Pathology Question.docx

**[Questions on CVS pathology]** **Mention the scientific term** - An **immune mediated** multisystem disease affecting **all [layers of heart and extra-cardiac sites]**. It occurs after group A beta-hemolytic streptococcal pharyngitis or tonsillitis. - Inflammation of the valvular en...

**[Questions on CVS pathology]** **Mention the scientific term** - An **immune mediated** multisystem disease affecting **all [layers of heart and extra-cardiac sites]**. It occurs after group A beta-hemolytic streptococcal pharyngitis or tonsillitis. - Inflammation of the valvular endocardium, with or without inflammation of the mural endocardium. - Attacks of retrosternal pain, radiating to the left shoulder. They develop after physical effort, psychological stress and, disappear on rest. - Patchy thickening of the intima as a result of lipid deposition, covered by fibrous cap. - Persistent elevation of resting blood pressure above 140/90. - Localized dilatation of the arterial wall. - *Out-pouching from one side of arterial wall* - *Circumferential dilatation of arterial wall* **List** - Pathologic features of rheumatic pancarditis - Three extracardiac lesions in rheumatic fever - Two complications for rheumatic fever - Four causes for secondary hypertension - Four risk factors for primary hypertension - Four major risk factors for atherosclerosis - Four constitutional factors for atherosclerosis - Two complications for acute infective endocardirtis - Four complications for subacute infective endocarditis - Five causes for aneurysm - Three complications for aneurysm **Fill in the spaces:** - Subacute infective endocarditis is caused by........................... and affects.........,.......,.........valves - Acute infective endocarditis is caused by.............and affects...................valves - The most common site for myocardial infarction is......................... - The major cause of death in benign hypertension is.......................... - The major cause of death in malignant hypertension is.................. - In benign nephrosclerosis, the kidneys size are................................... - In malignant nephrosclerosis, the surface of kidney shows........................................... - In benign hypertension, the wall of arteries and arterioles show..........................................\.... - In malignant hypertension, the wall of arteries and arterioles show....................................... - In rheumatic myocarditis, aschoff bodies are located.........................and microscopically showl.............. - The type of infarction in recent myocardial infarction is................................................................... - Cardiac specific troponins are..........................in myocardial infarction - Small adherent vegetations on aortic and mitral valve cusps are detected in................................. - Bulky detachable vegetations containing pus cells are detected in............................................. - Bulky detachable vegetations, free of pus cells are detected in................................................ - The main pathologic lesions in atherosclerosis are...................................................................................... **Common clinical presentations** +-------------+-------------+-------------+-------------+-------------+ | Rheumatic | Subacute | Angina | Malignant | Dissecting | | fever | Infective | | hypertensio | aneurysm | | | endocarditi | Ischemic | n | | | | s | heart | | | | | | | | | | | | +Atheroscle | | | | | | rosis | | | +=============+=============+=============+=============+=============+ | \-\-\-\-\-\ | \-\-\-\-\-\ | \-\-\-\-\-\ | \-\-\-\-\-\ | \-\-\-\-\-\ | | -\-\-\-\-\- | -\-\-\-\-\- | -\-\-\-\-\- | -\-\-\-\-\- | -\-\-\-\-\- | | \-\-\-\-\-\ | \-\-\-\-\-\ | \-\-\-\-\-\ | \-\-\-\-\-\ | \-\-\-\-\-\ | | -\-\-\-\-- | -\-\-\-\-\- | -\-\-\-\-\- | -\-- | -\-\-\-\-\- | | | \-\-\-\-\-\ | - | | \-\-\-\-\-\ | | | -- | | | -\-\-\-- | +-------------+-------------+-------------+-------------+-------------+ **Match the following diseases with appropriate features** 1-Granulomatous