أسئلة الثالثة باثولوجي RESP (قبل التعديل)
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What is a potential complication of tuberculosis localized to the pleura?

  • Miliary tuberculosis
  • Pleural effusion
  • Pleurisy (correct)
  • Pulmonary fibrosis

    • Which statement accurately describes the healing process of an apical lesion in a patient with good immunity?

  • There is no significant healing.
  • Healing results only in calcification.
  • A dense fibrous capsule surrounds the area of caseation. (correct)
  • Caseation necrosis occurs without fibrosis.

    • How does the spread of tuberculosis differ between primary and secondary TB?

  • Natural passage spread is rapid in primary TB.
  • Secondary TB has rapid blood spread.
  • Primary TB features late spread through natural passages. (correct)
  • Blood spread is less fatal in primary TB.

    • What determines the nature of the proliferative reaction in secondary tuberculosis?

    <p>It leads to cavitation and ulcer formation.</p> Signup and view all the answers

    Which of the following is NOT true regarding the mass of caseating tuberculous reaction?

    <p>It only occurs in the lungs.</p> Signup and view all the answers

    What is a major environmental factor that predisposes individuals to tuberculosis?

    <p>Bad general hygiene</p> Signup and view all the answers

    Which type of tuberculosis is primarily contracted through inhalation?

    <p>Human type</p> Signup and view all the answers

    Which of the following is NOT a characteristic of the T.B. bacilli?

    <p>Produces exotoxins</p> Signup and view all the answers

    Which demographic is more likely to be affected by tuberculosis due to personal factors?

    <p>Negroes compared to white persons</p> Signup and view all the answers

    Approximately what percentage of infected individuals develop significant tuberculosis disease?

    <p>5%</p> Signup and view all the answers

    What is the primary method by which tuberculosis is transmitted?

    <p>Inhalation</p> Signup and view all the answers

    What component is presented by macrophages to activate T cells in tuberculosis infection?

    <p>Purified protein derivative (PPD)</p> Signup and view all the answers

    What is a primary site of the initial tuberculosis infection complex?

    <p>Lung</p> Signup and view all the answers

    What is the primary location for pulmonary tuberculosis lesions?

    <p>Upper part of the middle lobe</p> Signup and view all the answers

    What is the favorable size and appearance of a caseous lesion in pulmonary tuberculosis?

    <p>1-2 cm in diameter, grayish yellow in color</p> Signup and view all the answers

    What is a potential consequence of TB lymphadenitis?

    <p>Spread to pleura causing TB Pleurisy</p> Signup and view all the answers

    Which statement about millary tuberculosis is true?

    <p>It presents with multiple scattered small tubercles.</p> Signup and view all the answers

    What does good fate mean in the context of tuberculosis progression?

    <p>Healing of the lesions</p> Signup and view all the answers

    What is a characteristic feature of pyemic abscesses in tuberculosis?

    <p>Abscesses surrounded by a hyperemic zone</p> Signup and view all the answers

    What is the main pathophysiological mechanism of miliary tuberculosis?

    <p>Spread by blood to various organs</p> Signup and view all the answers

    Which organ is least likely to be affected by miliary tuberculosis?

    <p>Liver</p> Signup and view all the answers

    What type of tissue reaction characterizes the fate of progressive lesions in tuberculosis?

    <p>Granulomatous inflammation with caseation</p> Signup and view all the answers

    What is a potential complication of lung destruction in tuberculosis?

    <p>Cor pulmonale</p> Signup and view all the answers

    What is a common outcome of localized tissue destruction in tuberculosis infections?

    <p>Development of an apical lesion</p> Signup and view all the answers

    How is the central area of caseation in tuberculosis described microscopically?

    <p>Encased by a granulomatous inflammatory reaction</p> Signup and view all the answers

    What distinguishes the fate of a lesion that is characterized as having a 'good fate' in tuberculosis?

    <p>Absence of hemoptysis and systemic involvement</p> Signup and view all the answers

    What role does Interferon gamma (INFy) play in the immune response against bacilli?

    <p>It activates macrophages and enhances immunity.</p> Signup and view all the answers

    The formation of Langhans giant cells is primarily due to the fusion of which type of cells?

