Patho Minimals 1st Semester 2013
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What do hypersensitivity reactions mean?
• They are immune responses.
• They lead to inflammation and consecutive tissue damage.
Which cells are the cellular mediators of tissue injury in anaphylactic hypersensitivity?
- • Mast cells.
- • Circulating basophil granulocytes.
Which cells of an inflammatory exsudate indicate anaphylactic reaction?
• Eosinophil granulocytes.
What is the mechanism of tissue injury in type III (immun-complex mediated)hypersensitivity?
- • Activation of complement.
- • Accumlation and activation of neutrophil granulocytes.
What kind of tissue damage is typical for type III hypersensitivity reaction?
• Fibrinoid necrosis in vessel walls (e.g. necrotising vasculitis).
Which cells are the effector cells in delayed (type IV.) hypersensitivity?
• Epithelioid cells that are transformed from macrophages.
How long does it take from the antigen exposure (e.g. skin) to develop a delayed typehypersensitivity reaction?
How long does it take from the antigen exposure to develop a granuloma?
• 2-3 weeks.
What is the mechanism of killing the target cells in CD8+ T-cell cytotoxicreactions?
- • Osmotic lysis based on membrane perforation
- • Induction of apoptosis by Fas-ligand binding
Which are the three commonest soft tissue tumors?
- • Lipoma.
- • Fibroma.
- • Leiomyoma.
What is the commonest site of a leiomyoma?
What are the features of myxoma?
- • it is a tumor composed of gelatinous connective tissue
- • its structure is similar to the fetal Wharton’s jelly
What is the main cell type in xanthoma?
• Lipoid storing histiocytes
How are benign blood vessel tumors called?
What are the two major forms of hemangiomas?
- • cavernous haemangioma
- • capillary haemangioma
What is a biopsy?
• A tissue sample taken for diagnostic histopathological evaluation
What is the basic principle of immunohistochemical methods?
- • Specific binding of antigens by test antibodies
- • the antibodies are labelled by an enzymatic reaction (e.g. with peroxydase ) or with a fluorescent dye
What is telepathology?
• a histopathological consultation method based on the electronic transmission of images
What are the conditions of primary wound healing?
- • The wound is caused by a sharp, clean devices
- • There is little tissue damage.
- • There is a good apposition of edges.
- • There is little bleeding and inflammation.
Explain the sequence of primary wound healing!
- • The wound edged are held together by fibrin, than by fibroblasts.
- • A small amount of granulation tissue is produced.
- • A small amount of collagen is synthesised.
- • The remaining scar is delicate.
Give an example of primary wound healing?
• wound healing after plastic surgery.
What are the characteristics of secondary wound healing?
- • Large tissue destruction
- • Lot of tissue debris
- • Infection and inflammatory reaction develops
Explain the sequence of secondary wound healing!
- • the wound cavity is gradually filled with granulation tissue.
- • massive collagen production.
- • terminates with a large scar.
Give an example of secondary wound healing!
From what source may stem cells be acquired for therapeutical purposes?
- • Bone marrow or peripheral blood of adults (adult stem cell).
- • From cells of an early embryo (embryonic stem cell).
What are the forms of amyloid?
- • Amyloid AA (i.e. amyloid associated) occurring in patients with chronic diseases associated with pronounced tissue destruction.
- • Amyloid AL (i.e. amyloid light chain) occurring in patients with abnormal proliferationof cells of B lymphocytic origin.
What is the common feature of the molecular structure of different types of amyloid?
• the beta-pleated sheet molecular conformation of the amyloid fibrils
How can you detect amyloid in a histologically?
- • Congo-red staining.
- • Bi-refringance in polarized light.
What is dysplasia?
- • Preneoplastic condition.
- • It occurs principally in epithelia.
- • Early recognition and surgical removal prevents tumor formation.
What are the morphological signs of dysplasia?
- • Nuclear and cellular polymorphism.
- • The cell nuclei are hyperchromatic.