inflammation A-Pericardial tumor ------------------------------ ----------------------------- 2-Suppurtaive inflammation B-Rheumatic pericarditis 3-Hemorrhagic inflammation C-Constrictive pericarditis 4-Fibrinous inflammation D-Septicemia 5-Fibrosis and adhesions E-Tuberculous pericarditis 1-Congenital aneurysm A-Mycotic aneurysms ------------------------------------- ---------------------------- 2-Small inflammatory aneurysm B-Dissecting aneurysm 3-Medionecrosis of aorta in old age C-Atherosclerotic aneurysm 4-Large fusiform aneurysm D-Berry aneurysm 5-Left ventricular hypertrophy E-Mitral stenosis 6-Left ventricle not affected F-Aortic stenosis **Classify Congenital Heart Diseases** +-----------------------------------+-----------------------------------+ | **Non Cyanotic** | **Cyanotic** | +===================================+===================================+ | 1- | 1- | | | | | 2- | 2- | | | | | 3- | 3- | | | | | 4- | 4- | | | | | 5- | | +-----------------------------------+-----------------------------------+ **Mention the pathologic lesions characteristic for Fallot's Triad and Fallot's tetralogy** +-----------------------------------+-----------------------------------+ | **Fallot's Triad** | **Fallot's tetralogy** | +===================================+===================================+ | 1- | 1- | | | | | 2- | 2- | | | | | 3- | 3- | | | | | | 4- | +-----------------------------------+-----------------------------------+ - **Define arteritis** - **Define, discuss the pathology & complications of Burger's disease** - **Mention two examples for collagen diseases of arteries** - **Define, discuss the pathology & complications of Polyarteritis nodosa** - **Define, discuss the pathogenesis and pathology of systemic lupus/ SLE** **[Model answer on CVS pathology]** **Mention the scientific term** - An immune mediated multisystem disease affecting **all [layers of heart and extra-cardiac sites]**. It occurs after group A beta-hemolytic streptococcal pharyngitis or tonsillitis. **Rheumatic fever** - Inflammation of the valvular endocardium, with or without inflammation the mural endocardium. **Endocarditis** - Attacks of retrosternal pain, radiating to the left shoulder. They develop after physical effort, psychological stress, disappear on rest. **Angina pectoris** - Patchy thickening of the intima as a result of lipid deposition, covered by fibrous cap. **Atherosclerosis** - Persistent elevation of resting blood pressure above 140/90. **Hypertension** - Localized dilatation of the arterial wall. **True aneurysm** - Out-pouching from one side of arterial wall **Saccular Aneurysm** - Circumferential dilatation of arterial wall **Fusiform Aneurysm** **List:** **Pathologic features of rheumatic pancarditis\ ** +-----------------------+-----------------------+-----------------------+ | **Acute Phase** | **Acute Phase** | **Acute Phase** | | | | | | - Fibrinous | **Aschoff bodies [ | ***Valvular | | Pericarditis | Pathognomonic of | endocardium:*** | | | Rheumatic | | | (Bread & butter) | Fever]** | - **VEGETATIONS** | | | composed of: | (***small | | | | thrombi*** on | | | - Perivascular | valves) ***firmly | | | fibrinoid | adherent*** on | | | necrosis | cusps (more left | | | surrounded by | side: aortic &, | | | | mitral valves) | | | - Macrophages | | | | called Anitschkow | ***Mural | | | cells | endocardium:*** | | | | | | | - Lymphocytes &, | - Aschoff bodies | | | plasma cells | | +-----------------------+-----------------------+-----------------------+ | **Chronic Phase:** | **Chronic Phase:** | **Chronic Phase:** | | | | Fibrosis | | - Milk spots | - Fibrosis | | | | | - ***Valvular***:Pe | | - Fibrous adhesions | | rmanent | | | | valve deformity | | | | (stenosis, | | | | incompetence or | | | | both) | | | | | | | | - ***Mural:*** | | | | McCallum patch | | | | (left atrium) | +-----------------------+-----------------------+-----------------------+ **Three extracardiac lesions in rheumatic fever** 1. Joints : ([**Fleating arthritis**] of large joints ) 2. Brain: [Rheumatic **Chorea**]: involuntary purposeless rapid movement.