NEET MDS Lessons
General Pathology
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
Seborrheic dermatitis is a scaly dermatitis on the scalp (dandruff) and face.
- due to Pitysporium species
- can be seen in AIDS as an opportunistic infection
Bacterial endocarditis
Endocarditis is an infection of the endocardium of the heart, most often affecting the heart valves.
A. Acute endocarditis
1. Most commonly caused by Staphylococcus aureus.
2. It occurs most frequently in intravenous drug users, where it usually affects the tricuspid valve.
B. Subacute endocarditis
1. Most commonly caused by less virulent organisms, such as intraoral Streptococcus viridans that can be introduced systemically via dental procedures.
2. Pathogenesis: occurs when a thrombus or vegetation forms on a previously damaged or congenitally abnormal valve. These vegetations contain bacteria and inflammatory cells. Complications can arise if the thrombus embolizes, causing septic infarcts.
Other complications include valvular dysfunction or abscess formation.
3. Symptoms can remain hidden for months.
4. Valves affected (listed most to least common):
a. Mitral valve (most frequent).
b. Aortic valve.
c. Tricuspid (except in IV drug users, where the tricuspid valve is most often affected).
Cholelithiasis (Biliary calculi)
- These are insoluble material found within the biliary tract and are formed of bile constituents (cholesterol, bile pigments and calcium salts).
Sites: - -Gall bladder, extra hepatic biliary tract. Rarely, intrahepatic biliary tract.
Predisposing factors:-
- Change in the composition of bile. - It is the disturbance of the ratio between cholesterol and lecithin or bile salts which may be due to Hypercholesterolaemia which may be hereditary or the 4 F (Female, Forty, Fatty, Fertile). Drugs as clofibrate and exogenous estrogen. High intake of calories (obesity).
Increased concentration of bilirubin in bile- pigment stones
Hypercalcaemia:- Calcium carbonate stones.
2- Staisis.
3- Infection.
Pathogenesis i- Nucleation or initiation of stone formation:- The nidus may be cholesterol “due to supersaturation” Bacteria, parasite
RBCs or mucous.
ii- Acceleration:- When the stone remains in the gall bladder, other constituents are added to the
nidus to form the stone.
Complications of gall stones:-
- Predispose to infection.- Chronic irritation leading to
a. Ulceration b. Squamous metaplasia & carcinoma.
Smallpox (variola)
- vesicles are well synchronized (same stage of development) and cover the skin and mucous membranes.
- vesicles rupture and leave pock marks with permanent scarring.
Bullous and Vesicular Disease
1. There are many diseases characterized by the presence of vesicles and bullae filled fluid.
2. In pemphigus vulgaris, large, flaccid bullae filled with fluid occur on the skin and within the oral mucosa.
- immunologic disease with IgG antibodies against the intercellular attachment sites between keratinocytes (type II hypersensitivity).
- the vesicle in pemphigus vulgaris has a suprabasal location (just above the basal cell layer and resembling "tombstones")
- scattered keratinocytes in the fluid as a result of acantholysis.
- Nikolsky's sign is where the epidermis slips when touched with the finger.
- fatal disease if left untreated (systemic corticosteroids)
3. Bullous pemphigoid is an immunologic vesicular disease whose vesicle are in a subepidermal location.
- circulating IgG antibody against antigens in the basement membrane (type II hypersensitivity).
4. Dermatitis herpetiformis is an immunologic vesicular lesion characterized by the presence of IgA immune complexes (type III hypersensitivity) at the tips of the dermal papilla at the dermal/epidermal junction producing a subepidermal vesicle filled with neutrophils.
- strong association with gluten-sensitive enteropathy, or celiac disease.
Streptococcal pharyngitis:
A disease of young people, enlarged lymphoid nodules and keratin plugs in the tonsillar pits is seen Complications include retro-pharyngeal abscess (quinsy)
Cellulitis of the deep tissues of the neck is Ludwig's angina
Scarlet fever ("scarlatina") is a strep throat caused by a streptococcus with the gene to make one of the erythrogenic toxins, Patients have a rash with PMNs
Streptococcal skin infections (Impetigo)
Erysipelas is a severe skin infection caused by group A strep; geographic of red, thickened, indurated areas of the skin are characteristic. Unlike staph infections, there is usually little or no tissue necrosis
Post-streptococcal hypersensitivity diseases include rheumatic fever, post-streptococcal glomerulonephritis, and some cases of erythema nodosum