
Q

Define epidemiology

A

the study of the distribution (pattern) and determinants (causes, risk factors) of health-related states, including disease

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10
Q

Define incidence

A

number of new cases arising in a population over a given time period

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11
Q

Define prevalence

A

total number of cases of the disease in a given population

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12
Q

What are the two main categories of divisions of Pathology at LHSC?

A

Anatomical pathology and clinical pathology

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13
Q

What are the subcategories of anatomical pathology?

A
  1. Surgical pathology
  2. Cytopathology
  3. Forensic pathology
  4. Molecular pathology
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14
Q

What are the subcategories of clinical pathology?

A
  1. Clinical chemistry
  2. Immunology
  3. Blood bank/hematology
  4. Microbiology
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15
Q

Describe surgical pathology

A

Large tissue specimens and their architecture under a microscope for diagnosis; typically removed surgically; steps include:
-Gross (macroscopic) examination of organs and tissues such as biopsies, e.g., skin, cervix, breast
-Histological (microscopic) examination
-Generation of a diagnostic pathology report that’s comprehensive to inform physicians and patients

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16
Q

Describe cytopathology

A

The examination of cells under the microscope in the absence of tissue architecture; several types of samples including:
1. Exfoliative
-Spontaneous (spontaneously produced by the patient) such as urine
-Mechanical such as cervical pap smear or bronchial brushings
2. Interventional
-Fine needle aspiration
a. Lymph node
b. Thyroid

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17
Q

Describe forensic pathology

A

Specializes in forensics and performs autopsies, including in criminally suspicious cases

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18
Q

Describe molecular pathology

A

A department on its own but also an adjunct for surgical and cytopathology

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19
Q

Describe clinical chemistry

A

i.Covers a bunch of different clinical and biochemical tests
ii.Clinical Chemistry Specimens: blood, urine, sputum, stool, other body fluids such as bone marrow

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20
Q

Describe hematology

A

Responsible for the blood products that are distributed in the hospital

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21
Q

Describe microbiology

A

looks at microorganisms, viruses, bacteria

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22
Q

What techniques are used in pathology?

A

-Gross examination – examine specimen with the naked eye
-Microscopic examination – light microscopy is used to look at cellular morphology
-Electron Microscopy (special technique) Looks at organelles within the cells
-Ancillary tests (special technique)

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23
Q

Describe ancillary tests

A

o Immunohistochemistry – selectively identifies proteins in cells to aid with diagnosis
o Special histochemical stains – highlight specific tissues (elastic tissue, collagen); pigment (iron, melanin); microorganisms
o Molecular pathology – the detection and/or analysis of nucleic acid molecules (DNA or RNA) to provide clinical information (Chromosomal analysis, DNA sequencing)
 Type of tests:
* Constitutional Genetic Disorders
* Metabolic Disorders
* Hereditary Cancer Panels – genetic predisposition to developing cancer
* Solid tumour testing – treatment purposes

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24
Q

List the pathway of a specimen through pathology and laboratory medicine

A
  1. Gross examination – described in gross section of pathology report
  2. Then prepare sample for microscopic examination, steps:
  3. Tissue cut from specimen
  4. Placed in cassette
  5. Processed – any water content removed
  6. Tissue embedded in wax
  7. Cut on microtome
  8. Thin section
  9. Slide and Stained (hematoxylin and eosin stain – pink/purple stain)
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25
Q

Techniques in anatomical pathology include what?

A

gross examination, microscopic examination, ancillary tests

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26
Q

What can be tested by the laboratory?

A

Most fluids and cells contain biological components that have diagnostic applications

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27
Q

In the chemistry laboratory the most common specimens are?

A

blood and urine

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28
Q

For blood tests, the two main collection types used are?

A

finger prick, or venipuncture

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29
Q

To obtain accurate test results, it is important to do what?

A

collect the proper specimen type in the correct tub and follow the correct order of draw

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30
Q

Most laboratory errors occur in which phase of testing?

A

pre-analytical phase
-ensuring the laboratory receives a quality specimen is key to reporting of accurate test results to the clinical team

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31
Q

Why are laboratory tests requested (10 reasons)?