    <p>Epithelioid cells</p> Signup and view all the answers

    What are the characteristics of the caseating material found in tubercles after 2-3 weeks?

    <p>It is structureless and eosinophilic without cellular details.</p> Signup and view all the answers

    The transformation of macrophages into epithelioid cells is triggered by engulfing what component of bacilli?

    <p>The lipid part</p> Signup and view all the answers

    What is the primary function of tumor necrosis factor (TNF-α) in the area of infection?

    <p>Increases blood flow and attracts lymphocytes.</p> Signup and view all the answers

    What forms the firm encirclement of a tubercle by fibroblasts?

    <p>Interferon gamma (INFy)</p> Signup and view all the answers

    Which of the following describes the visible characteristics of a tubercle after 3 weeks?

    <p>Visible 1-3 mm size with central yellow caseation</p> Signup and view all the answers

    What is the primary end product of the inflammatory response to bacilli in the formation of a tubercle?

    <p>Epithelioid granulomas with giant cells and other features</p> Signup and view all the answers

    What is the typical diameter of a caseous lesion in pulmonary tuberculosis?

    <p>1-2 cm</p> Signup and view all the answers

    Which outcome signifies a 'bad fate' in tuberculosis progression?

    <p>Development of tuberculous bronchopneumonia</p> Signup and view all the answers

    What histological feature characterizes the tubercles in miliary tuberculosis?

    <p>Poorly developed tupercles with central necrosis</p> Signup and view all the answers

    In which location do tuberculous lesions typically present within the lungs?

    <p>Lower part of the upper lobe and upper part of the middle lobe</p> Signup and view all the answers

    Which of the following describes the typical appearance of tuberculous lesions?

    <p>Multiple uniform small size tubercles separated by normal tissue</p> Signup and view all the answers

    What typically characterizes the nature of blood spread in primary tuberculosis compared to secondary tuberculosis?

    <p>Blood spread occurs late and is less severe in primary but rapid in secondary.</p> Signup and view all the answers

    Which of the following statements accurately reflects the differences in the spread of tuberculosis between primary and secondary sites?

    <p>Spread through natural passages is rapid in secondary TB and late in primary TB.</p> Signup and view all the answers

    What occurs as a result of healing in an apical lesion when a patient has good immunity?

    <p>A dense fibrous capsule surrounds a central area of caseation.</p> Signup and view all the answers

    Which of the following is NOT a feature of the proliferative reaction in secondary tuberculosis?

    <p>It is slower and characterized by firmer lesions.</p> Signup and view all the answers

    What is a common outcome of localized mass of caseating tuberculous reaction?

    <p>It may be mistaken for a benign tumor.</p> Signup and view all the answers

    Which of the following factors is NOT considered a personal factor predisposing individuals to tuberculosis?

    <p>Overcrowding</p> Signup and view all the answers

    What is the correct description of the T.B. bacilli regarding its motility?

    <p>Non-motile</p> Signup and view all the answers

    Which site is NOT considered a primary infection site for tuberculosis?

    <p>Heart</p> Signup and view all the answers

    Which characteristic is NOT associated with the structure of T.B. bacilli?

    <p>Produces exotoxins</p> Signup and view all the answers

    Among the following options, which is a method of infection transmission for tuberculosis?

    <p>Inhalation</p> Signup and view all the answers

    Which of the following correctly describes the bacilli's interaction with macrophages during the initial phase of infection?

    <p>Bacilli multiply within macrophages.</p> Signup and view all the answers

    What role do helper T cells play in the immune response to tuberculosis?

    <p>Assist macrophages in presenting PPD</p> Signup and view all the answers

    Which environmental factor is least likely to contribute to tuberculosis infection?

    <p>Frequent exercise</p> Signup and view all the answers

    What is the primary effect of interferon gamma (INFy) in the immune response against bacilli?

    <p>Activation of native and blood monocytes</p> Signup and view all the answers

    Which cells are formed by the fusion of multiple epithelioid cells in the granulomatous reaction?

    <p>Langhans giant cells</p> Signup and view all the answers

    What characteristic of the tubercle can be observed after 2-3 weeks of infection?

