Patho Minimals 1st Semester 2013

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Patho Minimals 1st Semester 2013
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2013-11-13 07:43:14
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medicine pathology debrecen
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minimum requirement questions for Pathology, University of Debrecen
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  1. What do hypersensitivity reactions mean?
    • They are immune responses.

    • They lead to inflammation and consecutive tissue damage.
  2. Which cells are the cellular mediators of tissue injury in anaphylactic hypersensitivity?
    • • Mast cells.
    • • Circulating basophil granulocytes.
  3. Which cells of an inflammatory exsudate indicate anaphylactic reaction?
    • Eosinophil granulocytes.
  4. What is the mechanism of tissue injury in type III (immun-complex mediated)hypersensitivity?
    • • Activation of complement.
    • • Accumlation and activation of neutrophil granulocytes.
  5. What kind of tissue damage is typical for type III hypersensitivity reaction?
    • Fibrinoid necrosis in vessel walls (e.g. necrotising vasculitis).
  6. Which cells are the effector cells in delayed (type IV.) hypersensitivity?
    • Epithelioid cells that are transformed from macrophages.
  7. How long does it take from the antigen exposure (e.g. skin) to develop a delayed typehypersensitivity reaction?
    2-3 days
  8. How long does it take from the antigen exposure to develop a granuloma?
    • 2-3 weeks.
  9. 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
  10. Which are the three commonest soft tissue tumors?
    • • Lipoma.
    • • Fibroma.
    • • Leiomyoma.
  11. What is the commonest site of a leiomyoma?
    myometrium
  12. 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
  13. What is the main cell type in xanthoma?
    • Lipoid storing histiocytes
  14. How are benign blood vessel tumors called?
    • Hemangiomas
  15. What are the two major forms of hemangiomas?
    • • cavernous haemangioma
    • • capillary haemangioma
  16. What is a biopsy?
    • A tissue sample taken for diagnostic histopathological evaluation
  17. 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
  18. What is telepathology?
    • a histopathological consultation method based on the electronic transmission of images
  19. 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.
  20. 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.
  21. Give an example of primary wound healing?
    • wound healing after plastic surgery.
  22. What are the characteristics of secondary wound healing?
    • • Large tissue destruction
    • • Lot of tissue debris
    • • Infection and inflammatory reaction develops
  23. Explain the sequence of secondary wound healing!
    • • the wound cavity is gradually filled with granulation tissue.
    • • massive collagen production.
    • • terminates with a large scar.
  24. Give an example of secondary wound healing!
    • • Dog bite.
    • • Burning.
  25. 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).
  26. 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.
  27. What is the common feature of the molecular structure of different types of amyloid?
    • the beta-pleated sheet molecular conformation of the amyloid fibrils
  28. How can you detect amyloid in a histologically?
    • • Congo-red staining.
    • • Bi-refringance in polarized light.
  29. What is dysplasia?
    • • Preneoplastic condition.
    • • It occurs principally in epithelia.
    • • Early recognition and surgical removal prevents tumor formation.
  30. What are the morphological signs of dysplasia?
    • • Nuclear and cellular polymorphism.
    • • The cell nuclei are hyperchromatic.
    • • Number of mitotic figures increases.
    • • Disturbed cell polarity.
  31. CIN is the acronym for?
    • Cervical Intraepithelial Neoplasia
  32. What is the meaning of the CIN categories?
    • They mark the severity of the precancerous condition within the squamous epithelium of the cervix
  33. 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.
  34. What does the stage of tumors mean?
    • the extension of the tumor
  35. What does TNM classification represent?
    • • the local extent of the tumor (T)
    • • lymph node involvement (N)
    • • presence of organ metastases (M)
  36. What is the basis of tumor ploidy determination?
    • the quantitation of the amount of DNA-binding stain
  37. What is the DNA index?
    • DNA content of tumor cells / DNA content of normal cells.
  38. What is homeostasis?
    • • physiological steady state
    • • ability for adaptation
  39. What is the meaning of atrophy?
    • Reduction of the functional cell volume (atrophia simplex).