A
  • Diagnosing a disease
  • Screening for a disease
  • Determine severity of an illness
    o E.g., serum K needed for nerve transmission in heart and muscle contraction
    o Normal range of serum K 3.5-5.0 mmol/L
  • Determine appropriate management
    o E.g, prostate cancer – prostate specific antigen (PSA) is used to monitor patient for post-surgical recurrence of tumour
  • Monitor the progress of surgical recovery
  • Therapeutic drug monitoring
  • Identify drugs of abuse or poisonings
  • Assessment of baseline or nutritional status
  • Protection against legal repercussions
  • Re-test to verify abnormal results
32
Q

Define accuracy

A

describes the ability of data, measurements, or results to match the actual ‘true’ value

33
Q

Define precision

A

is how close these data, measurements, or results are to each other, working as a measure of the spread of data from the average

34
Q

What is often used to confirm (rule in) or exclude (rule out) a disease?

A

Laboratory tests

35
Q

Define prevalence

A

defined as the percent of patients who have the disease that is being tested

36
Q

_____ _____ and _____ are important for interpreting test results, they are calculated based on the decision threshold and can change if that moves.

A

Test sensitivity and specificity

37
Q

Describe laboratory stewardship

A

Laboratory stewardship refers to the appropriate utilization of laboratory tests which encompasses correctly ordering, retrieving, and interpreting these tests

38
Q

What is Choosing Wisely Canada?

A

A national organization that is dedicated to the reduction of testing and efficacious resource use

39
Q

Why does unnecessary testing, procedures, and treatments occur?

A

-Fear of lawsuit
-Practice habits are difficult to change
-Patient requests without evidence or knowledge of risks/benefits
-Lack of time for shared decision making

40
Q

up to what percent of tests, treatments, and procedures performed in Canada are potentially unnecessary?

A

30%

41
Q

What are the five things physicians and patients should question (not send for testing)?

A
  1. Don’t perform population-based screening for 25-OH-Vitamin D deficiency.
  2. Don’t screen with Pap smears if under 21 years of age or over 69 years of age.
  3. Avoid routine preoperative laboratory testing for low-risk surgeries without a clinical indication.
  4. Avoid standing orders for repeat complete blood count (CBC) on inpatients who are clinically/laboratorily stable.
  5. Don’t send urine specimens for culture on asymptomatic patients including the elderly, diabetics, or as a follow up to confirm effective treatment.
42
Q

What are the types of errors in pathology and laboratory medicine?

A
  1. Pre-analytical – everything involving specimen retrieval
  2. Analytical – diagnosis
  3. Post-analytical – reporting
43
Q

What types of pre-analytical errors could occur?

A

Collection, Ordering, Specimen labeling, Specimen processing, Correct clinical information provided

44
Q

What precautions should you take to avoid the pre-analytical error involving collection?

A

-Collection – specimen collected from the correct patient
oVerbal and ID band confirmation
o2 step verification

45
Q

What precautions should you take to avoid the pre-analytical error involving ordering?

A

-Ordering – correct test ordered
oSample taken from correct location
oCorrect tube used (blood test)
oCorrectly input into ordering system

46
Q

What precautions should you take to avoid the pre-analytical error involving specimen labeling?

A

-Specimen labeling – patient and specimen identification
oPatient identification on label of specimen
oSpecimen correctly identified on label

47
Q

What precautions should you take to avoid the pre-analytical error involving specimen processing?

A

-Specimen processing
oInadequate sample (volume or size)
oLost specimen
oInadequate or incorrect fixative

48
Q

What precautions should you take to avoid the pre-analytical error involving correct clinical information provided?

