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PTHL 312a: Basic Disease Processes
Definition, Scope, and History of Pathology
Topic 1:
The Definition, Scope, and History of Pathology
Definition of Pathology
The Scope of Human Pathology
The Analysis of Disease
Chief Complaint
History of Present Illness
Medical and Dental History
Clinical, Radiographic, and Laboratory
Examinations
Diagnosis
Prognosis
Treatment Plan
The Pathologist’s Role in Disease Analysis
Development of Pathology as a Science
References
Learning Guide
Objectives
Definitions
Workbook
Web Site
Images
Study Questions
Definitions “Flash Cards”
Terms “Flash Cards”
Web Reader with Images
Reader/Learning Guides PDF
Ancient Beginnings (2000 BC - 1543 AD)
Ancient Egyptians
Greeks and Romans
The Stage of Gross Morbid Anatomy (15431858)
Anatomy Emerges from Art
Leonardo
Vesalius (De Fabrica -1543)
The Autopsy Emerges from Anatomy
Benivieni
Disease Study Becomes Accepted
Morgagni
Hunter
Bichat
Rokitansky
The Stage of Cellular Pathology (1858 - 1950)
Virchow (Cellular Pathologie - 1858)
Cohnheim
The Stage of Molecular Pathology (1950 -)
The Electron Microscope
Watson and Crick
©2008 William H. Crawford, Jr., D.D.S., M.S. All rights reserved. Coping for commercial purposes is prohibited.
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PTHL 312a: Basic Disease Processes
Definition, Scope, and History of Pathology
Definition of Pathology
Pathology is about diseases. The prefix “path-” means “disease” and the suffix “-ology” means the “study
of.” This course covers the basic processes underlying most diseases, important diseases of the oral cavity,
and some diseases of other body systems that dental patients may exhibit.
The term “disease” means a deviation from normal, now matter how slight the deviation is. Its literal
definition is “lack of ease.” Since “normal” is used in the definition of “disease” it, too, needs to be defined.
“Normal” is an “accepted standard.” Putting it all together, “disease” is a deviation from some accepted
standard. As an example, blood pressure less than 140/80 is the accepted standard of the normal blood
pressure range; pressures of 140/80 or higher signifies the disease known as “hypertension.”
Diseases are very common. They can occur in virtually all living things—from humans to microbes.
Diseases are often recognized by a visible sore, or, more properly, a “lesion.” Lesions that are visible to the
unaided eye are known as “gross” or “clinical” lesions. Lesions occur at microscopic and submicroscopic
levels too. Very often examination of cells and/or tissues with the light microscope (LM) or the electron
microscope (EM) reveals the existence of a disease before clinical lesions appear.
An early pathologist recognized that some diseases occurred in many body parts while others seemed to be
restricted to specific locations. He devised the term “general pathology” for the first group and “systemic
pathology” for the second. Years ago, it was standard practice to divide pathology textbooks and courses
along these lines; however, in more recent times this separation has been abandoned. One remnant of the
“general pathology” subdivision led to the recognition that there are a few basic disease processes that
underlie hundreds of specific diseases. Inflammation, neoplasia, developmental, and immune-mediated
conditions are examples of some “basic disease processes.” Thinking of such disease processes during
evaluation of patients can simplify the identification of diseases they may exhibit. A couple of additional
disease processes will be added when diseases of the oral and maxillofacial structures are presented.
The Scope of Human Pathology
Pathology is a specialty of medicine and dentistry. Those who have completed specialized training are called
“pathologists.” While pathologists are interested in most aspects of human disease, they are not involved in
all of them. They are not, for example, involved in the social, economic, psychological aspects, or treatment
of diseases. On the other hand, they are very much involved in the recognition of diseases, their causes, and
their progression. Pathologists, then, study the “lesions,” “etiology,” and “pathogenesis” of diseases.
Table 1: Example of Basic Pathologic Processes
Conditions
Example
Inflammation
Abscess, Carbuncle
Neoplasia
Lung Cancer
Developmental
Cleft lip and palate
Immune-Mediated
Lupus Erythematosus
Lesions—For centuries, diseases were identified and classified by their appearance with the unaided eye.
The observed changes became known as “lesions.” Lesions, then, are some visible manifestation of disease.
