Systemic Pathology Flashcards

Flashcards based on lecture notes about Systemic Pathology, covering topics like cardiovascular diseases, rheumatic fever, endocarditis, myocarditis, pericarditis, ischemic heart disease, heart failure, arteriosclerosis, hypertension, aneurysm, and lung diseases.

What is Rheumatic Fever defined as?

Acute recurrent immune-mediated post streptococcal disease characterized by wide- spread inflammatory & degenerative changes in a variety of tissues mainly heart and joints.

List four predisposing factors for Rheumatic Fever.

1) Bad ventilation. 2) Recurrent streptococcal infections. 3) Familial predisposition. 4) Sex and age: More common in female children and young girls from 5-15 years (school age).

Outline the Etiology and Pathogenesis of Rheumatic Fever.

Rheumatic fever is an immune-mediated disease occurring 2-3 weeks after infection by group A β-hemolytic streptococci (GABS). Theories involve Antigenic Similarity (Cross Reactivity) and Altered antigenicity.

Describe the tissue reactions seen in Rheumatic Fever.

1- Exudative: Tissue edema and infiltration by PNLs, plasma cells and histiocytes. 2- Proliferative: Granulomatous phase characterized by formation of Aschoff's nodules. 3- Healing: The lesions undergo fibrosis.

What are Aschoff Nodules?

Grayish-white nodules measuring about 1-2 mm usually found para-vascular, with a central area of fibrinoid degeneration surrounded by lymphocytes, macrophages and plasma cells.

Which organs are most commonly affected by Rheumatic Fever?

Cardiac:- all layers of heart (myocardium, pericardium, endocardium). Extra-cardiac:- joints, brain, skin, wall of blood vessels, others as pleura lung & pericardium

Define Pan-carditis

Pan-carditis is the term for Acute rheumatic heart disease characterized by Myocarditis, Endocarditis, and Pericarditis.

Describe the gross and microscopic appearance of Myocarditis associated with Rheumatic Fever.

Gross: Mild cardiac dilatation and softening of myocardium. Microscopic: Cloudy swelling and fatty degeneration of myocardial fibers; Aschoff 's nodules in the interstitial fibrous tissue areas.

Describe the gross and microscopic appearance of Endocarditis related to Rheumatic Fever.

Gross: Small (1-2 mm) whitish rubbery adherent platelet and fibrin thrombi called vegetations. Microscopic: Affected valves show inflammation, edema and ulcerations with thrombi formed mainly of platelets and fibrin.

Describe the gross and microscopic appearance of Rheumatic Arthritis in Joints.

Microscopic: Acute sero-fibrinous inflammation of the synovium with exudation in the joint cavity. No deformity because the articular cartilage is not affected.

Describe the gross and microscopic appearance of Subcutaneous nodules associated with Rheumatic Fever.

Gross: Circumscribed nodules about 2 cm in diameter, mobile and firm in consistency. Microscopic: Granulomatous reaction formed of Aschoff's nodules.

List the major and minor criteria for the clinical manifestations of Rheumatic Fever.

Major Criteria: J♥NES (Joint, ♥ (carditis), Nodules, Erythema marginatum, Sydenham chorea). Minor Criteria: Previous attack of rheumatic fever, Arthralgia, Leucocytosis, Elevated ESR, CRP and ASO titer.

Define Endocarditis.

Inflammation of mural and valvular endocardium.

Differentiate between Acute Bacterial Endocarditis (ABE) and Subacute Bacterial Endocarditis (SBE) regarding cause and causative agent.

ABE: Acute suppurative inflammation caused by highly virulent pyogenic organisms. SBE: Subacute inflammation caused by low virulent organisms.

Outline the pathogenesis of Acute Bacterial Endocarditis (ABE).

Valves are damaged by bacteria and its toxins leading to roughness of the endothelial lining predisposing to thrombus formation, followed by ulceration, perforation and destruction of valve cusps.

Outline the pathogenesis of Subacute Bacterial Endocarditis (SBE).