- • Number of mitotic figures increases.
- • Disturbed cell polarity.
CIN is the acronym for?
• Cervical Intraepithelial Neoplasia
What is the meaning of the CIN categories?
• They mark the severity of the precancerous condition within the squamous epithelium of the cervix
What does CIN – III mean?
- • Dysplasia of the whole thickness of epithelium.
- • The basement membrane is still intact, there are no signs of invasive growth
- • It is called in situ carcinoma.
What does the stage of tumors mean?
• the extension of the tumor
What does TNM classification represent?
- • the local extent of the tumor (T)
- • lymph node involvement (N)
- • presence of organ metastases (M)
What is the basis of tumor ploidy determination?
• the quantitation of the amount of DNA-binding stain
What is the DNA index?
• DNA content of tumor cells / DNA content of normal cells.
What is homeostasis?
- • physiological steady state
- • ability for adaptation
What is the meaning of atrophy?
• Reduction of the functional cell volume (atrophia simplex).
Which are the factors leading to atrophy?
- • Reduced activity
- • Reduced blood supply
- • Unsatisfactory alimentation (nourishment)
- • Lapse of nerve stimulation
- • Lack of hormonal stimulation
What are the main mechanisms of atrophy?
- • the ubiquitin-proteasome system
- • cellular autophagy
What is involution?
- • Reduction of the volume of the functional cells by atrophy (simple atrophy)
- • Reduction of the number of the functional cells by apoptosis (numerical atrophy)
What is hypertrophy?
• Organ or tissue enlargement by the increase of the volume of individual cells
What is hyperplasia?
• Organ or tissue enlagement by the increase of the number of cells
What is the mechanism of hypoxic or toxic cellular swelling?
• Sodium and water influx into the cells.
What is cell necrosis?
- • Cell or tissue death in a living organism.
- • The sum of morphological changes occuring within dead cells in a living environment.
What are the commonest forms of coagulative necrosis?
- • Infarction
- • Caseous necrosis (necrosis caseosa)
- • Zenker-type necrosis (etc. typhus, tetanus)
- • Slough necrosis (necrosis crustosa)
- • Fibrinoid necrosis (in arterial walls)
What is liquefactive necrosis?
- • occurs in tissues rich in fluid and lipoid substances and poor in proteins.
- • predominant swelling and liquefaction.
What is the pathomechanism of enzymatic fat cell necrosis?
- • Escape of pancreatic lipase
- • Neutral fat is digested into fatty acid and glycerol.
- • Formation of calcium soaps from fatty acids.
Which are important systems of tumor characterization with respect to prognosis and treatment?
- • Histopathological grading.
- • Pathological staging.
What is the pathology-based definition of anaplasia?
• Lack of cellular differentiation.
What types of tumor-progression are you aware of?
- • Clinical progression (size, dissemination).
- • Biological/histopathological progression (dedifferentiation/anaplasia).
What is the main point of molecular cancer screening?
- • detection of germ line mutations.
- • that may be associated with genetic disorders which may predispose for cancer.
What are the manifestations of gene amplification in chromosomal preparations?
- • Chromosomally integrated homogeneous staining region (HSR).
- • Extra chromosomal double minutes.
Name two gene amplifications with important clinical impact!
- • N-MYC gene amplification in neuroblastomas.
- • HER-2/NEU amplification in breast cancer.
List two well-known prognostic histopathological systems?
- • Nottingham Prognostic Index (NPI) in breast cancer.
- • Gleason-score in prostate cancer.
What is the basis of different skin colors?
- • The intensity of melanin synthesis in the melanocytes.
- • The number of melanocytes in the skin does not differ.
What is a melanocytic naevus?
• Benign tumor of the melanocytes (neoplasia).
Which are the forms of the melanocytic naevi?
- • Junctional naevus.
- • Compound naevus.
- • Intradermal naevus.
What is the precancerous lesion of malignant melanoma?
