1
Q
Name the 3 processes which occur in acute inflammation
A
- Change in vessel calibre - flow
- Increased vascular permeability and formation of the fluid exudate
- Formation of cellular exudate - emigration of the neutrophil polymorphs into extravascular space
2
Q
Describe 4 features of neutrophil polymorphs
A
- Short lifespan - 2 or 3 days
- Polymorph - polylobed nucleus, contain lysosomes - kill and digest phagocytosed bacteria
- Arrive first at acute inflammation
- Often die at site and phagocytosed by macrophages
3
Q
Name 4 features of macrophages
A
- Lifespan - month to years
- Phagocytose debris and bacteria
- Transport material to lymphocytes to induce secondary immune response
- Name depending on where located in the body
4
Q
Name 3 features of lymphocytes
A
- Long lived - years
- Produce chemicals involved in controlling inflammation and antibodies
- Immunological memory
5
Q
What is another name for acute inflammation
A
Neutrophil-mediated inflammation
6
Q
What is another name for chronic inflammation
A
Macrophage/lymphocyte-mediated inflammation
7
Q
Name the 4 steps of neutrophil action
A
- Margination
- Adhesion
- Emigration
- Diapedesis
8
Q
When are granulomas present in inflammation
A
Chronic inflammation with collections of macrophages/histocytes surrounded by lymphocytes
e.g. Due to myocardial infection - TB or leprosy
9
Q
Define resolution
A
Complete restoration of tissue to normal
10
Q
Define suppuration
A
Formation of pus (living, dying and dead neutrophils and bacteria, cellular debris) as the causative stimulant is still present
11
Q
Define organisation
A
Replacement of tissues by granulation tissue
12
Q
Define progression
A
Agent that caused acute inflammation is not removed
13
Q
Name the 5 cardinal signs
A
- Heat - calor
- Redness - rubor
- Swelling - tumour
- Pain - dolor
- Loss of function - functio laesa
14
Q
Define hypertrophy
A
Increase in size of tissue caused by an increase in size of its constituent cells
15
Q
Where does hypertrophy occur
Name an example
A
Occurs in organs where cells cannot divide
Examples
- Skeletal muscle in athletes/bodybuilders
16
Q
Describe hyperplasia
A
Increase in size of a tissue caused by an increase in the number of constituents
17
Q
Where does hyperplasia occur
Name an example
A
Occurs in organs where cells can divide
Examples
- benign prostatic hyperplasia
- endometrial hyperplasia
18
Q
Define mixed hypertrophy/hyperplasia
A
Increase in the size of an organ due to an increase in size and number of constituent cells
19
Q
When does mixed hypertrophy/hyperplasia occur
Name an example
A
Occurs in organs where cells can divide
Example
- Smooth muscle cells of the uterus during pregnancy
20
Q
Define atrophy
A
Decrease in the size of a tissue caused by a decrease in number of constituent cells or a decrease in their size
(Generic term for decrease in the size of an organ for whatever reason)
21
Q
Name an example of atrophy
A
Alzheimer’s dementia
Quadriceps muscle following knee injury
22
Q
Define metaplasia
A
Change in differentiation of a cell from one fully-differentiated type to a different fully-differentiated type
23
Q
Name an example of metaplasia
A
Bronchial epithelium from ciliated columnar epithelium to squamous epithelium
Barrett’s oesophagus - squamous epithelium to columnar epithelium
24
Q
Define dysplasia
A
Imprecise term for the morphological changes seen in cells in the progression to becoming cancer
25
Define carcinogenesis
The transformation of normal cells to neoplastic through permanent genetic alterations or mutations
26
Define oncogenesis
Development of a tumour(s) - malignant or benign
27
Define neoplasms
Arise from single cells that have become transformed by cumulative mutational events (clonal proliferations)
28
Define carcinogens
Environmental agents participating in the causation of tumours - act on DNA (mutagenic). Increase the probability of mutational events
29
Define carcinogenic
Cancer causing
30
Define oncogenic
Tumour causing
31
What is the main risk of exposure to carcinogens
Environment - 85%
32
Name 3 reasons why the identification environmental carcinogens possess a problem
1. Latent interval may last decades