A

-Correct clinical information provided
oPertinent information provided to assist with diagnosis

49
Q

List how disease is classified (based on cause)

A

-Host/Genetic Factors (ex. sickle cell disease)
-Environmental Factors (ex. traumatic head injury)
-Combination of Factors (ex. heart disease, diabetes, cancer)

50
Q

Not all _____ diseases manifest at birth

A

inherited (genetic)

51
Q

Not all _____ diseases are genetic

A

congenital

52
Q

Define congenital anomalies

A

Structural or functional deficits that occur in utero and are present at birth; may or may not have a genetic cause

53
Q

Define malformation

A

intrinsically abnormal development process (ex. polydactyly, Spina Bifida, Congenital heart disease)

54
Q

Define disruption

A

Secondary destruction of an organ or body region that was normal in development, extrinsic disturbance

55
Q

Define deformation

A

Secondary or extrinsic destruction of the normal development process (ex. localized or generalized compression of growing fetus by biomechanical forces)

56
Q

Genetic or congenital factors are what?

A

-Alterations in genetic material
oSingle mutation in a DNA base pair (ex. Sickle cell disease)
oAdditions/Deletions/Rearrangements of whole chromosomes
Trisomy 21 (Down Syndrome)

57
Q

Define teratogens

A

environmental factors causing abnormal development or congenital anomalies

58
Q

List common teratogens

A

-Infectious agents (ex. rubella, cytomegalovirus, toxoplasma)
-Drugs (ex. alcohol, isoretinoin)
-Chemical/heavy metals (ex. mercury, lead)
-Ionizing radiation
-Maternal disease (ex. maternal diabetes, hypertension)

59
Q

What types of environmental factors cause disease?

A
  1. physical agents (ex. mechanical trauma, temp.)
  2. chemical agents (ex. poisons)
  3. infections - bacteria, virus, etc.
  4. drugs - therapeutic, recreational
  5. allergens
60
Q

Describe exogenous allergens

A

originating outside the body

61
Q

Describe endogenous allergens

A

arising within the body itself, generally proteins

62
Q

How can we classify disease (based on pathology)?

A

1.Injury – physical, chemical, or biological agent
2.Inflammation – common to many diseases
3.Infection – infectious organisms; local or systemic
4.Immunological reaction – excessive/overactive response by the immune system; hypersensitivity reaction
5.Neoplasia – autonomous proliferation of cells; benign or malignant tumours
6.Metabolic or Endocrine – disorders of enzymes, hormones, secretory products/proteins ex. diabetes
7.Nutritional – deficiency in proteins or calories; decreased absorption, transport, or utilization (celiac disease); specific vitamin or mineral deficiencies (scurvy); psychological factors (anorexia nervosa); excess calories (obesity)
8.Vascular – important cause of death; narrowing of blood vessels (ex. atherosclerosis, heart attack (MI), stroke)
9.Psychological factors – can cause and affect disease processes; mental illness can lead to worsening somatic disease; addiction

63
Q

Define idiopathic

A

unknown etiology; currently no known cause

64
Q

Define iatrogenic

A

disease or any adverse condition resulting from treatment by a healthcare professional

65
Q

Describe adverse events

A

unintended injury or complication resulting in death, disability or prolonged hospital stay
(very important causes of morbidity and mortality)

66
Q

Define morbidity

A

illness or impairment/disability caused by disease
-Something that impairs the well-being or normal functioning of a patient

67
Q

Define mortality

A

something causing the death of patient (death from disease)

68
Q

What are the top 5 reasons for hospital stays in Canada?

A
  1. Giving birth
  2. COPD and bronchitis
  3. Heart attack
  4. Heart failure
  5. Osteoarthritis of the knee
69
Q

What are the top 5 causes of death in Canada (2019)?

A

1.Malignant Neoplasms (all cancers)
2.Heart disease
3.Accidents (unintentional injuries)
4.Cerebrovascular diseases (neurocognitive diseases)
5.Chronic lower respiratory diseases

70
Q

_____ are more likely to be diagnosed with cancer

A

Males

71
Q

_____ are more likely to survive cancer when compared to males

A

Females

72
Q

Approx. 90% of cancer diagnoses occur among Canadians who are at least _____ years of age

A

50 years of age

73
Q

Which type of cancer has the highest mortality in Canada?

A

Lung

74
Q

Life expectancy has been steadily increasing in Canada; increase of about _____ in life expectancy since 1921.

A

25 years

75
Q

What are some reasons for improved life expectancy?

A

Sanitation, medical care, public awareness of good nutrition and the health risks associated with smoking, community advocacy

PATH2420 (12 decks)

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