• Dysplastic naevus.
What are the risk factors for metastatis in malignant melanoma?
- • Depth of penetration.
- • Mitotic rate.
- • Epidermal ulceration.
- • Epithelioid cell type.
What is congestion?
• Intravascular stasis
What is hyperaemia?
• Increased blood content in small vessels of tissues and organs.
What is the definition of oedema?
• Extravascular and interstitial accumulation of transudate fluid.
What are the morphologic features of oedema?
- • macroscopically: tissue swelling, increase in weight
- • microscopically: widening of the extracellular space
What kinds of pathomechanisms may lead to oedema?
- • rise in hidrostatic pressure
- • drop of plasma oncotic pressure
- • increase of vascular permeability
- • lymphatic stasis
Name examples of increased hydrostatic pressure!
- • heart failure
- • venous thrombosis
- • hepatic cirrhosis with vascular decompensation
- • pregnancy
Name examples of decreased plasma oncotic pressure!
- • chronic renal failure
- • hepatic cirrhosis with parenchymal decompensation
- • starvation (inanitio)
- • low protein malnutrition
Give examples of oedema caused by lymphatic congestion!
- • excision of a lymphnode (block-dissection)
- • neoplasia of lymphnodes
- • inflammation and scarring of lymphnodes
What is thrombosis?
• Intravascular coagulation of blood in living organisms.
What types of thrombi do you know?
- • red thrombus – coagulation
- • white thrombus – precipitation (conglutination)
- • mixed or laminated thrombus (red and white components)
- • hyalin thrombus (fibrin microthrombus usualy in DIC)
- • complex thrombus
What types of thrombosis can be distinguished?
- • arterial
- • venous (phlebothrombosis, deep veins in the lower extremities, portal vein)
- • intracavital thrombus of the heart (mural thrombus or vegetatio globulosa)
What facilitates the development of thrombosis?
- • endothelial lesion
- • deceleration of the bloodflow (congestion)
- • dilatated vessels (turbulence)
- • increased blood coagulation (hyperviscosity syndrome, thrombocytosis, activation and accumulation of coagulation factors)
What is embolisation?
- • intravascular solid, liquid or gaseous material that is carried by the blood stream
- • causes obstruction of an artery (emablo = to throw in)
What forms of emboli can be differentiated?
What are the sources of endogenous emboli?
- • thrombus
- • tissue particles
- • cells (trauma, tumor)
- • fat (trauma, medical malpractice)
- • amniotic fluid
- • atheroma (cholesterin crystals in the renal capillaries)
- • gas-embolisation (Caisson-syndrome or decompression-syndrome)
What are the sources of exogenous emboli?
- • air embolisation
- • foreign body (oily injection, catheter, broken needle-tip)
What is haemorrhage?
• extravasation of all of the components of blood in a living organism
What are the causes of haemorrhage?
- • Discontinuity of the vessel wall. (Haemorrhagia per rhexim, haemorrhagia perarrosionem)
- • Step-over bleeding (haemorrhagia per diapedesim, occuring at the level of capillaries)
What are the causes of haemorrhagia per rhexim?
- • injury of the vessel wall (cut, puncture, contusion, incision)
- • spontaneous rupture of the vessel wall (atherosclerosis, media necrosis, aneurysma,varyx)
What are the causes of haemorrhagia per arrosionem?
- • ulcer (gastric or duodenal)
- • inflammation (e.g. TBC in lung)
- • tumor (malignant tumors)
What is haemothorax?
• Accumulation of blood in the thorax.
What is haemopericardium?
• Accumulation of blood in the pericardial cavity.
What is the medical expression for the accumulation of blood in the peritoneal cavity?
• Haemoperitoneum or haemascos.
What is „haemocephalus internus”?
• Accumulation of blood in the cerebral ventricules.
What is „haemocephalus externus”?
• Accumulation of blood in the subarachnoideal spaces.
What is „haematometra”?
• Accumulation of blood in the uterine cavity.