Boils, carbuncles, and ulcers are examples of gross (clinical) lesions. It is important to realize that effects of
disease can be seen within cells before they become visible with the unaided eye. Today, some diseases are
identified at the sub cellular level; changes visible with the electron microscope (EM) are sometimes called
“EM lesions;” changes observed at the molecular level are “molecular lesions.”
Etiology—Pathologists study the causes of diseases or, more scientifically, the “etiology” of diseases.
“Etiology” is defined as the “study of disease causes.” More specifically, the term refers to study of agents
that cause disease. For example, the etiology for some lip cancers is overexposure to sunlight. Sunlight,
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PTHL 312a: Basic Disease Processes
Definition, Scope, and History of Pathology
then, is an etiologic agent of these cancers. As another example, the human immunodeficiency virus (HIV)
is the etiologic agent of the acquired immunodeficiency syndrome (AIDS) and the type I herpes simplex
virus (HSVI) is the causative agent of oral herpes.
Pathogenesis—Pathologists are also involved in learning how etiologic agents produce abnormal
observable changes (lesions). The steps involved in these transformations are known as the “pathogenesis.”
Continuing with the oral herpes example, how HSVI produces mouth blisters is the pathogenesis of oral
herpes. Pathogenesis, then, is the “mode of development” of diseases. It refers to the biochemical, cellular,
tissue, and organ events resulting in the formation of lesions. The following diagram shows the relationship
between etiology, pathogenesis, and lesions.
Figure 1: The relationship between “etiology,” “pathogenesis,” and “lesion.”
Etiology
Pathogenesis
Lesion
The Analysis of Disease
Over the years, a standard method of assessing patients has emerged. This method or “system” is presented
to medical students early in their education and is reinforced in their clinical rotations, their internships, and
their residencies. Use of the system becomes, therefore, second nature to medical personnel. In recent years,
the dental profession has adopted this system of disease analysis to help practitioners identify oral disease
and to evaluate their patient’s medical status.
Step 1. The Chief Complaint
When a physician or dentist first sees patients, it is essential to determine what propelled them to seek care.
The answer to the practitioner’s question may be as simple as “I need a check up” or as complicated as “I
have terrible headaches.” Finding out why patients seek care is embodied in the term “chief complaint.”
Step 2. History of the Present Illness
Whatever the situation, it is important to talk to patients about the problem (complaint) that they came to
correct. This step is known as “taking the history of the present illness.”
History is defined as “learning by inquiry.” It is natural and logical to learn more about the chief complaint
by asking questions. “How long have you noticed that” or “describe the pain for me” is the sort question
used to learn more about the patient’s condition and constitutes the “history of the present illness.”
Signs and Symptoms—When talking to patients about their chief complaint they may describe visible sores
or invisible pains from which they suffer. The visible complaints are “signs” and the invisible ones are
“symptoms.” “Signs” are complaints the practitioner can see and measure—they are objective.
“Symptoms,” on the other hand, are complaints the practitioner cannot see or measure—they are subjective.
A practitioner can see “signs”; a patient must tell a practitioner about “symptoms.” Headaches are
symptoms; ulcers are signs. Elevated blood pressure is a sign; pain is a symptom.
Step 3. The Medical and Dental History
After learning about a patient’s chief complaint, the next step is to learn more about her/his general health
and about past diseases from which he/she recovered. “Have you been treated by a physician in the past two
years?” and “are you taking any medications at the present time?” are two questions that offer some idea of
what is being sought in obtaining the past medical history. It is also appropriate to learn about the patients
past experiences with dental care.
Step 4. The Clinical, Radiographic, and Laboratory Examinations
After talking to a patient about the current illness (chief complaint) and the past medical history, it is time to
examine for additional signs of disease. The extent and nature of the examination of a patient varies
according to the circumstances. The physical or clinical examination includes those procedures carried out
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PTHL 312a: Basic Disease Processes
Definition, Scope, and History of Pathology
by the physician or dentist—measurement of blood pressure is but one example. Laboratory and
radiographic studies may be undertaken as part of the patient examination as well. In some cases a surgical
procedure, like biopsy, may be needed to insure a complete examination.