    <p>Central caseating material becomes soft</p> Signup and view all the answers

    What is the primary role of tumor necrosis factor (TNF-α) during an inflammatory response?

    <p>To enhance blood flow and attract immune cells</p> Signup and view all the answers

    What describes the structural appearance of central caseating material in tuberculosis?

    <p>Structureless eosinophilic material with no cellular details</p> Signup and view all the answers

    What is the function of fibroblasts in the formation of tubercles?

    <p>They encircle the tubercle forming a firm encapsulation</p> Signup and view all the answers

    Which statement best describes the characteristics of epithelioid granulomas?

    <p>They comprise a mixture of giant cells and lymphocytes with central caseation</p> Signup and view all the answers

    What happens to macrophages that engulf the lipid part of bacilli in tuberculosis?

    <p>They transform into epithelioid cells</p> Signup and view all the answers

    What is the pathogenetic feature of pulmonary tuberculosis that indicates a poor prognosis?

    <p>Presence of an apical lesion with significant caseation</p> Signup and view all the answers

    Miliary tuberculosis is characterized by which of the following features?

    <p>Uniform small lesions separated by healthy tissue</p> Signup and view all the answers

    What is a key histopathological finding in a pyemic abscess associated with tuberculosis?

    <p>Central area with pus and acute inflammatory responses</p> Signup and view all the answers

    In the context of tuberculosis, what does 'hypersensitivity reaction' lead to?

    <p>Local tissue destruction and excessive caseation</p> Signup and view all the answers

    What fate is primarily associated with destructive pulmonary lesions in tuberculosis?

    <p>Pulmonary fibrosis and right sided heart failure</p> Signup and view all the answers

    How does the organization of abscesses in pyemic abscesses differ from that in miliary tuberculosis?

    <p>Pyemic abscesses are surrounded by hyperaemia and congestion</p> Signup and view all the answers

    Which statement accurately describes the appearances of small lesions in miliary tuberculosis?

    <p>They are all uniform in size and surrounded by necrotic tissue.</p> Signup and view all the answers

    What is the primary environmental factor contributing to tuberculosis infection?

    <p>Overcrowding.</p> Signup and view all the answers

    What immune cells are primarily responsible for presenting PPD in tuberculosis infection?

    <p>Macrophages.</p> Signup and view all the answers

    What is the significance of a dense fibrous capsule surrounding a central area of caseation in tuberculosis?

    <p>It indicates successful healing of the apical lesion in patients with good immunity.</p> Signup and view all the answers

    How does the nature of the proliferative reaction differ between primary and secondary tuberculosis?

    <p>Primary TB shows a slow, firm reaction while secondary TB features a rapid and softer response causing cavitation.</p> Signup and view all the answers

    What is the main characteristic of T.B. bacilli in terms of bacterial properties?

    <p>Acid-fast.</p> Signup and view all the answers

    What is the role of calcification in the context of latent tuberculosis?

    <p>Calcification signals a previous infection and indicates that the person has latent TB which can reactivate if immunity decreases.</p> Signup and view all the answers

    What percent of individuals infected with tuberculosis develop significant disease?

    <p>About 5%.</p> Signup and view all the answers

    What does the rapid spread of secondary tuberculosis through natural passages imply about its pathophysiology?

    <p>It suggests that secondary TB can progress quickly and is more easily transmitted, indicating a more aggressive disease behavior.</p> Signup and view all the answers

    What type of socioeconomic standard is linked with a higher risk of developing tuberculosis?

    <p>Low socioeconomic standard.</p> Signup and view all the answers

    Why is lymph node enlargement typically absent in secondary tuberculosis compared to primary tuberculosis?

    <p>Lymph node involvement is less in secondary TB, indicating a different immune response and site of infection.</p> Signup and view all the answers

    What is the role of macrophages during the initial phase of tuberculosis infection?

    <p>They take up the bacilli but cannot kill them.</p> Signup and view all the answers

    Which demographic group is identified as having a higher predisposition to tuberculosis based on personal factors?

    <p>Negroes.</p> Signup and view all the answers

    What histological feature distinguishes the tubercles in miliary tuberculosis from other forms?