Infection by streptococcus viridans usually results from septic dental focus or throat infection. The affected predisposed valve has low vitality and rough surface, favoring bacterial deposition and multiplication.

Describe the gross appearance of vegetations in Acute Bacterial Endocarditis (ABE).

The Site: mainly on left sided valves (on the cusps). The vegetations are Large, Bulky, Polypoid, Detachable, septic.

Describe the gross appearance of vegetations in Subacute Bacterial Endocarditis (SBE).

The site of vegetations depends on the site of the predisposing valvular lesion. The vegetations are large, polypoidal, friable. The vegetations cover the valve cusps and spread on mural endocardium.

Describe the microscopic appearance of vegetations in Acute Bacterial Endocarditis (ABE).

Vegetations contain fibrin, platelets, bacteria, neutrophils. The valves are infiltrated by: lymphocytes, macrophages, PNL's. Healing by granulation tissue and fibrosis.

Describe the microscopic appearance of vegetations in Subacute Bacterial Endocarditis (SBE).

The vegetations are small and formed of: fibrin, platelets, bacterial colonies and few neutrophils.

List the complications of Acute Bacterial Endocarditis (ABE).

1) Detached vegetations lead to circulation of septic emboli. 2) Spread of infection to aorta or heart wall. 3) Toxic manifestations (toxemia and septicemia)

List the complications of Subacute Bacterial Endocarditis (SBE).

1) Embolic manifestations with infarctions in various organs. 2) Focal embolic glomerulonephritis. 3) Osler nodules. 4) Toxemia.

What are the usual Causes, Vegetations, Affected Valve, Associated Valve Lesion, and Embolization pattern of Rheumatic Endocarditis?

Post streptococcal infection, Small Multiple Firm adherent at sites of valve closure, Normal Valves, Inflammation.

What are the usual Causes, Vegetations, Affected Valve, Associated Valve Lesion, and Embolization pattern of Acute Bacterial Endocarditis?

Infection by highly virulent pyogenic organisms, Bulky Multiple Polypoidal at the free edge, Normal Valves, Inflammation, Ulceration, Perforation, Common pyemia.

What are the usual Causes, Vegetations, Affected Valve, Associated Valve Lesion, and Embolization pattern of Subacute Bacterial Endocarditis?

Infection by low virulent pyogenic organisms, Large Multiple Polypoidal at the free edge, Predisposed mostly by rheumatic or congenital lesion, Inflammation in addition to previous rheumatic or congenital lesion, Common infarction.

What are the causes and effects of Mitral Stenosis?

Causes: Healed rheumatic valvulitis, Subacute bacterial endocarditis. Effects: Dilatation and hypertrophy of left atrium, Pulmonary hypertension, Right-sided heart failure.

What are the causes and effects of Mitral Incompetence?

Causes: Healed rheumatic valvulitis or subacute bacterial endocarditis, Relative M.I. due to dilatation of the left ventricle as anemia and hypertension. Effects: Hypertrophy and dilatation of the left atrium, Hypertrophy of the left ventricle, Pulmonary congestion → Rt sided heart failure.

Define Mitral Valve Prolapse (MVP) and list its complications.

Definition: One or the 2 cusps of the mitral valve become floppy and balloon back into the left atrium during systole. Complications: Arrhythmia, Infective endocarditis, Rupture & sudden death.

What are the causes and effects of Aortic Stenosis (A.S)?

Causes: Congenital stenosis, Healed rheumatic valvulitis or subacute bacterial endocarditis, Atherosclerotic changes (e.g. senile aortic stenosis). Effects: Concentric hypertrophy of left ventricle, Left ventricular failure, Generalized ischemia.

What are the causes and effects of Pulmonary Stenosis (P.S)?

Causes: Congenital stenosis, Healed rheumatic valvulitis or subacute bacterial endocarditis, Atherosclerotic changes, Carcinoid syndrome. Effects: Right ventricular hypertrophy, Right-sided heart failure.

Define Myocarditis and list its causes.

Inflammation of the heart muscles characterized by leukocytic infiltration, necrosis or degeneration of the myocytes. Causes: Infectious and Non-infectious.