Step 5. Determine the Nature of the Disease (“Diagnosis”)
Once sufficient information has been assembled it is time to make a determination of the nature of a
patient’s illness and, as is often said, to make a “diagnosis.” “Diagnosis” according to one standard
dictionary means “to determine the nature of a disease.” In “making a diagnosis,” a practitioner
distinguishes one disease from another; thus, diagnosis is an act of discrimination and categorization.
Pathologists have created classifications to assist practitioners in this task. Many of these will be the subjects
of topics to come.
Step 6. The Prognosis
A prognosis is the forecast of the outcome of a disease. Obviously, patients want to know what is in store for
them. Will the disease clear up quickly? Is it life threatening? Will they have to live with it? These and other
related questions are related to the prognosis. Today, with the need to obtain a patient’s “informed consent”
before therapy is undertaken, it is necessary to predict the outcome of treatment. What will the prognosis be
without treatment? What will it be with treatment A or treatment B? These are questions that need to be
considered in determining a prognosis.
Step 7. The Treatment Plan and Treatment
Treatment should not be undertaken until the nature of a patient’s illness is known. Treatment should be
rational, based on scientific facts, and planned carefully. Complex therapies, like cancer chemotherapy
undertaken in large medical centers follow standardized protocols. These rational, structured, organized
efforts are known as “treatment plans.” Much treatment rendered in dentistry, while usually not life-saving,
is very complex. Many procedures may be required; specialists may need to complete some phases of
treatment. These activities must be guided by a formal written treatment plan.
Table 2: Sequence in Disease Analysis
Steps
Chief Complaint
History of Present Illness
Past Medical (and Dental) History
Patient Examination
Categorization of Disease (“diagnosis”)
Prognosis
Treatment Plan & Treatment
The Pathologist’s Role in Disease Analysis
Medical Pathologists—The medical pathologist is a medical specialist who has successfully completed a
four year residency after completion of medical school and internship. These men and women center their
activities in assisting other physicians reach a proper diagnosis. Because they do not interact with patients
directly, they are not involved in the chief complaint, history, or treatment. Medical pathologists often
supervise the facility in which laboratory tests are conducted (e.g., hospital laboratories). They spend most
of their time, however, performing autopsies and studying tissues removed from living patients (biopsies).
Their findings are written in reports that state the diagnosis of the disease in question; these may also include
comments that help the referring physician determine the treatment plan and the prognosis. In sum the
medical pathologist is most involved with “categorization of disease” or “making a diagnosis.”
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PTHL 312a: Basic Disease Processes
Definition, Scope, and History of Pathology
Oral Pathologists—Oral pathology is one of eight recognized specialties within dentistry. Oral pathologists
are dentists who have completed a three or four year residency in a medical center after completing dental
school. Unlike medical pathologists who number in the thousands, there are only about 200 oral and
maxillofacial pathologists most of whom are employed by dental schools. Like their medical colleagues,
oral pathologists are most involved with the categorization of oral diseases; that is, making diagnoses about
oral diseases. Unlike their medical counterparts, however, oral pathologists often examine patients with
uncommon oral diseases and become involved in many, if not all, steps in the analysis of disease. This
general involvement will, no doubt, decrease in time due to 1) the increased numbers of dentists trained in
oral medicine, and 2) the increased diagnostic sophistication of general dental practitioners. As dental
clinicians become more skilled in recognizing and managing a patient’s dental and medical illnesses, oral
pathologists will be able to restrict their activities to the “making a diagnosis” step in the disease
management protocol.
Development of Pathology as a Science
It may seem that it was always known that diseases are caused by agents (or processes) and that produce
functional and structural changes within the body. Actually, these ideas were developed over a 2,000 year
span and came into practical use only in the last 150 years.
Ancient Beginnings (2000 BC–1543 AD)
The techniques now used in most parts of the world to identify and treat disease can be traced to the early
beginnings in the Western World. There is no doubt that important advances took place in the Eastern World
that may have preceded those in the West but records of them have been lost.
Ancient Egyptians
Given the interest in the after-life as evidenced by mummification of deceased high officials, one would
expect that Egyptian physicians would have studied and written about the lesions they must have seen. If
they did, no written record has been discovered. In spite of the fact that royal embalmers must have handled
a great deal of diseased tissues, there seems to have been little interest in analyzing and recording what they
saw. Some surviving records suggest progress in anatomy and in the ancient equivalent of clinical medicine.
