NEET MDS Lessons
General Pathology
Pleural effusion is a medical condition where fluid accumulates in the pleural cavity which surrounds the lungs, making it hard to breathe.
Four main types of fluids can accumulate in the pleural space:
Serous fluid (hydrothorax)
Blood (hemothorax)
Lipid (chylothorax)
Pus (pyothorax or empyema)
Causes:
Pleural effusion can result from reasons such as:
- Cancer, including lung cancer or breast cancer
- Infection such as pneumonia or tuberculosis
- Autoimmune disease such as lupus erythematosus
- Heart failure
- Bleeding, often due to chest trauma (hemothorax)
- Low oncotic pressure of the blood plasma
- lymphatic obstruction
- Accidental infusion of fluids
Congestive heart failure, bacterial pneumonia and lung cancer constitute the vast majority of causes in the developed countries, although tuberculosis is a common cause in the developing world.
Diagnosis:
- Gram stain and culture - identifies bacterial infections
- Cell count and differential - differentiates exudative from transudative effusions
- Cytology - identifies cancer cells, may also identify some infective organisms
- Chemical composition including protein, lactate dehydrogenase, amylase, pH and glucose - differentiates exudative from transudative effusions
- Other tests as suggested by the clinical situation - lipids, fungal culture, viral culture, specific immunoglobulins
Pemphigoid
1. Ulcerative lesions on the skin and oral mucosa.
2. An autoimmune disease in which patients have autoantibodies against basal cells (desmosome attachment to the basement membrane).
3. Histologically, the entire epithelium appears to separate from the connective tissue. There is no acantholysis.
4. A positive Nikolsky sign is observed.
5. Complications include blindness, due to ocular lesions present in some patients.
6. Treatment: corticosteroids.
HYPERPLASIA
It is the increase in the size of an organ or tissue due to increase in the number of its constituent cells. This is seen in organs made up of labile and stable cells.
Causes
I. Increased demand:
- Bone marrow in hypoxia and haemolytic states.
- Thyroid gland in puberty
2. Persistant Trauma:
- Acanthosis of the epidermis in chronic inflammations and in warts.
- Hyperplasia of oral mucosa due tooth and denture trauma.
- Mucosa at the edges of a gastric ulcer.
3. Endocrine target organ:
- Pregnancy hyperplasia of breast.
- Prostatic hyperplasia.
4. Compensatory:
Hyperplasia of kidney when the other kidney has been removed.
5. Idiopathic:
Endocrine organs like thyroid, adrenals, pituitary etc. can undergo hyperplasia with no detectable stimulus. .
Paroxysmal nocturnal haemoglobinuria (PNH).
Feature:
- Acquired RBC rnembrane defect rendering it susceptible to complement lysis.
- Features of intravascular haemolysis.
- Blood picture of haemolysis anemais with pancytopenia.
- Ham’s acid serum test (lysis at 37COin acid pH) + ve
Hyperthyroidism
Hyperthyroidism (Thyrotoxicosis) is a hypermetabolic state caused by elevated circulating levels of free T3 and T4 . This may primary (Graves disease) or rarely, secondary (due to pituitary or hypothalamic diseases).
- The diagnosis is based on clinical features and laboratory data.
Lab Test
- The measurement of serum TSH concentration provides the most useful single screening test for hyperthyroidism, because TSH levels are decreased in primary cases, even when the disease is still be subclinical.
- In secondary cases TSH levels are either normal or raised.
- A low TSH value is usually associated with increased levels of free T4 .
- Occasionally, hyperthyroidism results from increased levels of T3 .
CARCINOMA IN SITU
Epithelial malignancy which has not yet invaded even -the local confines viz basement membrane is termed as carcinoma in situ (intra epithelial neoplasia, pre-invasive cancer)
This lesion merges morphologically with severe dysplasia
Common sites for carcinoma-in-situ :
- Cervical squamous epithelium
- Oropharynx
- Bronchial epithelium.
- Breast ducts and lobules.
- Skin, in the form of Bowen's disease.
- Glans penis and vulva in the form of Erythroplasia of Queyrat
Lichen planus is an itchy, violaceous, flat-topped papule highlighted by white dots or lines called Wickham's striae.
- lichen planus may occur in the oral mucosa, where it has a fine white net-like appearance.
- increased epidermal proliferation; ? immunologic; initiated by epidermal injury from drugs, viruses, or topical agents.
- characteristic histologic features include:
- hyperkeratosis
- absence of parakeratosis
- prominent stratum granulosum
- an irregular "saw toothed" accentuation of the rete pegs.
- dermal-epidermal junction obscured by a band-like infiltrate of lymphocytes.
- It is generally self-limiting and resolves spontaneously 1 to 2 years after onset; however, the oral lesions may persist for years.