2. Complexity of the environment
3. Ethical constraints
33
Name the classes of carcinogens
1. Chemical
2. Viral
3. Ionising and non-ionising radiation
4. Biological agents
5. Miscellaneous carcinogens
34
Name 3 factors influencing invasion
1. Decreased cellular adhesion
2. Secretion of proteolytic enzymes
3. Abnormal or increased cellular motility
35
Define matrix metalloproteinases and their role
Enzymes which are secreted by malignant neoplastic cells
Enables them to digest the surrounding connective tissue
36
Name the 3 major families of matrix metalloproteinases
1. Interstitial collagenases
2. Gelatinases
3. Stromelysins
37
What do interstitial collagenases degrade
Type I, II, III collagen
38
Define metastasis
Process whereby malignant tumours spread from their site of origin (the primary tumour) to form other tumours (secondary tumours) at distant sites
39
Define carcinomatosis
Used to denote extensive metastatic disease
40
Describe the sequence of metastasis (5)
1. Detachment of tumour cells from their neighbours
2. Invasion of the surrounding connective tissue to reach conduits from metastasis (blood and lymphatics vessels)
3. Intravasation into the lumen of vessels
4. Adherence to endothelium at a remote location
5. Extravasation of cells from the vessel lumen into surrounding tissue
41
Define invasive carcinoma
Carcinoma which has invaded through the basement membrane and gone into the stroma
42
Define a microinvasive carcinoma
Gone through the basement membrane into the stroma by a little bit (1 to 2 mm) - risk of spreading is very small
43
Name 3 ways in which the spread of carcinomas are described
1. In situ carcinoma
2. Micro-invasive carcinoma
3. Invasive carcinoma
44
Describe 3 ways in which carcinomas avoid immune system recognition
1. Aggregate with platelets
2. Shed surface antigens
3. Clump together - ones in the middle are safer
45
Name the 5 metastases which travel to bone
1. Lung
2. Breast
3. Kidney
4. Thyroid
5. Prostate
BLT KP
46
What is BLT KP
Way to remember the metastasis which travel to bone
1. Breast
2. Lung
3. Thyroid
4. Kidney
5. Prostate
47
Name 3 routes of metastasis
1. Haematogenous
2. Lymphatic
3. Transcoelomic
48
What route of metastasis do carcinomas prefer
Lymphatic spread
49
What route of metastasis do sarcomas prefer
Haematogenous spread
50
Define a tumour
Abnormal swelling
Can be due to neoplasm, inflammation, hypertrophy, hyperplasia
51
Define angiogenesis
Process by which new blood vessels form from pre-existing ones (essential to growth of tumour cells)
52
Define neoplasm
A lesion resulting from the autonomous or relatively autonomous abnormal growth of cells which persists after the initiating stimulus has been removed
53
What are neoplasms made up from
1. Neoplastic cells
2. Stroma
54
What is the classification of neoplasms
1. Benign
2. Borderline
3. Malignant
55
Name 8 features of benign neoplasm
1. Localised, non-invasive
2. Slow growth rate
3. Low mitotic activity
4. Close resemblance to normal tissue
5. Circumscribed or encapsulated
6. Nuclear morphology - normal
7. Necrosis and ulceration = rare
8. Growth on mucosal surface usually exophytic
56
Name 7 features of malignant neoplasm
1. Invasive
2. Rapid growth rate - increased mitotic activity
3. Variable resemblance to normal tissue
4. Poorly defined/irregular border
5. Hyperchromatic, pleomorphic nuclei
6. Necrosis and ulceration = common
7. Growth on mucosal surface and skin often endophytic
57
Name the benign neoplasm of the non-glandular non-secretory epithelium
Papilloma
58
Name the benign neoplasm of glandular or secretory epithelium
Adenoma
59
Name the malignant epithelial neoplasm
Carcinoma
60
How are benign connective tissue neoplasms named
By their site + oma
61
How are malignant connective tissue neoplasms named
By their site + sarcoma
62
What is the name given when cell type of origin of a neoplasm cannot be determined
Anaplastic
63
What type of prevention is cancer screening
Secondary prevention
64
Name the 3 cancer screening programmes in the UK
1. Breast
2. Bowel
3. Cervical
No screening programme for prostate cancer in the UK because the PSA test is not reliable enough
65
Who can have bowel cancer screening?