While that may be, the insights of these physicians has little or no impact on the study of disease. This is
surprising because ancient Egyptians made lasting contributions in mathematics and astronomy.
Initial Contributions of the Greeks and Romans
The Greeks, of course, made an enormous impact on the intellectual foundation of Western culture. Their
philosophers and scientists were also scholars: they studied, classified, and wrote about things that
interested them. Their contributions in philosophy, politics, government, art, drama, and architecture were
augmented by contributions in biology, medicine, and anatomy. In the earliest days, Hippocrates (460–370
BC), the great Greek physician, made a lasting impact on medicine by his formulation of the Hippocratic
Oath. Although some scientific achievements flowed from the work of Hippocrates and his colleagues, they
were hindered by the absence of what is now called the “scientific method.” Instead, they relied on intuition
by engaging in inductive rather than deductive reasoning. As a consequence, the Greeks explained diseases
as being caused by “humors” like blood, phlegm, yellow bile, and black bile. While their concept was based
upon observation of these “humors,” they did not appreciate that they were the results (lesions), not the
causes (etiology) of disease.
Celsus—While hindered by the humoral theory of disease, some physicians accomplished a great deal. One
was Cornelius Celsus, a Roman who lived from 30 BC to 38 AD. He is remembered for identifying the signs
of acute inflammation: heat (calor), redness (rubor), pain (dolor), and swelling (tumor). Two-thousand years
after his death, students continue to memorize the terms he devised.
Galen—The Greek and Roman contributions ended with the work of Galen (129–201 AD) who, some
maintain, was the greatest physician of all time. As physician to the Roman gladiators, he gained surgical
and anatomic expertise. Galen’s great powers of observation allowed him to study, classify, and record
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PTHL 312a: Basic Disease Processes
Definition, Scope, and History of Pathology
anatomic and pathologic observations. Some of his observations, like the crab-like growth of cancers, were
correct. However, others were wrong.
While Galen’s writings survived the dark Middle Ages; however, little additional knowledge was added to
the foundations he laid. Galen’s writings were viewed by the Church and medical scholars as infallible.
Neither criticism nor testing of the validity of Galen’s precepts was allowed. This prohibition stalled
progress for centuries. It was not until the thirteenth and fourteenth centuries—the Renaissance—that
progress resumed.
The Stage of Gross Morbid Anatomy (1543–1858)
Anatomy Emerges from Art
In the early Renaissance, dissection of the dead became a logical way to learn about the body’s structure and
function. However, it was easier said than done. Dissection was taboo; the Church forbade it and the public
didn’t understand the need for it. Dissection became a clandestine enterprise. Bodies were exhumed in the
dead of night and carted off to crude laboratories. In face of these problems, it is amazing that anything of
significance was accomplished.
Leonardo—Leonardo da Vinci (1452–1519) was anything but an ordinary artist. His passion for depicting
the human form led him to question the reason for body shapes and contours. To answer these questions,
Leonardo turned to human dissection. His genius gave him the ability to translate structural features, like
bones, muscles, and tendons, into functional insights about posture, movement, and strength. His approach
exemplified the scientific method: he raised questions then sought answers through observation, analysis,
and measurement—all of which he recorded meticulously. The drawings of his studies still exist;
reproductions are widely available.
Vesalius—After Leonardo’s death, a remarkable scientist, Andreas Vesalius (1514–1564), turned his talents
to the study of human anatomy. His efforts resulted in a monumental work, De Fabrica Corpora Humani,
published in 1543. Reprints of this book are still available and still instructive. The drawings of the skeleton
are exquisite not only in their detail and accuracy but in their artistry as well. From his drawings, it is clear
that science and art were fused to a degree not matched since.
The work of Renaissance geniuses like Leonardo and Vesalius made scientific investigation and scientific
publication a method by which complicated processes would be explained—the scientific method. Their
work had a more practical result: it set the stage for others to use anatomic dissection to study the nature of
human disease and, eventually, explain the causes of human death.
The Autopsy Emerges from Anatomy
Benivieni—During Leonardo’s lifetime, a physician, Antonio Benivieni (1443–1502), first used anatomic
dissection to determine the cause of his patient’s deaths. It was Benivieni, then, who is credited with
performing the first autopsy. Actually, he performed many of them and recorded the results of 20 in a book.