  40. Which are the factors leading to atrophy?
    • • Reduced activity
    • • Reduced blood supply
    • • Unsatisfactory alimentation (nourishment)
    • • Lapse of nerve stimulation
    • • Lack of hormonal stimulation
  41. What are the main mechanisms of atrophy?
    • • the ubiquitin-proteasome system
    • • cellular autophagy
  42. 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)
  43. What is hypertrophy?
    • Organ or tissue enlargement by the increase of the volume of individual cells
  44. What is hyperplasia?
    • Organ or tissue enlagement by the increase of the number of cells
  45. What is the mechanism of hypoxic or toxic cellular swelling?
    • Sodium and water influx into the cells.
  46. 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.
  47. 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)
  48. What is liquefactive necrosis?
    • • occurs in tissues rich in fluid and lipoid substances and poor in proteins.
    • • predominant swelling and liquefaction.
  49. 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.
  50. Which are important systems of tumor characterization with respect to prognosis and treatment?
    • • Histopathological grading.
    • • Pathological staging.
  51. What is the pathology-based definition of anaplasia?
    • Lack of cellular differentiation.
  52. What types of tumor-progression are you aware of?
    • • Clinical progression (size, dissemination).
    • • Biological/histopathological progression (dedifferentiation/anaplasia).
  53. 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.
  54. What are the manifestations of gene amplification in chromosomal preparations?
    • • Chromosomally integrated homogeneous staining region (HSR).
    • • Extra chromosomal double minutes.
  55. Name two gene amplifications with important clinical impact!
    • • N-MYC gene amplification in neuroblastomas.
    • • HER-2/NEU amplification in breast cancer.
  56. List two well-known prognostic histopathological systems?
    • • Nottingham Prognostic Index (NPI) in breast cancer.
    • • Gleason-score in prostate cancer.
  57. 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.
  58. What is a melanocytic naevus?
    • Benign tumor of the melanocytes (neoplasia).
  59. Which are the forms of the melanocytic naevi?
    • • Junctional naevus.
    • • Compound naevus.
    • • Intradermal naevus.
  60. What is the precancerous lesion of malignant melanoma?
    • Dysplastic naevus.
  61. What are the risk factors for metastatis in malignant melanoma?
    • • Depth of penetration.
    • • Mitotic rate.
    • • Epidermal ulceration.
    • • Epithelioid cell type.
  62. What is congestion?
    • Intravascular stasis
  63. What is hyperaemia?
    • Increased blood content in small vessels of tissues and organs.
  64. What is the definition of oedema?
    • Extravascular and interstitial accumulation of transudate fluid.
  65. What are the morphologic features of oedema?
    • • macroscopically: tissue swelling, increase in weight
    • • microscopically: widening of the extracellular space
  66. What kinds of pathomechanisms may lead to oedema?
    • • rise in hidrostatic pressure
    • • drop of plasma oncotic pressure
    • • increase of vascular permeability
    • • lymphatic stasis
  67. Name examples of increased hydrostatic pressure!
    • • heart failure
    • • venous thrombosis
    • • hepatic cirrhosis with vascular decompensation
    • • pregnancy
  68. Name examples of decreased plasma oncotic pressure!
    • • chronic renal failure
    • • hepatic cirrhosis with parenchymal decompensation
    • • starvation (inanitio)
    • • low protein malnutrition
  69. Give examples of oedema caused by lymphatic congestion!
    • • excision of a lymphnode (block-dissection)
    • • neoplasia of lymphnodes
    • • inflammation and scarring of lymphnodes
  70. What is thrombosis?
    • Intravascular coagulation of blood in living organisms.
  71. 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
  72. 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)
  73. 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)
  74. 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)
  75. What forms of emboli can be differentiated?
    • • endogenous
    • • exogenous
  76. 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)
  77. What are the sources of exogenous emboli?
    • • air embolisation
    • • foreign body (oily injection, catheter, broken needle-tip)
  78. What is haemorrhage?
    • extravasation of all of the components of blood in a living organism
  79. 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)
  80. 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)
  81. What are the causes of haemorrhagia per arrosionem?
    • • ulcer (gastric or duodenal)
    • • inflammation (e.g. TBC in lung)
    • • tumor (malignant tumors)
  82. What is haemothorax?
    • Accumulation of blood in the thorax.
