Pathology Flashcards

1
Q

what is oedema

A

excess watery fluid gathering in tissues/cavities

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2
Q

describe the pathology of pneumonia

A

infection involving the distal airspaces usually with inflammatory exudation, localised oedema

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3
Q

why does consolidation result from pneumonia

A

due to fluid present in air spaces

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4
Q

how is pneumonia classed by morphology

A

structure and form e.g. lobar pneumonia/bronchopneumonia

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5
Q

what is RSV

A

respiratory syncytial virus, can cause pneumonia

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6
Q

name 2 more viruses that can cause pneumonia

A

influenza, parainfluenza, measles

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7
Q

describe lobar pneumonia

A

confluent (flowing together or merging) consolidation involving a complete lung lobe

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8
Q

what is lobar pneumonia most commonly caused by

A

streptococcus pneumoniae

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9
Q

what transmits legionella

A

inhalation of vaporised stagnant water

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10
Q

is lobar pneumonia usually community or hospital acquired

A

community

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11
Q

describe the the acute inflammatory response associated with lobar pneumonia

A

exudation of fibrin-rich fluid, neutrophil infiltration, macrophage infiltration, resolution

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12
Q

what does the role of antigens lead to

A

opsonisation (serum molecules attach to microbes making them more attractive to antibodies- identification of pathogens by phagocytes that engulf them) and phagocytosis of bacteria

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13
Q

describe the pathology of meningitis

A

pus around the brain stem

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14
Q

what is edema

A

swelling- due to injury/inflammation, because of small blood vessels leaking in to tissue

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15
Q

what is an abscess a differential diagnosis of

A

cancer

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16
Q

what are the complications of lobar pneumonia

A

organisation (fibrous scarring), abscess, bronchiectasis, empyema

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17
Q

what is empyema

A

collection of pus in (pleural) cavity

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18
Q

what is a bronchopenuomia

A

infection starting in the airways and spreading to the adjacent alveolar lung

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19
Q

describe the pathology present in bronchopneumonia

A

patches of consolidation within the lung rather than the whole lung in lobar pneumonia

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20
Q

what (4) is bronchopneumonia usually a result of

A

COPD (exacerbation, acute bronchitis, hypoxic, resp failure), cardiac failure, complication of viral infection (influenza), aspiration of gastric contents (aspiration pneumonia)

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21
Q

what organisms commonly cause bronchopneumonia

A

more varied- strep. pneumoniae, haemophilus influenza, staphylococcus, anaerobes, coliforms (gut bacteria)

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22
Q

what microbes are common in aspiration pneumonia

A

staph., anaerobes, coliforms

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23
Q

what are the complications of bronchopneumonia

A

organisation, abscess, bronchiectasis, empyema

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24
Q

what symptoms of an abscess means its commonly misdiagnosed with cancer

A

chronic malaise (discomfort) and fever

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25
Q

what is an abscess

A

localised collection of pus

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26
Q

what is the tissue surrounding a tumour often like

A

haemorrhagic, inflamed and congested

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27
Q

what is bronchiectasis

A

abnormal fixed dilation of the bronchi

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28
Q

what is bronchiectasis usually due to

A

fibrous scarring following infection

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29
Q

give examples of infections/ conditions that result in infection that can cause fibrous scarring

A

pneumonia, tuberculosis, cystic fibrosis

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30
Q

how does scar tissue open airways

A

by contracting, dilates it

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31
Q

what does airway dilation do to the surrounding tissue?

A

destroys it

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32
Q

what results form the dilated airways

A

accumulation of purulent secretions, chronic suppuration, an inability to clear secretions

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33
Q

what is bronchiectasis also seen with

A

chronic obstruction (tumour)

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34
Q

what is tuberculosis

A

mycobacterial, chronic infection

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35
Q

how is tuberculosis pathology characterised

A

delayed type IV hypersensitivity (granulomas with necrosis)

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36
Q

describe hypersensitivity and what mediates it

A

t cell mediated, when own immune cells damage the body

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37
Q

what is a granuloma

A

localised collections of activated macrophages

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38
Q

what do organisms other than m. tuberculosis/ m. bovis cause

A

atypical infection especially in immunocomprimised host

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39
Q

what is pathogenicity

A

the ability of an organism to cause disease

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40
Q

describe the pathogenicity of organisms that cause tuberculosis

A

able to avoid phagocytosis- tough enzyme resistant coat, can stimulate a host T-cell response- hypersensitivity