Benivieni set the standards that guide autopsies to this day. As examples of his diligence, he sought
permission from the deceased’s family before starting an autopsy and established a protocol guiding
dissection and recording of findings, procedures used to this day. Because of his considerable contributions,
he is revered by pathologists as the “father of pathologic anatomy.”
Disease Study Becomes Accepted
Morgagni—Many others made important contributions to pathologic dissection. Among these are Giovanni
Morgagni and John Hunter. Morgagni’s life bridged the fifteenth and sixteenth centuries (1682–1771). He
was a gifted Italian physician who rose to the chairmanship of Anatomy at the University of Padua. Late in
life, he compiled his clinical observations as a series of case histories. In these, he correlated a patient’s
symptoms with his autopsy findings, a principle that still guides postmortem examinations.
Hunter—John Hunter, an Englishman from the famous line of Hunterian physicians, was a pathologist who
lived from 1728 to 1793. Among his achievements, Hunter devised a method of preserving diseased tissues
and organs so that they might be studied in future years. Ultimately, his collection became incorporated in
London’s Hunterian Museum of Anatomic Pathology. Apparently the museum not only housed interesting
manifestations of diseases in ordinary people, but also contained specimens from the rich and famous as
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PTHL 312a: Basic Disease Processes
Definition, Scope, and History of Pathology
well. A specimen from King George III is reputed to have been the source of learning, in more recent years,
that the King suffered from porphyria, a disease that explains his fits of madness.
Bichat—With the establishment of anatomy as a scientific discipline and the use of anatomic methods to
study disease in postmortem examinations, the stage was set for further progression in the study of disease.
One who capitalized on these advances was Marie-Francois-Xavier Bichat (1771–1802). In retrospect, it
seems that Bichat was one of the first pathologist in the modern sense of that word. He classified what he
saw and noted that some diseases seemed to affect all organs while others were restricted to one organ
system or another. Bichat, then, identified two subdivisions of pathology, general and systemic. In
recognition of his accomplishments, many consider him the “father of modern pathology.” It is interesting
to note that Bichat died as the result of tubercular meningitis acquired, no doubt, while performing an
autopsy on a patient who had died of tuberculosis.
Rokitansky—At the end of a stage in history, there often is an individual whose scientific output is so prolific
that little of significance can be added. Such a person was Carl Rokitansky (1804–1878), a Vienna
pathologist. In his productive lifetime, Rokitansky performed about 20,000 autopsies; an additional 60,000
were performed under his general direction. Given that this level of activity continued for 50 years, he
supervised about 2,000 postmortem examinations each year. As the result of the information gained from
these examinations, there was little that could be added to the result of the study of diseased tissues and
organs with the unaided eye.
The Stage of Cellular Pathology (1858–1950)
Virchow—Antonj van Leeuwenhoek (1632–1723) is credited with development of the first usable
compound microscope. It wasn’t until Rudolf Virchow (1821–1905) came along that the microscope aided
the study of disease. Virchow (pronounced vir-cough), was the first to recognize that diseases arise from
alterations within tissues and cells. He identified and classified a number of such conditions; many still carry
his designations like “thrombosis” and “embolism.” Virchow compiled his observations and his
classifications in the important book Cellular Pathology (Cellular Pathologie) published in 1858. His
contributions lead to the identification of disease at the microscopic level and led to the development of
biopsy and cytology procedures. While recent advances at the sub cellular level will, no doubt, change the
methods of disease recognition in the 21st century, identification and treatment of most diseases now
continue to rely upon developments that flowed from Virchow’s work.
Cohnheim—Most of the early efforts in anatomy and pathology focused upon the structure of normal and
abnormal tissues. In the middle of the 19th century some scholars began to incorporate what was known
about function (physiology) into their considerations. One of these was Julius Cohnheim (1839–1884), a
student of Virchow. While well versed in structure, Cohnheim became interested in functional rather than
anatomic pathology. He devised experiments to study inflammation as it was happening rather than after the
tissue was dead. These experiments led him to be called the “father of experimental pathology.” Cohnheim
was always in the quest for functional explanations of diseases an endeavor now known as “pathologic
physiology.”