List infectious causes of Myocarditis

Viruses, Chlamydia, Bacteria, Fungi, Helminths

List non-infectious causes of Myocarditis

Immune-Mediated Reactions, Physical agents: Radiation, trauma

Describe the gross and microscopic picture of Myocarditis.

Gross: Normal-sized or enlarged heart, Pale foci and minute hemorrhages. Microscopic: Viral: Isolated myofiber lysis, Inflammatory lymphocytic infiltrate. Bacterial: Suppurative reaction, micro-abscesses.

Detail the clinical presentation of Myocarditis.

The condition may be asymptomatic and is suspected by ECG. Symptoms include Arrhythmia, fatigue, dyspnea, palpitations, pericordial discomfort and mild fever. Death due to cardiac failure can occur. Long term viral cases may develop Congestive cardiomyopathy.

Define Pericarditis

An inflammatory disorder of the visceral and parietal layers of the pericardium, with or without associated myocardial disease.

What are the main pathological features of Acute Pericarditis?

Fibrinous inflammation, Purulent inflammation, Caseous necrosis, Hemorrhagic pericarditis.

What are the main pathological features of Chronic Pericarditis?

Adhesive (restrictive) pericarditis: Mild fibrosis, with adherence of the pericardium to adjacent structures. Constrictive pericarditis: Dense fibrous thickening and, sometimes, calcification of pericardium.

Define Pericardial Effusion.

Accumulation of fluid in pericardial sac (N: 30-50 ml serous fluid).

What are the types and causes of Pericardial Effusion?

1- Serous: CHF, hypoproteinemia. 2-Chylous: Lymphatic obstruction. 3- Hemopericardium: Trauma, myocardial rupture, tumors.

Define Hemopericardium and provide several general and local causes.

Accumulation of blood in the pericardial sac. General Causes: Hypertension, Hemophilia, Purpura, Leukemia, Vit C & Vit K deficiency. Local Causes: Congenital telangiectasia, Traumatic, Inflammatory, Neoplastic, Spontaneous rupture aneurysm.

Define Ischemic Heart Disease

Sudden or gradual occlusion of coronary blood supply depending on the nature of coronary artery disease. The left ventricle is the main affected chamber.

List three causes of cardiac ischemia related to coronary blood flow.

1- Decreased coronary blood flow: atherosclerosis superimposed by thrombosis or vasospasm, Arteritis superimposed by thrombosis, Emboli from the left side of the heart.

What are the types of Angina Pectoris?

1- Typical (Stable) Angina, 2- Prinzmetal's Angina, 3- Unstable Angina

Define Myocardial Infarction (M.I).

Localized irreversible myocardial damage or death due to sudden occlusion of coronary blood supply.

List the major and minor risk factors associated with Myocardial Infarction (M.I).

Major risk factors: Hyperlipidemia, Diabetes mellitus, Hypertension, Smoking. Minor risk factors: Old age more in male, High stress life, Family history of atherosclerotic arterial disease.

What are the anatomic and morphologic types of Myocardial Infarction (MI)?

Transmural and Subendocardial

Outline the pathogenesis of Myocardial Infarction.

Major cause is coronary atherosclerosis. Loss of contractility occurs with 1-2 min of ischemia. Disintegration of dead myofibers. Macrophage infiltration with dying neutrophils. Granulation tissue progressively replaces the necrotic area.

Briefly describe the process of M.I. diagnosis

I. Clinical picture II. ECG changes III. Enzyme changes IV. Leukocytosis

What are the top two most common complications of a Myocardial Infarction (M.I)?

1- Arrhythmia: The most common complication and the most common cause of death in the early infarction period. 2-Sudden death: Most often due to arrhythmia.

Define Heart Failure.

The inability of the heart to pump blood sufficiently to meet the body circulatory demands.

Differentiate between Lt.-sided and Rt.-sided Heart Failure Causes

Lt.-sided: Systemic hypertension, Coronary heart disease, Aortic valve disease. Rt.-sided: Restrictive lung diseases as lung fibrosis, Tricuspid & pulmonary valve disease

What is Arteriosclerosis?