(inflammation of basal ganglia) 3. [**Subcutaneous Nodules**] (over bony prominences)& skin rash **Two complications for rheumatic fever** 1)Predisposes to [**subacute infective** **endocarditis**]. 2\) Heart failure ( valve lesions): Stenosis or incompetence or both **Four causes for secondary hypertension** 1. **Renal:** Glomerulonephritis, Pyelonephritis, Hydronephrosis, Polycystic kidney 2. **Endocrine:** Pheochromocytoma (adrenal medulla tumor), Cushing syndrome. 3. **Vascular:** Coarctation of the aorta 4. **Blood:** Polycythemia vera **Four risk factors for primary hypertension** a. Familial b. Chronic stress c. Excess salt intake d. Renal artery vasoconstriction renal ischaemia peripheral vasoconstriction **Four major risk factors for atherosclerosis** **1- [Hyperlipidemia]** (high level of plasma lipids): - The total plasma ***cholesterol*** or ***low density lipoprotein (LDL)*** correlate strongly with the severity of atherosclerosis. **2- [Hypertension]** **3- [Diabetes mellitus ]** **4- [Smoking]** **Four constitutional factors for atherosclerosis** ***1- [Age:]** The lesions may start during childhood, but clinical disease after age of 40yrs.* ***2- [Women]** relatively protected by estrogen but the incidence increases after the menopause.* ***3- [Hereditary (familial) predisposition]:** more than one genetic factor* ***4- [Lack of exercise ]**& **[stressful life]**.* **Two complications for acute infective endocardirtis** a\) **Septicemia** b\) **Cusp perforation** **of valves**. **Four complications for subacute infective endocarditis** - **Moderate toxemia** Fever, clubbing of fingers - **Embolic Lesions**: - Infarction of kidney, brain, spleen... - Retinal artery embolus (blindness) - Coronary embolism (rare). - Mycotic aneurysms - Osler\'s nodules: Painful finger nodules Focal embolic glomerulonephritis (flea bitten kidney) **Five causes for aneurysm** - **Hypertension** - **Weakening of the media** - **Congenital**: At bifurcation of arterial wall - **Atherosclerosis** - **Medionecrosis** - **Inflammatory:** - Subacute infective endocarditis - Polyarteritis nodosa **Three complications for aneurysm** 1. Pressure on the surroundings 2. Thrombosis & embolism 3. Rupture & hemorrhage **Fill in the spaces:** - Subacute infective endocarditis is caused commonly by... Streptococcus viridans and affects...rheumatic valves, prosthetic valves and congenital anomalous valves - Acute infective endocarditis is caused commonly by... Staph. aureus, or - The most common site for myocardial infarction is......left ventricle................... - The major cause of death in benign hypertension is.........heart faliure................. - The major cause of death in malignant hypertension is......acute renal failure............ - In benign nephrosclerosis, the kidneys size are.........small.......................... - In malignant nephrosclerosis, the surface of kidney shows...............hemorrhagic foci............................ - In benign hypertension, the wall of arteries and arterioles show......hyalinosis....................................\.... - In malignant hypertension, the wall of arteries and arterioles show.........Fibrinoid necrosis.............................. - In rheumatic myocarditis, aschoff bodies are located......perivascular...................and show microscopically perivascular fibrinoid necrosis surrounded by macrophages called Anitschkow cells - The type of infarction in recent myocardial infarction is.........coagulative necrosis.......................................................... - Cardiac specific troponins and cardiac fraction of creatine kinase are...elevated.......................in myocardial infarction - Small adherent vegetataions on aortic and mitral valve cusps are detected in......rheumatic endocarditis........................... - Bulky detachable vegetations containing pus cells are detected in......acute infective endocarditis....................................... - Bulky detachable vegetations, free of pus cells are detected in...subacute infective endocaritis............................................. - The main pathologic lesions in atherosclerosis are fatty streaks, athermatous plaque and athermanous ulcer... **Match