The Stage of Molecular Pathology (1950–)
There are two events that have propelled pathology in more recent times: the use of the electron microscope
(EM) and the discovery of the molecular basis of inheritance. When diseased tissues and cells were
examined with the EM, it was clear that changes in organelles were responsible for many of the conditions
Virchow described; in other words, the roots of disease could be found at the EM level. Similarly, when
Watson and Crick uncovered molecular explanation of inheritance, the study of disease moved to the
molecular level
Today hardly a day goes by without a report of the genetic (molecular) basis of some disease. Advances are
coming more rapidly now than in the earlier days. The breakthroughs of today and tomorrow rely, as they
always have, on a firm understanding of the basic biologic principles underlying medical and dental
practice.
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PTHL 312a: Basic Disease Processes
Definition, Scope, and History of Pathology
References:
Florey: General Pathology. Third Edition, W.B.Saunders Company, 1962.
Long, E. R.: History of Pathology. Dover, New York, NY, 1965.
Learning Guide
1.
After completion of this Topic, the student should be able to
• write or identify the terms and definitions presented below
• name and identify the four basic pathologic processes.
• write and identify the differences between “etiology”, “pathogenesis” and “lesions” and be able
to recognize examples of each.
• write and identify the differences between “signs” and “symptoms” and be able to recognize
examples of each.
• write and identify the eight steps in disease analysis
2.
Associate (by identifying them) the following prefixes/suffixes and their meanings. In other words,
when confronted with these prefixes/suffixes, be able to pick the correct term/definition from a list
(multiple choice or matching).
dis-, dys-
bad, deficient
osis
condition of
etio
cause
path
disease
genesis, genic
beginning, onset, producing
pro
before
gno
knowledge
sym
acting together, in union
ology
study of
3.
Associate (by writing them) the following terms with their definitions or with clinical examples of
them. In other words, when confronted with the definition or example of the following, be able to
write, and correctly spell, the defined term. In addition, be able to recognize the context in which
each exists. In addition be able to pick the correct term/definition from a list (multiple choice or
matching).
The complaint (sign or symptom) for which a patient seeks treatment
Etiology
Study of disease causes; an agent that causes disease (e.g., a virus)
Lesion
Visible evidence of diseases (e.g., a “sore”)
Normal
An accepted standard
Pathogenesis
The process by which an etiologic agent produces a disease; the route
of disease development
Prognosis
The forecast or outlook for a disease
Sign
An objective, measurable manifestation of disease; (e.g., lesions and
altered physical findings)
Symptom
A subjective complaint that the health practitioner is not able to see
but must rely on the patient’s description.
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Chief Complaint
PTHL 312a: Basic Disease Processes
4.
Definition, Scope, and History of Pathology
Associate (by identifying them) the following terms and their definitions. In other words, when confronted
with the term or definition of the following, be able to pick the correct term/definition from a list (multiple
choice or matching).
Celsus
A Roman physician credited with reporting the clinical signs of
inflammation (calor, rubor, etc.)
Diagnosis
Categorization of disease; determination of the nature of a disease
Disease
Lack of ease; deviation from normal
Examination
Direct assessment of a patient’s disease by observations, measurements, radiographs, and laboratory tests
Gross
Large; big enough to be seen with the unaided eye
History
Learning by inquiry; learning more about a patient by inquiry
History of Present Illness
Learning more about a patient’s chief complaint by asking questions
about it
Past Medical History
Learning more about a patient’s past medical problems by asking
questions about it
Pathology
The study of diseases
Treatment
Procedures that will be undertaken to improve the patient’s condition; follows the treatment plan
Treatment Plan
A rational, structured list of steps to be followed in treating a patient
Developmentals
Immune-Mediated
Condition
Neoplastic
By placing an “X” in the empty cells, indicate which of the listed conditions are characterized by the indicated basic disease types.
Inflammatory
5.
Abscess
Oral cancer
Cleft lip
Lupus Erythematosus
Carbuncle
Atrophy
Bowel polyp
Supernumerary teeth
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PTHL 312a: Basic Disease Processes
Symptom?
By placing an “X” in the empty cells, indicated whether the printed statements are “signs” or “symptoms.”.
Sign
6.
Definition, Scope, and History of Pathology
Term
Dull, throbbing pain
Fluid-filled blisters
Elevated blood pressure
Headache
Red spot on the tongue
Lesion
Pathogenesis
By placing an “X” in the empty cells, match “etiology,” “pathogenesis,” or “lesion” with the printed statements.
