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Questions and Answers
Haemorrhage into a joint is termed:
Haemorrhage into a joint is termed:
The condition where multiple small haemorrhages are seen in the skin and mucous membranes due to a very low circulating platelet number is termed:
The condition where multiple small haemorrhages are seen in the skin and mucous membranes due to a very low circulating platelet number is termed:
A characteristic of primary shock is low blood pressure mediated by a transient neurovascular reaction:
A characteristic of primary shock is low blood pressure mediated by a transient neurovascular reaction:
True
Which type of thrombus would appear to be layered (i.e. showing the lines of Zahn in its cut surface) and would only partially block the vascular lumen?
Which type of thrombus would appear to be layered (i.e. showing the lines of Zahn in its cut surface) and would only partially block the vascular lumen?
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Which type of thrombus would be found on a heart valve?
Which type of thrombus would be found on a heart valve?
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Match the appropriate condition on the left with its aetiology on the right:
Match the appropriate condition on the left with its aetiology on the right:
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Which of the following genes are targets for genetic damage, leading to the development of cancer?
Which of the following genes are targets for genetic damage, leading to the development of cancer?
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Which of the following is an intrinsic factor that is associated with carcinogenesis?
Which of the following is an intrinsic factor that is associated with carcinogenesis?
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Match the carcinogen on the left with a tumour that it is often associated with on the right:
Match the carcinogen on the left with a tumour that it is often associated with on the right:
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The human immunodeficiency virus infects which cells in the body? (Select all correct responses)
The human immunodeficiency virus infects which cells in the body? (Select all correct responses)
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A baby diagnosed with agammaglobulinaemia (Bruton’s disease) will present with what type of infection?
A baby diagnosed with agammaglobulinaemia (Bruton’s disease) will present with what type of infection?
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A viral infection associated with secondary immunodeficiency is:
A viral infection associated with secondary immunodeficiency is:
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If a patient survives an infarct in the myocardium, the condition is most commonly followed by:
If a patient survives an infarct in the myocardium, the condition is most commonly followed by:
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Match the appropriate term on the left with its definition or association on the right:
Match the appropriate term on the left with its definition or association on the right:
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Individuals with primary hyperaldosteronism may develop secondary hypertension.
Individuals with primary hyperaldosteronism may develop secondary hypertension.
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Which person is likely to have the most severe and advanced atherosclerosis (all patients being of the same age and sex)?
Which person is likely to have the most severe and advanced atherosclerosis (all patients being of the same age and sex)?
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Match the appropriate term with its definition or association:
Match the appropriate term with its definition or association:
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Which person is likely to have the most severe arteriolosclerosis in their renal arterioles?
Which person is likely to have the most severe arteriolosclerosis in their renal arterioles?
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Which of the following stimuli are likely to cause a cell mediated hypersensitivity in predisposed individuals? (Select all correct responses)
Which of the following stimuli are likely to cause a cell mediated hypersensitivity in predisposed individuals? (Select all correct responses)
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A cell that is important in type I hypersensitivity reactions is the:
A cell that is important in type I hypersensitivity reactions is the:
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A patient was given an incompatible blood transfusion. What type of reaction is likely to have occurred?
A patient was given an incompatible blood transfusion. What type of reaction is likely to have occurred?
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An example of type III hypersensitivity is “serum sickness”.
An example of type III hypersensitivity is “serum sickness”.
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The accumulation of oedema fluid in the peritoneal cavity is termed:
The accumulation of oedema fluid in the peritoneal cavity is termed:
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Generalized oedema involves increased secretion of:
Generalized oedema involves increased secretion of:
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Which of the following blood losses is an example of an internal haemorrhage?
Which of the following blood losses is an example of an internal haemorrhage?
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In which part of the body may a small volume of haemorrhage be fatal?
In which part of the body may a small volume of haemorrhage be fatal?
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Which of the following terms describes a very small spot of haemorrhage?
Which of the following terms describes a very small spot of haemorrhage?
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What is the main effect of haemorrhage?
What is the main effect of haemorrhage?