the following diseases with appropriate features** 1-Granulomatous inflammation E-Tuberculous pericarditis ------------------------------ ----------------------------- 2-Suppurtaive inflammation D-Septicemia 3-Hemorrhagic inflammation A-Pericardial tumor 4-Fibrinous inflammation B-Rheumatic pericarditis 5-Fibrosis and adhesions C-Constrictive pericarditis 1-Congenital aneurysm D-Berry aneurysm ------------------------------------- ---------------------------- 2-Small inflammatory aneurysm A-Mycotic aneurysms 3-Medionecrosis of aorta in old age B-Dissecting aneurysm 4-Large fusiform aneurysm C-Atherosclerotic aneurysm 5-Left ventricular hypertrophy F-Aortic stenosis 6-Left ventricle not affected E-Mitral stenosis +-------------+-------------+-------------+-------------+-------------+ | **Rheumatic | **Subacute | **Angina** | **Malignant | **Dissectin | | fever** | Infective | | hypertensio | g | | | endocarditi | **Ischemic | n** | aneurysm** | | | s** | heart** | | | | | | | | | | | | **+Atherosc | | | | | | lerosis** | | | +=============+=============+=============+=============+=============+ | Child | Young age | Old age | Young age | Old age | | | | | | | | History: | History of | Chest pain | Very high | Sudden | | fever& sore | fibrotic/ | radiating | BP 260/120 | severe | | throat/tons | rheumatic/ | to left | | chest pain | | illitis | prosthetic | shoulder | headache | radiating | | | valve | | | to the back | | After 2-3 | | ++ by | eye/ | and down to | | weeks | After 2-3 | exercise | papilledema | abdomen | | | weeks of | | | | | Arthritis(K | tooth | High LDL | Kidney | Hypertensiv | | nee | extraction | | functions: | e | | or | | | abnormal , | patient | | polyarthrit | Fever, | | high | | | is) | fatigue, | | creatinine | Die of | | | clubbing of | | | shock and | | Increased | fingers | | Cerebral | internal | | ESR and | | | hemorrhage | hemorrhage | | ASOT | | | | | +-------------+-------------+-------------+-------------+-------------+ **Classify congenital heart diseases** **ARTERITIS** **[Definition]:** Arterial Wall Inflammation **BUERGER\'S DISEASE** **(THROMBOANGIITIS OBLITERANS)** **[Definition:]** - Segmental inflammation of medium & small arteries that spreads to adjacent veins & nerves. - The disease affects heavy **smoking**, middle-aged males. - Extremities are the main sites. **[Pathology:]** - The arterial walls show acute & chronic **inflammation** associated with **thrombosis**. Thrombi undergo organization and recanalization. **[Effects & complications]:** - a- Intermittent claudications - b- Gangrene **COLLAGEN DISEASES OF ARTERIES:** - **1- Polyarteritis Nodosa** - **2- Systemic Lupus Erytherematosis (SLE)** **1-POLYARTERITIS NODOSA:** **[Definition:]** It is an **autoimmune collagen disease** affecting medium-sized and small arteries of any organ **[except] the lung**. [**Pathology**: ] **Gross:** The wall of the affected artery shows **multiple small nodular swelling** **Microscopic** The nodules consist of **fibrinoid necrosis**, **eosinophils, neutrophils**, and mononuclear leucocytes. Fibrosis develops gradually. **[Effects & complications]**: a\) Thrombosis and infarcts. b\) Mycotic aneurysms due to dilatation of the weak fibrotic parts. c\) Hemorrhage due to rupture of the aneurysms. **2-[SYSTEMIC LUPUS ERYTHEMATOSUS:(SLE):]** **[Definition:]** A fairly common multisystem **autoimmune collagen disease** **[Sex:]** **Female** are much more commonly affected. **[Pathogenesis:]** The main autoantibodies are **antinuclear antibodies (ANAs)**. **[Pathological Features:]** **a-[Acute Necrotizing Vasculitis]:** - It occurs in all tissues - It affects small arteries & arterioles which show **[Fibrinoid necrosis]**, accompanied by [perivascular lymphocytic] infiltrates. Later, these vessels undergo fibrous thickening & [narrowing]. **b-[Kidney Lesions]:** Glomerular involvement may lead to nephrotic syndrome and renal failure.   **c-[Skin rash]: A maculopapular rash** , usually in the butterfly area of the face **d-[Serous membranes]:** Serofibrinous inflammation **e-[Heart lesions]:** [endocarditis], [Myocarditis] & [Pericarditis.] **f-[Joints]:** inflammation