    <p>Miliary tuberculosis lesions consist of multiple scattered small tubercles, typically around 3mm in size, characterized by poorly developed blood vessels and central necrosis.</p> Signup and view all the answers

    Describe the 'bad fate' outcomes of tuberculosis and one potential consequence for each.

    <p>The 'bad fate' outcomes include local spread to the pleura causing TB pleurisy and lymphatic spread to mediastinal structures, as well as hematogenous spread leading to miliary tuberculosis.</p> Signup and view all the answers

    What is the composition and appearance of a typical caseous lesion found in pulmonary tuberculosis?

    <p>A typical caseous lesion appears grayish-yellow, measuring 1-2 cm in diameter, located beneath the pleura in the lungs, especially in the upper lobe.</p> Signup and view all the answers

    Explain the role of TB lymphangitis and TB lymphadenitis in the progression of tuberculosis.

    <p>TB lymphangitis involves inflammation of lymphatic vessels, while TB lymphadenitis refers to inflammation of lymph nodes, both contributing to the systemic spread of TB infection.</p> Signup and view all the answers

    What distinguishes the fate of tuberculosis lesions classified as having a 'good fate'?

    <p>'Good fate' lesions typically heal without complication, limiting the spread of the disease and preventing significant tissue damage.</p> Signup and view all the answers

    What role does interleukin 12 (IL-12) play in the immune response to infection?

    <p>IL-12 activates helper T lymphocytes to secrete interferon gamma (INFy) and tumor necrosis factor (TNF-α).</p> Signup and view all the answers

    Describe the morphological changes that occur in macrophages after engulfing the lipid part of bacilli.

    <p>Macrophages transform into larger epithelioid cells with large vesicular nuclei and eosinophilic cytoplasm.</p> Signup and view all the answers

    What characterizes the formation of Langhans giant cells?

    <p>Langhans giant cells are formed by the fusion of multiple epithelioid cells and have a characteristic horseshoe arrangement of nuclei.</p> Signup and view all the answers

    How does tumor necrosis factor (TNF-α) influence the inflammatory response?

    <p>TNF-α increases blood flow to the area of inflammation and attracts lymphocytes and monocytes.</p> Signup and view all the answers

    What is the appearance of a tubercle after three weeks and its central caseation material?

    <p>A three-week tubercle typically measures 1-3 mm, with central yellow caseation surrounded by a grey periphery.</p> Signup and view all the answers

    Describe the composition of the central caseating material in a tubercle.

    <p>The central caseation consists of structureless eosinophilic material with no cellular details, surrounded by epithelioid cells, macrophages, Langhans giant cells, and lymphocytes.</p> Signup and view all the answers

    What is the significance of fibroblasts in the context of tubercle formation?

    <p>Fibroblasts encircle the tubercle, contributing to the formation of a firm structure, influenced by INFy.</p> Signup and view all the answers

    What key process starts within the center of a tubercle after 2-3 weeks?

    <p>Central caseation begins, leading to the softening of the tubercle.</p> Signup and view all the answers

    What pathophysiological process causes the formation of multiple small acute abscesses in a pyemic abscess?

    <p>Septic emboli impacted in capillary and small blood vessels cause the formation of multiple small acute abscesses.</p> Signup and view all the answers

    Describe the typical size and appearance of lesions found in miliary tuberculosis.

    <p>Lesions in miliary tuberculosis are typically uniform in size (3mm) and are separated by normal tissue.</p> Signup and view all the answers

    What is the significance of the Assmann focus in the context of tuberculosis?

    <p>The Assmann focus is an apical lesion that begins as a small caseating tuberculous granuloma.</p> Signup and view all the answers

    How does the organism responsible for tuberculosis affect tissue during hypersensitivity reactions?

    <p>Hypersensitivity reactions lead to excessive tissue destruction and extensive caseation from the organism's presence.</p> Signup and view all the answers

    What are the implications of pulmonary hypertension in the context of pulmonary tuberculosis?

    <p>Pulmonary hypertension can arise from the destruction of lung tissue and contributes to right-sided heart failure (cor pulmonale).</p> Signup and view all the answers

    Study Notes

    Tuberculosis (Lecture 3)

    • Definition: A chronic infective granuloma primarily affecting the lungs, but potentially affecting other body systems.