Etiology
7.
Statement
Patients with tuberculosis have nodules,
called granulomas, in their lungs.
A bacterium, Mycobacterium tuberculosis, is responsible for tuberculosis.
An antigenic material on the surface of
Mycobacterium tuberculosis elicits a
hypersensitivity reaction in sensitized
patients.
The Herpes simplex virus infects epithelial cells with resulting fluid accumulation
with the cells.
Fluid-filled blisters are features of infection with the Herpes simplex virus.
The Herpes simplex virus, HSV is
responsible for oral herpetic infection.
8.
10
Complete the following diagram by inserting the terms “pathogenesis,” “lesion,” and “etiology” in their
proper locations.
PTHL 312a: Basic Disease Processes
9.
Definition, Scope, and History of Pathology
In the reader, eight steps were listed guiding the analysis of disease and an order was suggested. List them in
the following table (in order) and briefly describe what each is to accomplish (i.e., their definitions).
Disease Analysis Steps
What the Step is to Accomplish (Definition)
1.
2.
3.
4.
5.
6.
7.
8.
10. By placing an “X” in the empty cells, match the printed stages and dates with their associated descriptions.
1950-?
1858-1950
1453-1858
Before 1543
Dates
Stage of Molecular Biology
Stage of Cellular Pathology
Stage of Gross Morbid Anatomy
Ancient Beginnings
Stage (Age)
Anatomy emerges from art, the autopsy emerges from anatomy, and disease study becomes accepted.
Diseases become studied at submicroscopic and molecular
levels.
Hippocratic Oath, clinical description of inflammation, and
first known anatomic texts that were authorities for centuries
Microscopic basis of disease becomes known and the study
of abnormal function becomes possible.
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PTHL 312a: Basic Disease Processes
Definition, Scope, and History of Pathology
Treatment
History Segment
Prognosis
Treatment Plan
Diagnosis
Examination
Past Medical History
History of Present Illness
Chief Complaint
11. By placing an “X” in the empty cells, match the printed terms with the appropriate portion of jumbled fictitious patient history.
Mr. Forzato said he was currently in “good health.” He was hospitalized three years previously for removal of “gall stones.” He stated
that he was not on any prescribed medication but “took an aspirin or
two” to deal with the sore pain. Mr. Forzato admitted to smoking two
packs of cigarettes a day and having several drinks of bourbon each
evening.
The cancer surgeon admitted Mr. Forzato to a hospital where the necessary surgery was performed. Radiation was performed by a radiation oncologist in a series of outpatient visits.
Mr. Forzato appeared to be overweight and sedentary. He was about
5' 10" tall, his respiration was 20 breaths/minute, and his blood pressure was 160/90. He proved to be partly dentulous without any
replacement prostheses. Some remaining teeth showed evidence of
dental caries. There was much plaque and calculus; probing revealed
several deep periodontal pockets. In the floor of the mouth was a 2.0
x 2.5 cm crated ulcer. Palpation of the area revealed the ulcer to be
“fixed” to the surrounding tissues. Palpation of the neck revealed no
abnormalities.
The patient was referred to an oral surgeon who performed an incisional biopsy of the ulcer. The subsequent pathology report stated
that the ulcer was an “invasive squamous cell carcinoma.”
Mr. Forzato, 58 year-old white male presented himself at a dental
office to determine the cause of a “sore” in his mouth.
Mr. Forzato was informed of the results and was told that cancers of
this size and location carried a 60% five-year survival rate.
Mr. Forzato sought dental care only for emergencies; in such cases,
he appeared at whatever dental office was closest. He said that the
“sore” had been present for about two months. He added that he
thought it was a “canker sore” and that he had expected it to “go
away”-- when it didn't he came to dentist to “give him some ointment
to make it go away.”
Subsequently Mr. Forzato was referred to a head and neck cancer
surgeon who determined that removal of the cancer required wide
resection and subsequent radiation.
12
PTHL 312a: Basic Disease Processes
Definition, Scope, and History of Pathology
12. Again using the history above, find the word(s) that fit the listed terms.
Lesion
Diagnosis
Prognosis
13
PTHL 312a: Basic Disease Processes
Notes:
14
Definition, Scope, and History of Pathology