What is „haemarthros”?
• Accumulation of blood in the synovial cavity.
What is „petechia”?
• Small, spot like, 1-2 mm in diameter bleeding.
What is „purpura”?
• Multiple, small bleedings ranging in diameter from 3mm to 1cm.
What is „suffusio” or „sugillatio”?
• Lamellar bleeding in the subcutaneous connective tissue.
What is „haematoma”?
• Extensive interstitial bleeding causing volume expansion.
What is „ecchymosis”?
• 1-2 cm in diameter or larger patchy, mostly subcutaneous bleeding
What is „apoplexia”?
• Bleeding causing tissue destruction.
What is „exsanguinatio”?
• Loosing a significant amount of blood in a short time; bleeding to death
What is the medical expression for blood in the urine?
What is the medical expression for bloody vomit?
What is the medical expression for blood in the sputum?
What is the medical expression for nose bleeding?
What is the medical expression for the stool containing digested blood?
What is the medical expression for the stool containing fresh blood?
What is the classification of the inflammation according to extension?
- • local (circumscribed)
- • generalized (sepsis)
What is the classification of the inflammation according to its duration?
- • hyperacute (anaphylactic)
- • acute
- • subacute
- • chronic
What are the factors influencing the outcome of inflammation?
- • the nature of the inducing factor (physical and chemical = aseptic,
- bacterial = infectious/septic)
- • the intensity/the virulence of the inducting factor
- • the location of the inflammation (which organ or tissue)
- • immuneresponses (hypersensitivity, immunocomplex formation)
What does pus contain?
- • Tissue debris
- • Fibrin
- • Neutrophil granulocytes
- • Bacteria
What are the classical signs of the acute inflammation?
- • Rubor redness
- • Tumor swelling
- • Calor heat
- • Dolor pain
- • Functio laesa loss of function
How do we categorise acute inflammation regarding the exudate?
- • Serous
- • Fibrinous
- • Purulent or suppurative
- • Hemorrhagic
- • Gangrenous
What is characteristic for serous inflammation?
- • Occurs in tissue interstitium and cavities of the body
- • Presents as a serum-like fluid
- • The mildest form of inflammation
What is characteristic for fibrinous inflammation?
- • Starts with a serous exudation
- • The exudate becomes sero-fibrinous
- • Thick layer of fibrin may precipitate
What is characteristic for purulent inflammation?
- • Usually is the results of bacterial infections
- • Leukodiapedesis
- • Pus production
What is folliculitis?
• Purulent inflammation of the skin’s hair follicles.
What is the name of the deep inflammation affecting sebaceous glands?
What is carbuncule?
• Deep inflammation developed by the fusion of furuncules.
What is pustule?
• Pus filled vesicles of the superficial epidermis (e.g. varicella).
What is characteristic for a chronic abscess?
- • It is lined with a thick wall
- • The inner layer is the pyogenic wall (granulation tissue infiltrated byneutrophiles)
- • The outer layer is the hypocellular scar tissue.
How do we call pus within an anatomical cavity?
What is a phlegmone?
• Inflammatory exudate spreading freely along the tissue interstitium.
What is characteristic for hemorrhagic inflammation?
- • Endothel injury
- • Erythrodiapedesis
- • Blood stained exudate
- • May follow serous or purulent inflammation
What is characteristic for gangrenous inflammation?
- • Exudation and proliferation are less important.
- • The dominant feature is the tissue necrosis.
- • The immune response is deficient.
- • The inducing microorganisms are putrifying bacterias (spirochetes, fusiform bacteriae).
What are the types of gangrene?
- • Dry (sicca)
- • Wet (humida).
What could be the outcome of the acute inflammation?
- • Complete healing (restitutio ad intergum).
- • Fibrosis or scar.
- • Abscess formation.
- • Chronic inflammation.
What are the types of chronic inflammation?
- • Immun-mediated chronic inflammations.