Hardening of arteries, with arterial wall thickening and loss of elasticity

What are the main types of Arteriosclerosis?

1) Atherosclerosis. 2) Medial calcification (Monkenberg's medial sclerosis). 3) Arteriolosclerosis

Define Atherosclerosis.

A degenerative disease of arteries marked by elevated intimal fibro-fatty plaques formed of: Lipid deposition, Smooth muscle proliferation, Synthesis of extracellular matrix.

What are the major risk factors of Atherosclerosis?

Hypercholesterolemia, Dyslipidemia, Old age more in males, Diabetes mellitus, Sedentary and stressful life, Hypertension .

Describe the gross picture of Atherosclerosis

The large elastic arteries as aorta and medium-sized muscular arteries as coronary and cerebral arteries are affected. The characteristic atheromatous plaques 'ATHROMA' is yellowish white intimal lesion that reaches up to 1.5 cm in diameter and protrudes into the vascular lumen.

List the complications of Atherosclerosis

1) Narrowing of blood vessels, 2) Hypertension due decreased vascular elasticity, 3) Fissuring and hemorrhage in atheroma, 4) Detachment of atheroma, 5) Weakening of vascular wall aneurysmal dilatation.

What is Arteriolosclerosis?

Degenerative changes affecting small sized arteries and arterioles (< 2 mm in diameter) resulting from persistent high blood pressure.

Compare the affected arteries, morphology, and other features between Benign and Malignant Arteriolosclerosis

Affected Arteries: Benign affects small sized arteries and arterioles less than 100 M in diameter. Morphology: Hyalinosis, Thickening of the arterial wall and narrowing of the lumen. Elastosis. Malignant is characterized by Fibrinoid necrosis in the arterial wall. Marked thickening of the vascular walls & narrowing of lumens

Define Hypertension.

Resistent increase in systolic and diastolic blood pressure above 140/90 mmHg in at least three measurements on at least three separate occasions.

Compare Benign and Malignant Essential Hypertension

Benign Essential Hypertension: Age is above the age of forty. ABP is slow elevation. The arterioles all over the body show the picture of hyaline arteriolosclerosis. Malignant Essential Hypertension is a rapid progressive elevation. ABP is usually over 200/120 mmHg.

Define Aneurysm.

Abnormal, localized dilatation in the arterial wall.

List causes of Aneurysm

All lesions that lead to weakness of the media: Vasculitis as polyarteritis nodosa, Atherosclerosis, Syphilis, Congenital aneurysm.

What are the types of Aneurysm based on shape?

Saccular, Fusiform, Cylindrical

What are the types of Aneurysm based on wall layers?

True Aneurysm and False Aneurysm

Detail the unique features and pathogenesis of Syphilitic Aneurysm.

Syphilitic aortitis begins in the adventitia involving the vasa vasora with resultant obliterative endarteritis; Saccular or fusiform aneurysm occurs in tertiary stage of syphilis confined to the ascending aorta.

What are the major complications of Aneurysms?

1) Pressure atrophy in the surrounding structures. 2) Rupture and hemorrhage. 3) Thrombosis 4) Ischemia 5) Embolization.

Define Reactive Lymphadenitis.

Expansion of one or more of the lymph nodes compartments by proliferating lymphoid cells. The architecture of the lymph node is preserved.

Differentiate between Follicular Hyperplasia, Paracortical Lymphoid Hyperplasia, and Sinus Histiocytosis.

Follicular Hyperplasia: prominent large pale germinal centers. Paracortical Lymphoid Hyperplasia: Reactive changes within the T-cell regions of the lymph node. Sinus Histiocytosis: prominent, distended lymphatic sinusoids caused by marked hypertrophy of lining endothelial cells and infiltration with macrophages.

Define Tonsillitis.

Inflammation of the tonsils.