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Study Notes
Pathology Study Guide: Weeks 5-8
Carcinogenesis
- Carcinogenesis is the process of initiation and promotion of cancer
- Involves genetic alterations in four classes of genes:
- Growth promoting proto-oncogenes
- Growth-inhibiting tumour suppressor genes
- Genes that regulate apoptosis
- Genes involved in DNA repair
- Genetic alterations lead to abnormal uncontrolled proliferation of cells
- Aetiology of cancer is multifactorial, with carcinogens playing only one part
- Factors that cause tumours are subdivided into intrinsic and extrinsic factors:
- Intrinsic factors: genetic, racial, geographic, immunological, sex, and hormonal factors
- Extrinsic factors: chemical, physical, and biological agents
Immunopathology
- Immunopathology refers to any abnormality in the immune system function leading to a pathological state
- Subdivided into immunodeficiencies, hypersensitivities, and autoimmune disorders
- Primary immunodeficiencies:
- Agammaglobulinaemia (Bruton's disease)
- Thymic aplasia (Di George syndrome)
- Combined immunodeficiency (Swiss syndrome)
- Secondary immunodeficiencies:
- Infection with HIV (AIDS)
- Miscellaneous causes (ageing, infections, tumours, drugs, radiation exposure)
- Hypersensitivities:
- Type I: immediate hypersensitivity (anaphylactic reaction)
- Type II: antibody-mediated hypersensitivity (cytotoxic reaction)
- Type III: immune complex-mediated hypersensitivity
- Type IV: T cell-mediated hypersensitivity (delayed hypersensitivity)
- Autoimmune disorders:
- Involves failure of self-recognition and reaction of the immune system against components of the body
- Autoantigens and autoantibodies are involved in tissue damage
- Cell-mediated immune mechanisms are also important
- Organ-specific autoimmune diseases (e.g. Hashimoto's disease, chronic autoimmune gastritis)
- Systemic autoimmune diseases (e.g. SLE, rheumatoid arthritis)
Oedema
- Oedema is the abnormal accumulation of fluid in intercellular spaces or in body cavities
- Subdivided into localized and generalized oedema
- Localized oedema:
- Due to acute inflammation, allergic hypersensitivity reaction, lymphatic obstruction, or impaired venous drainage
- Examples: ascites, hydrothorax, hydropericardium, hydrocoele, anasarca
- Generalized oedema:
- Due to right heart failure, renal disease, liver disease, malnutrition, or other states
- Involves kidneys, adrenal gland, pituitary gland, and hormonal mechanisms
Haemorrhage and Haemorrhagic Diatheses
- Haemorrhage may be internal or external
- Haemorrhagic diatheses:
- Inherited or acquired disorders that predispose to bleeding
- Examples: haemophilia A, purpura
- Purpura:
- Condition of increased likelihood of haemorrhages from small vessels
- May be related to reduced platelet number, abnormalities in small vessels, or abnormal platelet function
Shock
- Shock is a syndrome indicating a problem in supplying the tissues of the body with adequate amounts of nutrients and oxygen
- Primary shock:
- Mild neurovascular reaction to pain, emotion, or injury
- Secondary shock:
- More severe and involves fluid and electrolyte imbalance in the body
- Due to hypovolaemia, heart failure, or septicaemia
Thrombosis and Embolism
- Thrombosis:
- Clotting of blood within the circulation during life
- Three types of thrombi: white, red, and mixed
- Virchow's triad: changes in the vessel wall, change in blood flow, and changes in blood constituents
- Fates of thrombosis (7)
- Embolism:
- Occlusion of a vessel by a mass of material that is transported in the bloodstream
- Types of emboli (6)### Oedema
- Oedema is the accumulation of fluid in the interstitial tissue, which can lead to swelling
- Causes of oedema:
- Malnutrition (e.g. kwashiorkor)
- Hyperoestrinism (e.g. ovarian disease)
- Liver disease
- Heart failure
- Pulmonary oedema (e.g. as seen in pneumonia)
- Cerebral oedema (e.g. as seen after head trauma)
- Pathogenesis of generalized oedema involves:
- Disrupted Starling forces
- Reduced plasma protein (hypoproteinemia)
- Reduced plasma osmotic pressure
- Hormonal mechanisms involving kidneys, adrenal gland, and pituitary gland
Haemorrhage
- Haemorrhage is the escape of blood from the circulation, which can be life-threatening
- Types of haemorrhage:
- External: Blood is shed outside the body
- Internal: Blood lost into the interstitial tissues or internal body cavities
- Effects of haemorrhage:
- Hypovolaemia
- Shock
- Anaemia
- Haemorrhagic diatheses:
- Congenital (e.g. Haemophilia A)
- Acquired (e.g. liver disease, malnutrition)
Shock
- Shock is a clinical syndrome characterized by a collection of symptoms and signs (e.g. pallor, nausea, hypotension, confusion)