- • Non immun-mediated chronic inflammations.
- • Granulomatous inflammations.
What are the steps of tissue regeneration?
- • Production of granulation tissue.
- • Remodeling of granulation tissue.
- • Fibrosis.
- • Scar.
What are the types of wound healing?
- • Primary wound healing (sanatio vulneris per primam intentionem).
- • Under scale wound healing (for example umbilical cord).
- • Secondary wound healing (sanatio vulneris per secundam intentionem).
A large number of eosinophil granulocytes indicates that cause of the inflammation is:
- • Allergic
- • Fungal
- • Parasitic
A large number of lymphocytes and plasma cells indicate that the cause of the inflammation is:
• Chronic or immunomediated inflammation (e.g. autoimmune disease)
The presence of epitheloid type macrophages indicate that the cause of the inflammation is:
• Type IV immuno-mediated inflammation.
What are the main reasons of anemia?
- • Decrease in red blood cell production.
- • Hemolysis.
- • Bleeding.
What are the circumstances leading to iron deficiency anemia?
- • Low iron intake.
- • Iron malabsorption.
- • Increased iron demands.
- • Chronic blood loss.
- • Malignant diseases.
What are the major features of aplastic anaemia?
- • Bone marrow stem cell disease.
- • Trilinear bone marrow aplasia.
- • Pancytopenia.
Which are the chronic myeloproliferative diseases?
- • Chronic myelogenous leukemia(CML).
- • Essen tial thrombocytemia.
- • Polycythemia vera.
- • Chronic idiopathic myelofibrosis.
What are the phases of the CML?
- • Chronic phase.
- • Accelerated phase.
- • Blastic crisis.
What is the characteristic genetic abnormality in CML?
What are the phases of polycythemia vera and what are their characteristics?
- • Proliferative phase: trilinear proliferation.
- • Postpolycythaemic phase: myelofibrosis.
What are the characteristics of essential thrombocytaemia?
- • Isolated bone marrow megakaryocytic proliferation.
- • Chronic elevation of platelet count.
- • Increased tendency for thrombosis.
What are the characteristic signs of myelofibrosis?
- • Collagen fibrosis in the bone marrow.
- • Extramedullary haematopoesis.
- • Leukoerythroblastic blood smear.
What is refractory anemia refractory for?
• vitamin-substitution therapy.
What are the factors influencing the outcome of myelodysplastic syndromes?
- • insufficient blood cell production (pancytopenia).
- • blastic transformation (acute leukemia).
What is the basic requirement for the diagnosis of acute myeloid leukemia?
• the blast rate in the bone marrow is higher than 20%
How do we classify lymphomas according to the clinical course?
How do we classify lymphomas according to the cellular differentiation?
What is MGUS?
• Monoclonal gammopathy of undetermined significance
What are the characteristic features of plasma cell myeloma?
- • Monoclonal plasma cell proliferation
- • Monoclonal gammopathy
- • Osteolytic bone lesions
- • Pathologic fractures
What are the types of Hodgkin's lymphoma?
- • Nodular lymphocyte predominant Hodgkin's lymphoma
- • Classical Hodgkin's lymphoma
Which cells are typical for Hodgkin's lymphoma?
- • Hodgkin cells
- • Mirror image cells
- • Sternberg-Reed cells
Based on the nature of presentation, Burkitt’s lymphoma can be:
- • Endemic (EBV associated)
- • Sporadic
- • Immunodeficiency associated (HIV associated)
What are the most frequent sites of extranodal lymphomas?
- • GI tract
- • Skin
- • Respiratory tracts
- • Mediastinum
What does the abbreviation MALT stand for?
• Mucosa associated lymphoid tissue
Which microorganism has a causative role in the development of the MALT lymphoma of the stomach?
• Helicobacter pylori
What is mycosis fungoides?
• The commonest cutaneous T-cell lymphoma.
What is Sezary syndrome?
• Leukemic manifestation of the mycosis fungoides.
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