  83. What is haemopericardium?
    • Accumulation of blood in the pericardial cavity.
  84. What is the medical expression for the accumulation of blood in the peritoneal cavity?
    • Haemoperitoneum or haemascos.
  85. What is „haemocephalus internus”?
    • Accumulation of blood in the cerebral ventricules.
  86. What is „haemocephalus externus”?
    • Accumulation of blood in the subarachnoideal spaces.
  87. What is „haematometra”?
    • Accumulation of blood in the uterine cavity.
  88. What is „haemarthros”?
    • Accumulation of blood in the synovial cavity.
  89. What is „petechia”?
    • Small, spot like, 1-2 mm in diameter bleeding.
  90. What is „purpura”?
    • Multiple, small bleedings ranging in diameter from 3mm to 1cm.
  91. What is „suffusio” or „sugillatio”?
    • Lamellar bleeding in the subcutaneous connective tissue.
  92. What is „haematoma”?
    • Extensive interstitial bleeding causing volume expansion.
  93. What is „ecchymosis”?
    • 1-2 cm in diameter or larger patchy, mostly subcutaneous bleeding
  94. What is „apoplexia”?
    • Bleeding causing tissue destruction.
  95. What is „exsanguinatio”?
    • Loosing a significant amount of blood in a short time; bleeding to death
  96. What is the medical expression for blood in the urine?
    • Haematuria.
  97. What is the medical expression for bloody vomit?
    • Haematemesis.
  98. What is the medical expression for blood in the sputum?
    • Haemoptoe.
  99. What is the medical expression for nose bleeding?
    • Epistaxis.
  100. What is the medical expression for the stool containing digested blood?
    • Melaena.
  101. What is the medical expression for the stool containing fresh blood?
    • Haematocchesia.
  102. What is the classification of the inflammation according to extension?
    • • local (circumscribed)
    • • generalized (sepsis)
  103. What is the classification of the inflammation according to its duration?
    • • hyperacute (anaphylactic)
    • • acute
    • • subacute
    • • chronic
  104. 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)
  105. What does pus contain?
    • • Tissue debris
    • • Fibrin
    • • Neutrophil granulocytes
    • • Bacteria
  106. What are the classical signs of the acute inflammation?
    • • Rubor redness
    • • Tumor swelling
    • • Calor heat
    • • Dolor pain
    • • Functio laesa loss of function
  107. How do we categorise acute inflammation regarding the exudate?
    • • Serous
    • • Fibrinous
    • • Purulent or suppurative
    • • Hemorrhagic
    • • Gangrenous
  108. 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
  109. What is characteristic for fibrinous inflammation?
    • • Starts with a serous exudation
    • • The exudate becomes sero-fibrinous
    • • Thick layer of fibrin may precipitate
  110. What is characteristic for purulent inflammation?
    • • Usually is the results of bacterial infections
    • • Leukodiapedesis
    • • Pus production
  111. What is folliculitis?
    • Purulent inflammation of the skin’s hair follicles.
  112. What is the name of the deep inflammation affecting sebaceous glands?
    • Furuncule.
  113. What is carbuncule?
    • Deep inflammation developed by the fusion of furuncules.
  114. What is pustule?
    • Pus filled vesicles of the superficial epidermis (e.g. varicella).
  115. 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.
  116. How do we call pus within an anatomical cavity?
    • Empyema.
  117. What is a phlegmone?
    • Inflammatory exudate spreading freely along the tissue interstitium.
  118. What is characteristic for hemorrhagic inflammation?
    • • Endothel injury
    • • Erythrodiapedesis
    • • Blood stained exudate
    • • May follow serous or purulent inflammation
  119. 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).
  120. What are the types of gangrene?
    • • Dry (sicca)
    • • Wet (humida).
  121. What could be the outcome of the acute inflammation?
    • • Complete healing (restitutio ad intergum).
    • • Fibrosis or scar.
    • • Abscess formation.
    • • Chronic inflammation.
  122. What are the types of chronic inflammation?
    • • Immun-mediated chronic inflammations.
    • • Non immun-mediated chronic inflammations.