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41
Q

what does the t-cell response to an organism enhance

A

macrophage ability to kill mycobacteria

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42
Q

what does t-cell response cause in hypersensitivity type IV

A

granulomatous inflammation, tissue necrosis and scarring

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43
Q

when does primary TB occur

A

1st exposure up to 5 years

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44
Q

describe the pathologocial process of gaining immunity against tuberculosis after inhalation of organism

A

organism phagocytosed and carried to hilar lymph nodes. immune activation (few weeks) leads to a granulomatous response in nodes (and in lung) usually with killing of organism

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45
Q

when does the infection spread within the body

A

when the infection is overwhelming or immune response impaired

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46
Q

what is secondary TB

A

reinfection or reactivation of TB in a person with some immunity

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47
Q

how does secondary tuberculosis tend to initially exist

A

remains localised, often shadows in apices of lung

48
Q

how can secondary TB spread within the body

A

by airways or in bloodstream

49
Q

what tissue changes occur in primary TB

A

small focus (Ghon focus) in periphery of mid zone of lung, granulomatous- large hilar nodes

50
Q

what tissue changes occur in secondary TB

A

fibrosing and cavitating apical lesion, necrosis

51
Q

what is a lesion

A

region of tissue that has suffered damage

52
Q

is the organism killed in hypersensitivity

A

no

53
Q

what does TB reactivate?

A

decreased T-cell function, reinfection at high does or with more virulent organism

54
Q

what decreased T cell function

A

age, coincident disease (HIV- decreased T cell function T4H), immunosupressive therapy (steroids, cancer, chemotherapy)

55
Q

when and how can TB reactivate

A

any stage in life with many manifestations

56
Q

what pathogens/ infections affect an immunocompromised host

A

opportunistic pathogens- dont usually cause harm

virulent infections with common organisms

57
Q

what is a lavage

A

washing out of body cavity

58
Q

how is TB diagnosed

A

high index of suspicion (e.g. on treatment), multidisciplinary team, broncho-alveolar lavage, biopsy

59
Q

how can TB cause a haemorrhage

A

infection spreads into blood vessel

60
Q

how does HIV virus affect cells

A

swollen, enlarged nucleus due to viral particles

61
Q

describe the dual supply of the pulmonary circulation

A

composed of pulmonary and bronchial arteries

62
Q

is the pulmonary circulation a high or low pressure system

A

low

63
Q

how are the pulmonary arteries able to act as a filter for the entire bloodstream

A

as pulmonary arteries receives entire cardiac output

64
Q

because the pulmonary circulation is a low pressure system- at normal pressures- describe the vessels and incidence of atherosclerosis

A

thin walled vessels, low incidence of atherosclerosis

65
Q

what is a pulmonary oedema

A

accumulation of fluid in the lung

66
Q

describe interstitium oedema’s effect on patients

A

makes them breathless

67
Q

describe oedema in the alveolar spaces

A

severe, causes consolidation

68
Q

what are the two causes of pulmonary oedema

A

haemodynamic (increased hydrostatic pressure) cellular injury (alveolar lining and endothelium cells)

69
Q

what causes localised cellular injury in the lungs

A

pneumonia

70
Q

what causes generalised cellular injury in the lungs

A

adult respiratory distress syndrome

71
Q

how does cardiac disease cause lung disease

A

as increases hydrostatic pressure

72
Q

what is ARDS

A

adult respiratory distress syndrome

73
Q

what is DADS

A

diffuse alveolar damage syndrome

74
Q

what is shock lung

A

acute respiratory distress syndrome

75
Q

what causes shock lung

A

sepsis, diffuse infection, severe trauma, oxygen treatment

76
Q

describe the pathogenesis pf ARDS that leads to injury of cell membrane

A

inflammatory cells infiltrate lung, produce cytokines and oxygen free radicals

77
Q

what pathological effects does ARDS have

A

fibrinous exudate lining alveolar walls (hyaline membranes), cellular regeneration, inflammation