    • Environmental Factors: Low socioeconomic status, poor hygiene, contact with TB patients, overcrowding, and environmental pollution are predisposing factors.

    • Personal Factors: People of African decent are more at risk, malnutrition, debilitating diseases (like diabetes), and immune deficiency states are also risk factors.

    Tuberculosis: Morphology, Causative Agents, and Structure

    • Morphology: Tuberculosis bacteria are aerobic, acid-fast, non-motile, do not produce exotoxins, and are carried by macrophages.

    • Causative Agents: Tuberculous bacteria (named T.B. bacilli).

    • Structure: Bacteria contain carbohydrate, lipid, and protein (tuberculoprotein or PPD).

    • Types: Human TB is caused by inhalation, and bovine TB is caused by ingestion.

    Types of Tuberculous Reaction

    • Tuberculosis Pathogenesis (Primary Tuberculosis):

      • Primary Pulmonary Tuberculosis (0-3 weeks): Initial unchecked bacillary proliferation, mannose-capped glycolipid interactions with macrophages, and alveolar macrophage interaction.
      • Primary Pulmonary Tuberculosis (>3 weeks): "Activated" macrophages, IFN-γ, TNF-α, IL-12, caseous necrosis involvement, and the development of tuberculin positivity ("hypersensitivty").
      • The development of granuloma, a mix of macrophages and lymphocytes.

    Primary Tuberculosis (Childhood Type)

    • Incidence: Occurs in young, non-immunized people, with a low percentage developing significant disease.
    • Methods of Infection: Inhalation, ingestion, and direct contact.
    • Site of Primary Complex: Lung, tonsils, skin, intestines, and nose (rare).

    Reaction of Body Against Bacilli

    • Proliferative Reaction: The initial response to the bacilli, where macrophages take up the bacteria but are unable to kill them; then, the macrophages present PPDs on their surface to helper T cells, which triggers production of interferon gamma and tumor necrotizing factor, leading to more inflammation and granuloma formation.

    Histological Features - N/E and M/E

    • N/E Findings: (Normal/Excisional): Tubercles visible in 3 weeks, approximately 1-3 mm in size, with central yellow caseation and peripheral grey or grey-yellow appearance.
    • M/E Findings: (Micro-excision/Microscopic): Central caseating material, no cellular details, epithelioid cells, macrophages, and Langhan's giant cells. Peripheral reaction surrounding the caseation. Epithelioid granulomas and central caseation and peripheral fibrosis eventually forms..

    Pulmonary Tuberculosis (TB)

    • Site: Favourable due to easy inhalation and aeration. The pulmonary caseous lesions are 1-2 cm in diameter underneath the pleura in the lower part of the upper lobes or upper middle lobes.
    • Parenchymatous Lesion (Ghon's Focus): A caseous lesion.
    • TB Lymphangitis: Lymphatic vessels inflammation.
    • TB Lymphadenitis: Lymph node inflammation.
    • Fate: Good: Healing. Bad: Spread (local, lymphatic, blood, natural passages).

    Miliary Tuberculosis

    • Lesions: Small, uniform-sized tubercles (approximately 3 mm) separated by normal tissue, not surrounded by congestion, found on the surface of organs
    • Microscopic Features: Poorly developed tubercles, absent giant cells, central necrosis, associated with blood vessels.
    • Related to Blood Vessels: The source of scattering of miliary TB is blood vessels.

    Pyemic Abscess

    • Cause: Caused by pyemia (infection in the blood) - septic emboli.
    • Features: Multiple small abscesses, equal in size, on the outer surface, surrounded by hyperaemia.

    Secondary Pulmonary TB

    • Acquisition: Acquired exogenously or from a healed primary complex in adults.
    • Organ Involvement: Kidney, suprarenal gland, fallopian tube, epididymis, brain, and meninges or bones/joints.
    • Pathogenesis: Hypersensitivity reaction leads to excessive tissue damage and caseation; no nodal involvement and likely destruction of the lung to cavities.

    Tuberculoma

    • A localized mass of caseating tuberculous reaction surrounded by fibrous tissue, often mistaken for a tumor.
    • Can occur in almost any organ (lung, kidney, brain etc).

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