Every 2 years
Between age of 60-74 yrs
Gradually expanding the programme to invite people aged 50-59
People over 75 can request
66
Describe the bowel screening test
Faecal immunochemical test (FIT) - look for tiny traces of blood in sample of poo
67
Define a false positive (screening test)
Test picks up something - person does not have cancer
68
Define a false negative (screening test)
Test misses cancer
69
Who is eligible for breast cancer screening?
50 to 70 yrs - every 5 years
70
What does the breast cancer screening test involve?
Mammogram (x-ray) - takes two x-rays of each breast
Can help detect breast cancers when they are too small to see or feel
Finds cancer in around 9/1000
71
When would an individual have a breast cancer screening test earlier?
Family history - every year in 40s. Younger than 40 = MRI.
Gene mutation - yearly MRI. TP53 - from age of 20. BRAC1/2 - from age of 30.
72
Describe cervical screening
Tests for HPV - present with possible cell change
Sample of cells using smear test
73
Who can have cervical screening?
25-64 yrs
Every 3-5 years
Under 25 cell changes in cervix = common
74
Describe the HPV vaccination
12-13 yrs offered vaccination against HPV before encounter the virus
75
Define Atherosclerosis
Accumulation of fibro lipid plaques in systemic arteries (e.g. aorta)
Major course of organ ischaemia
76
Name 4 non-modifiable risks of atherosclerosis
1. Age
2. Gender
3. Family history
4. Radical origin
77
Name 6 modifiable risks of atherosclerosis
1. Lipids
2. Smoking
3. Hypertension
4. Diabetes mellitus
5. Obesity
6. Lack of exercise
78
Describe why diabetes is a risk factor of atherosclerosis
Due to super oxide and anions present and glycosylation products which both cause oxidative stress and endothelial injury
79
Describe why smoking is a risk factor for atherosclerosis
Due to CO, free radicals and nicotine affecting all stages including oxidative stress, endothelial damage, HDL inhibition and increased vulnerability and thrombogenicity of plaques
80
Describe why hypertension is a risk factor of atherosclerosis
Due to shearing forces and increased pressure on endothelial cells increasing inflammation and permeability of lipids through endothelium
81
Describe the endothelial damage theory
1. Damage occurs to endothelium
2. Lipids become trapped under lining. Attracting macrophages taking in the oxidised LDLs and form foam cells
3. Overtime build up forming fibrous plaque
82
Define primary prevention
Measures aimed at preventing disease or its clinical manifestations
83
Define secondary prevention
Preventing progression of the disease of recurrent events in patients who already have the disease
84
Define co-benefits
Activities or changes people can make that will benefit the management of climate change as well as having positive effects on health
85
Name 5 examples of primary prevention in atherosclerosis
1. Improve diet
2. Smoking cessation
3. Increase exercise
4. Small dose aspiring - 75mg/day to lower BP
5. Alcohol avoidance
86
Name 5 examples of secondary prevention on atherosclerosis
1. Statins
2. Diabetes management
3. Antihypertensives
4. Diuretics
5. Antiplatelet therapy
87
Define apoptosis
Programmed cell death
Takes place in single cells.
Important in development and cell turnover.