Differentiate between Acute Catarrhal, Acute Follicular, Membranous Tonsillitis

Acute Catarrhal: Tonsils are Enlarged and Red. Acute Follicular: Acute suppurative inflammation covered by pus. Membranous: Surface of tonsils shows pus spots. The exudate fuses forming a yellow membrane covering the tonsillar surface. It is symmetrical and limited to tonsillar boundaries and non- ( ماااااااااھ ) . adherent

How does the etiology of Primary Infection and Secondary Infections for Tuberculosis of the tonsils differ?

Primary Infection: drinking infected milk. Secondary Infection: Spread of infection from pulmonary lesions.

Define Lymphoma

Malignant neoplasms of cells of the lymphoid tissue (nodal or extranodal).

What are the main diagnostic differences between Classic HL and Nodular Lymphocyte Predominant HL based on cell markers?

Classic HL: CD30+, CD15+, CD20-, CD3-. Nodular Lymphocyte Predominant HL R-S cells are: CD20+, CD45+, CD30-, CD15-

Differentiate between Hodgkin and Non-Hodgkin Lymphoma.

Hodgkin is localized. Non-Hodgkin is peripheral.

What is the general diagnostic difference between Reactive Lymph Nodes and Neoplastic Follicles

Neoplastic Follicles show a Loss of lymph node architecture, and Reactive Follicles show Preserved lymph node architecture

Define Polycythemia

It is an increase in the number of mature red blood cells in the circulation.

Define Leukocytosis.

Increased number of leukocytes in peripheral blood.

Define Leucopenia.

Decreased total leucocytic count below 4000 / mm. Reduced neutrophils.

Define Agranulocytosis.

Decreased total WBC's count below 1000/c. mm. Most of the cells in the peripheral blood are lymphocytes. No anemia or thrombo-cytopenia.

Define Leukemia.

Malignant proliferation of white blood cell precursors. Manifested by the appearance of blast cells in blood and BM.

What are the pathological effects of Leukemia?

Bone Marrow infiltration, Generalized lymphadenopathy, Splenomegaly & Hepatomegaly, Blast Cell Infiltration of other tissues. Bleeding in different parts of the body. Changes in the peripheral blood.

Define Hemorrhagic Blood Diseases.

Group of diseases in which hemorrhage occurs spontaneously or as a result of minimal trauma.

Define Purpura.

Petechial hemorrhages in skin & mucous membranes.

What is a general diagnostic definition of Hemophilia?

Hereditary x-linked disorder affecting males transmitted from a female carrier, results from deficiency of coagulation factors.

Define Rhinosinusitis.

Inflammation of the mucous membranes of the nose and nasal sinuses.

What are the subtypes of Rhinosinusitis?

1. Allergic (Atopic). 2. Non-Allergic: Infectious, Non-infectious, Specific, Non-specific.

What are the underlying causes of Chronic Non-Specific Rhinosinusitis?

Simple chronic rhinitis, Hypertrophic rhinitis, Atrophic rhinitis.

Define Rhinoscleroma.

Chronic infective bacterial granuloma caused by Klebsiella rhinoscleromatis that starts in the nose but may extend upwards to Naso-pharynx and upper lip or extends downwards to the larynx and trachea

What is a Nasal Polyp?

Polypoid mucosal thickening of the nose & nasal sinuses.

Define Epistaxis.

Bleeding from the nose.

What is Nasopharyngitis?

Inflammation of the nasopharynx.

What are Adenoids?

Reactive enlarged lymphoid tissue in posterior wall of the nasopharynx, due to repeated chronic inflammation causing upper airway obstruction.

How does Naso-pharyngeal fibroma display itself under a microscope?

Consists of fibrous tissue intermingled with blood sinusoids.

Define Laryngitis.

Inflammation of the larynx.

Define Pneumonia

Patchy or diffuse inflammation of the lung alveoli with consolidation.

Define Pneumonitis.

Inflammation of the lung alveoli without consolidation.

Define Consolidation

Solidification of lung alveoli.

Define Lobar Pneumonia

Acute diffuse fibrinous inflammation of lung alveoli with consolidation in one or more lung lobes.