    • • Granulomatous inflammations.
  123. What are the steps of tissue regeneration?
    • • Production of granulation tissue.
    • • Remodeling of granulation tissue.
    • • Fibrosis.
    • • Scar.
  124. 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).
  125. A large number of eosinophil granulocytes indicates that cause of the inflammation is:
    • • Allergic
    • • Fungal
    • • Parasitic
  126. A large number of lymphocytes and plasma cells indicate that the cause of the inflammation is:
    • Chronic or immunomediated inflammation (e.g. autoimmune disease)
  127. The presence of epitheloid type macrophages indicate that the cause of the inflammation is:
    • Type IV immuno-mediated inflammation.
  128. What are the main reasons of anemia?
    • • Decrease in red blood cell production.
    • • Hemolysis.
    • • Bleeding.
  129. What are the circumstances leading to iron deficiency anemia?
    • • Low iron intake.
    • • Iron malabsorption.
    • • Increased iron demands.
    • • Chronic blood loss.
    • • Malignant diseases.
  130. What are the major features of aplastic anaemia?
    • • Bone marrow stem cell disease.
    • • Trilinear bone marrow aplasia.
    • • Pancytopenia.
  131. Which are the chronic myeloproliferative diseases?
    • • Chronic myelogenous leukemia(CML).
    • • Essen tial thrombocytemia.
    • • Polycythemia vera.
    • • Chronic idiopathic myelofibrosis.
  132. What are the phases of the CML?
    • • Chronic phase.
    • • Accelerated phase.
    • • Blastic crisis.
  133. What is the characteristic genetic abnormality in CML?
    • Philaderphia-translocation.
  134. What are the phases of polycythemia vera and what are their characteristics?
    • • Proliferative phase: trilinear proliferation.
    • • Postpolycythaemic phase: myelofibrosis.
  135. What are the characteristics of essential thrombocytaemia?
    • • Isolated bone marrow megakaryocytic proliferation.
    • • Chronic elevation of platelet count.
    • • Increased tendency for thrombosis.
  136. What are the characteristic signs of myelofibrosis?
    • • Collagen fibrosis in the bone marrow.
    • • Extramedullary haematopoesis.
    • • Leukoerythroblastic blood smear.
  137. What is refractory anemia refractory for?
    • vitamin-substitution therapy.
  138. What are the factors influencing the outcome of myelodysplastic syndromes?
    • • insufficient blood cell production (pancytopenia).
    • • blastic transformation (acute leukemia).
  139. What is the basic requirement for the diagnosis of acute myeloid leukemia?
    • the blast rate in the bone marrow is higher than 20%
  140. How do we classify lymphomas according to the clinical course?
    • • Indolent
    • • Agressive
  141. How do we classify lymphomas according to the cellular differentiation?
    • • Precursor
    • • Peripherial
  142. What is MGUS?
    • Monoclonal gammopathy of undetermined significance
  143. What are the characteristic features of plasma cell myeloma?
    • • Monoclonal plasma cell proliferation
    • • Monoclonal gammopathy
    • • Osteolytic bone lesions
    • • Pathologic fractures
  144. What are the types of Hodgkin's lymphoma?
    • • Nodular lymphocyte predominant Hodgkin's lymphoma
    • • Classical Hodgkin's lymphoma
  145. Which cells are typical for Hodgkin's lymphoma?
    • • Hodgkin cells
    • • Mirror image cells
    • • Sternberg-Reed cells
  146. Based on the nature of presentation, Burkitt’s lymphoma can be:
    • • Endemic (EBV associated)
    • • Sporadic
    • • Immunodeficiency associated (HIV associated)
  147. What are the most frequent sites of extranodal lymphomas?
    • • GI tract
    • • Skin
    • • Respiratory tracts
    • • Mediastinum
  148. What does the abbreviation MALT stand for?
    • Mucosa associated lymphoid tissue
  149. Which microorganism has a causative role in the development of the MALT lymphoma of the stomach?
    • Helicobacter pylori
  150. What is mycosis fungoides?
    • The commonest cutaneous T-cell lymphoma.
  151. What is Sezary syndrome?
    • Leukemic manifestation of the mycosis fungoides.

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