88
Define p53
Protein in cells which can detect DNA damage and trigger apoptosis
89
Define necrosis
Wholesale destruction of large numbers of cells by some external factors
Death of tissues following bioenergetic failure and loss of plasma membrane integrity
90
Define coagulative necrosis
In most tissues, firm pale area, with ghost outlines on microscopy
91
Define colliquative necrosis
Seen in brain, the dead area is liquified
92
Define caseous necrosis
Seen in TB, there is a pale semi-solid material
93
Define gangrene
Necrosis with putrefaction, it follows vascular occlusion or certain infections and is black
94
Define fibrinoid necrosis
Microscopic feature in arterioles in malignant hypertension
95
Define fat necrosis
May follow trauma and cause a mass, or may follow pancreatitis visible as multiple white spots
96
Define ischaemia
Result of impaired vascular perfusion, depriving affected tissue of vital nutrients, especially oxygen (reduction of blood flow)
Can be reversible
97
Define infarction
Necrosis of tissue as a result of ischemia (reduction in blood flow with subsequent death of cells)
Is irreversible
98
Define shock
Pathophysiological - state of circulatory collapse resulting in impaired tissue perfusion
99
Define thrombus
A solid mass of blood constituents formed within the vascular system of life
100
Describe the formation of arterial thrombus
1. Atheromatous plaque on intima surface of artery
2. Plaque becomes enlarged and protrudes lumen (degree of turbulence flow)
3. Turbulence caused loss of intimal cells - plaque surface presented to blood cells
4. Turbulence predisposes to fibrin deposition and platelet clumping + bare luminal surface - has exposed and platelets settle
5. Layers protrude
6. Thrombi grows in the direction of blood flow = propagation
101
Define an embolus
Mass of material in the vascular system able to become lodged within a vessel and block its lumen
102
Describe the different between a venous and arterial thrombus
Blood pressure is lower in veins, so atheroma does not occur
Most venous thrombi occurs in valves
103
Name an example of a venous thrombus
Pulmonary embolism
104
Name an example of an arterial thrombus
Systemic embolism
105
Name the 3 parts of Virchow's Triangle
1. Change in vessel wall
2. Change in blood flow
3. Change in blood constituents
106
Name the 2 steps of primary platelet formation
1. Platelet adhesion
2. Platelet aggregation
3. Fibrin generation
107
What are the 3 steps involved in coagulation?
1. Vascular spasm
2. Formation of a primary platelet plug
3. Formation of a secondary stable plug
108
What are the 3 steps of to form a primary platelet plug
Adhesion
Activation
Aggregation
109
What mechanism is used to form a secondary stable plug
Coagulation cascade
110
Describe adhesion in the formation of a primary platelet plug
1. Injury exposed endothelium and collagen
2. Collagen fibres bind to vWF, then binds to platelets
3. Exposed fibres trigger the clotting cascade generating thrombin
4. Thrombin converts fibrinogen to fibrin creating a platelet plug
111
Describe activation in the formation of a primary platelet plug
1. Platelet binds to collagen activating glycoprotein IIb/IIa pathway
2. Results in secretion of thromboxane and ADP activating other platelets
3. Results in increased surface area of platelets as prepare for aggregation
112
Describe aggregation in the formation of a platelet plug
1. Platelets express GPIIb/IIIa receptors binding to vWF or fibrinogen
2. Fibrinogen facilitates the crosslinks between platelets
3. Aids aggregation to form a platelet plug
113
What is the extrinsic pathway of the coagulation cascade triggered by
External trauma which causes blood to escape the circulation
114
What is the intrinsic pathway of the coagulation cascade triggered by
Interna damage to the vessel wall
114
Thrombosis
Name 3 factors which affect the vessel wall
Atheroma formation - think of everything which can cause this
Inflammatory response
Direct trauma
114
Thrombosis - name a factor which affects change in blood flow
Recent immobilisation
Most common is DVT
115
Thrombosis - Name 4 factors that can result in a change of blood constituents
1. Smoking
2. Sepsis
3. Malignancy
4. Inherited blood disorders
116
What cancer does polycyclic aromatic hydrocarbons cause?
Where are people exposed to there?
Lung cancer
Skin cancer
Smoking
Mineral oils
117
What cancer do aromatic amines cause?
Where would you be exposed to these?