78
Q

what does a hyaline membrane do to alveolar lining

A

thickens it

79
Q

what are three outcomes of ARDS

A

death, resolution, fibrosis (chronic restrictive lung disease)

80
Q

what causes neonatal RDS

A

deficiency in surfactant causing physical damage to cells because of increased effort in expanding lung

81
Q

what is an embolus

A

detached intravascular mass carried by the blood to a site in the body distant from its point of origin

82
Q

what are most emboli

A

thrombi (clots)

83
Q

what are 4 other types of embolus

A

gas, fat, foreign bodies, tumour clumps

84
Q

what are pulmonary emboli an important cause of

A

sudden death and pulmonary hypertension

85
Q

what is the source of most pulmonary emobli

A

DVT of lower limbs

86
Q

what is a clot made of

A

platelets and fibrin

87
Q

what does virchows trad show

A

risk factors for PE or DVT

88
Q

what is virchows triad

A

factors in vessel wall, abnormal blood flow, hypercoaguable blood

89
Q

what are the effects of a PE

A

sudden death, severe chest pain, dysnpnoea, haemopytsis, pulmonary infarction, pulmonary hypertension

90
Q

what do the effects of a PE depend on

A

seize of embolus, cardiac function, respiratory function

91
Q

what can be the effects of a small emboli

A

clinically silent, recurrent= pulmonary hypertension

92
Q

what can be the effect of a large emboli

A

death, infarction, severe symptoms

93
Q

what is ischaemic necrosis

A

death of tissue due to lack of blood supply (pulmonary infarct)

94
Q

what is secondary pulmonary hypertension almost always due to

A

lung disease

95
Q

how does hypoxia cause pulmonary hypertension

A

as causes vascular constriction ONLY IN THE LUNG- EVERYWHERE ELSE HYPOXIA CAUSES DILATION

96
Q

how does congenital heart disease cause pulmonary hypertension

A

as increases flow through pulmonary vascular bed

97
Q

how does a PE or emphysema cause pulmonary hypertension

A

blackage (PE) or loss (emphysema) of pulmonary vascular bed (blood vessels of the lungs)

98
Q

what type of heart failure can cause pulmonary hypertension

A

left sided heart faiure- back pressure

99
Q

describe the hypertrophy present in pulmonary hypertension

A

right ventricular hypertrophy, medial hypertrophy of arteries

100
Q

what are two other factors of the morphology of pulmonary hypertension

A

intimal thickening (firbrosis), atheroma (fatty material that forms deposits in arteries)

101
Q

what causes the thickening of pulmonary arteries in pulmonary hypertension and what is it called

A

caused by muscular fibrosis and pulmonary hypertension. called intimal fibrosis

102
Q

what is cor pulmonale

A

pulmonary hypertension complicating lung disease

103
Q

what are the three components of cor pulmonale

A

right ventricular hypertrophy, right ventricular dilatation, right heart failure

104
Q

what is the pleura

A

a mesothelial (lubricated) surface lining the lungs and the mediastinum

105
Q

what is a pleural effusion

A

accumulation of fluid in the pleural cavity

106
Q

is transudate or exudate low or high in protein

A

transudate low protein

exudate high protein

107
Q

what type of process is transudate and what causes it

A

passive process= cardiac failure, hypoproteinaemia

108
Q

what type of process is exudate and what causes it

A

inflammatory process due to; pneumonia, TB, connective tissue disease, malignancy

109
Q

give an example of when a purulent pleural effusion

A

empyema

110
Q

what causes a effusion to be purulent

A

when its full of acute inflammatory cells

111
Q

what is a pneumothorax and what can cause it

A

air in pleural space caused by trauma or rupture of bulla (blister)

112
Q

what causes a spontaneous pneumothorax

A

rupture of bulla

113
Q

what are the two types of primary pleural neoplasia

A

benign (rare), malignant mesothelioma

114
Q

what is a common form of secondary pleural neoplasia

A

adenocarcinomas

115
Q

can you get benign mesothelioma

A

no

116
Q

why can mesothelioma look like either sarcoma or carcinoma

A

mixed epithelial/mesenchymal differentiation