- Types of shock:
- Primary shock: Seen after injury, great pain, or strong emotion; results in syncope and patients recover soon after
- Secondary shock: Seen when there is a disturbance of fluid balance; results in peripheral circulatory deficiency and renal functional deficiency
- Hypovolaemic shock: Due to haemorrhage, plasma loss, or fluid/electrolyte loss
- Cardiogenic shock: Due to cardiac diseases or respiratory disorders affecting the heart
- Septic shock: Due to septicaemia
Thrombosis and Embolism
- Thrombosis: The process of forming a solid or semi-solid mass from the constituents of the blood, within the vascular system
- Embolism: The transfer of abnormal material by the bloodstream and its subsequent lodgement in the vessels downstream
- Infarction: An area of anoxic necrosis produced by an acute interference with a tissue's blood supply
- Virchow's triad:
- Changes in the vessel wall
- Changes in the blood flow
- Changes in the blood constituents
- Clinical risk factors for thrombosis:
- Increased age
- Heart conditions
- Health status
- Immobility
- Cigarette smoking
Infarction
- Infarction is the process of anoxic necrosis due to an acute interference with a tissue's blood supply
- Types of infarcts:
- Pale infarcts: Arise when the arterial blood supply is obstructed and there are no collateral arterial vessels
- Red infarcts: Arise when venous drainage is obstructed and there are no collateral vessels
- Mixed infarcts: Begin as pale infarcts and then have blood readmitted to some areas
- Sequelae of infarction:
- Minimal clinical effects
- Death
- Organization
- Dystrophic calcification
- Sepsis
Hypertension
- Hypertension is a persistent rise in systemic blood pressure to levels >140/90 mmHg
- Types of hypertension:
- Primary hypertension (idiopathic, ~90% of cases)
- Secondary hypertension (known cause, ~10% of cases)
- Benign hypertension (long course, compatible with long life, ~95% of cases)
- Malignant hypertension (short course, life-threatening, ~5% of cases)
- Effects of hypertension:
- Cardiovascular disease
- Renal disease
- Cerebrovascular disease
Arteriosclerosis
- Arteriosclerosis is a group of disorders that involve the hardening and loss of elasticity of arteries
- Types of arteriosclerosis:
- Atherosclerosis: A disease of the intima of large elastic arteries involving lipid deposition and calcification
- Mönckeberg's medial calcification: A disease of the media of medium-sized muscular arteries
- Arteriolosclerosis: A disease of small arteries and arterioles
- Pathogenesis of atherosclerosis:
- Hard and soft risk factors
- Reaction to injury theory
- Clinical effects: Intermittent ischaemic effects, thrombosis, embolism, infarction, and aneurysms### Arteriolosclerosis
- A disease of small arteries and arterioles
- Wall undergoes fibrinoid necrosis with microthrombus formation
- Artery becomes progressively narrowed with ischemic effects
Atherosclerosis
- Aorta and its major branches are mainly affected
- Typical lesion is referred to as an atheroma or atheromatous plaque
- Atheromatous plaques develop in distinct stages:
- Fatty streaks: disputed precursors in the development of atheroma (consist of lipid-laden macrophages)
- Musculoelastic lesions: definite precursors of the typical atheromatous plaque (consist of smooth muscle cells, connective tissue fibers and matrix, plasma proteins and few lipids)
- Typical atheromatous plaques: lead to thickening of the intima and cause the lumen to narrow, while the media become thinner (consist of lipids and necrosis in the intima, a fibrous cap, chronic inflammation)
- Complicated plaques: the atheroma becomes complicated by ulceration, hemorrhage, dystrophic calcification, thrombosis, and aneurysm formation
- Atherosclerosis is a multifactorial disease
- Hard risk factors: hyperlipidemia, hypertension, cigarette smoking, diabetes mellitus, genetics
- Soft risk factors: dietary factors, obesity, lack of exercise, stress, lifestyle factors, personality type, hormonal factors
- Hard risk factors are multiplicative
- Major effects of atherosclerosis: thrombosis, thromboembolism, and infarction which manifest as myocardial and cerebral infarcts
Mönckeberg's Medial Calcification
- A disorder involving medium-sized muscular arteries
- Characterized by degeneration and necrosis of the medial smooth muscle followed by dystrophic calcification
- Intima is not affected and the lumen remains patent unless there is coincident atheroma
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A flexible learning resource to review lectures on pathology delivered in weeks 5, 7, and 8 at your own pace.