Bladder cancer
Rubber/dye workers
118
What cancer do nitrosamines cause?
Gut cancer
119
What cancer do alkylating agents cause?
Leukaemia
120
What is the associated cancer of human herpes virus 8
What type of virus is it
Kaposi sarcoma
DNA virus
121
What is the associated cancer of Epstein Barr Virus (2)
What type of virus is it
Burkitt lymphoma
Nasopharyngeal carcinoma
DNA virus
122
What is the associated cancer of hepatitis B virus
What type of virus is it
Hepatocellular carcinoma
DNA virus
123
What is the associated cancers of human papillomavirus virus
What type of virus is it
Squamous cell carcinomas of the cervix, penis, anus, head and neck
DNA virus
124
What is the associated cancer of Merkle cell polyomavirus
What type of virus is it
Merkle cell carcinoma
DNA virus
125
What is the associated cancer of human T-lymphotropic virus
What type of virus is it
Adult T-cell leukaemia
RNA virus
126
What is the associated cancer of hepatitis C virus
What type of virus is it
Hepatocellular carcinoma
RNA virus
127
Exposure to UVA or UVB radiation increases the risk of what cancers
Basal cell carcinoma
Squamous cell carcinoma
Melanoma
128
Increased hormone oestrogen increases the risk of which cancers
Mammary/endometrial cancer
129
Mycotoxins are associated with which cancer
Hepatocellular carcinoma
130
Parasite - chlonorchis sinensis is associated with which cancer
Cholangiocarcinoma
131
Parasite - shistosoma - is associated with which cancer
Bladder cancer
132
Name a malignant cell of melanocytes
Melanoma
133
Define melanoma
malignant cell of melanocytes
134
Name a malignant neoplasm of mesothelial cells
Mesothelioma
135
Define mesothelioma
malignant neoplasm of mesothelial cells
136
Name a malignant neoplasm of lymphoid cells
Lymphoma
137
Define lymphoma
malignant neoplasm of lymphoid cells
138
Name a benign connective tissue neoplasm of adipocytes
Lipoma
139
Define lipoma
benign connective tissue neoplasm of adipocytes
140
Name a benign connective tissue neoplasm of cartilage
Chondroma
141
Define chondroma
benign connective tissue neoplasm of cartilage
142
Name a benign connective tissue neoplasm of bone
Osteoma
143
Define osteoma
benign connective tissue neoplasm of bone
144
Name a benign connective tissue neoplasm of vascular
angioma
145
Define angioma
benign connective tissue neoplasm of vascular
146
Name a benign connective tissue neoplasm of straited muscle
Rhabdomyoma
147
Define rhabdomyoma
benign connective tissue neoplasm of striated muscle
148
Name a benign connective tissue neoplasm of smooth muscle
Leiomyoma
149
Define leiomyoma
benign connective tissue neoplasm of smooth muscle
150
Name a benign connective tissue neoplasm of nerves
Neuroma
151
Define neuroma
benign connective tissue neoplasm of nerves
152
Name a malignant connective tissue neoplasm of adipose tissue
Liposarcoma
153
Define liposarcoma
malignant connective tissue neoplasm of adipose tissue
154
Name a malignant connective tissue neoplasm of striated muscle
Rhabdomyosarcoma
155
Define rhabdomyosarcoma
malignant connective tissue neoplasm of straited muscle
156
Name a malignant connective tissue neoplasm of smooth muscle
Leiomyosarcoma
157
Define leiomyosarcoma
malignant connective tissue neoplasm of smooth muscle
158
Name a malignant connective tissue neoplasm of cartilage
Chondrosarcoma
159
Define chondrosarcoma
malignant connective tissue neoplasm of cartilage
160
Name a malignant connective tissue neoplasm of bone
Osteosarcoma
161
Define osteosarcoma
malignant connective tissue neoplasm of bone
162
Name a malignant connective tissue neoplasm of blood vessels
Angiosarcoma
163
Define angiosarcoma
malignant connective tissue neoplasm of blood vessels
Phase 2a
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