1. Growth Adaptations, Cellular Injury, and Cell Death

Question 1

List the permanent tissues (that can undergo hypertrophy but not hyperplasia).

Answer 1

1) Cardiac muscle
2) Skeletal muscle
3) Myocytes

Question 2

What is the exception to the rule that pathologic hyperplasia can progress to dysplasia and cancer?

Answer 2

Benign Prostatic Hyperplasia (BPH) does NOT increase the risk for prostate cancer

Question 3

How does a decrease in cell size occur?

Answer 3

ubiquitin-proteosome degradation of the cytoskeleton and autophagy of cellular components

Question 4

True or false: metaplasia is irreversible.

Answer 4

FALSE (it is reversible with the removal of the driving stressor)

Question 5

What is the exception to the rule that metaplasia can progress to dysplasia and cancer?

Answer 5

Apocrine metaplasia of the breast carries NO increased risk for cancer

Question 6

What are the 2 major consequences of Vitamin A deficiency?

Answer 6

• Night blindness

- Maturation of immune system gets dysregulated

Question 7

True or false: dysplasia is reversible.

Answer 7

TRUE (with alleviation of the inciting stress)

Question 8

What cell type is most susceptible to ischemic injury (can survive only 3-5 minutes with no oxygen)?

Answer 8

Neurons

Question 9

How does the response to quickly occurring ischemia differ from the response to slowly occurring ischemia?

Answer 9

Quickly occurring ischemia often leads to injury while slowly occurring ischemia often leads to growth adaptations

Question 10

What are the 2 most common causes of Budd Chiari syndrome?

Answer 10

• Polycythemia vera

- Lupus anticoagulant

Question 11

What is the characteristic PaO2 and SaO2 with anemia?

Answer 11

PaO2 and SaO2 are both normal

Question 12

What is the characteristic PaO2 and SaO2 of CO poisoning?

Answer 12

PaO2 is normal and SaO2 is decreased

Question 13

What is the characteristic PaO2 and SaO2 with methemoglobinemia?

Answer 13

PaO2 is normal and SaO2 is decreased

Question 14

What is the underlying problem in methemoglobinemia?

Answer 14

oxidant stress (drugs) or immature machinery (newborns) leads to oxidation of the heme in iron which decreases oxygen binding capacity

Question 15

How do you treat methemoglobinemia?

Answer 15

IV methylene blue

Question 16

What is the hallmark of reversible cell injury?

Answer 16

cellular swelling (Na+/K+ ATPase can’t work so Na+ and water build up in cell)

Question 17

What is the hallmark of irreversible cell injury?

Answer 17

membrane damage

Question 18

Where is the ETC located?

Answer 18

inner mitochondrial membrane

Question 19

What is the word for nuclear condensation?

Answer 19

pyknosis

Question 20

What is the word for nuclear fragmentation?

Answer 20

karyorrhexis

Question 21

What is the word for nuclear dissolution?

Answer 21

karyolysis

Question 22

What ALWAYS follows necrosis?

Answer 22

inflammation

Question 23

What is the pattern of necrosis where the tissue remains firm and the cell shape and organ structure are preserved (often pale and wedge-shaped)?

Answer 23

coagulative necrosis

Question 24

What leads to coagulative necrosis?

Answer 24

ischemic infarction

Question 25

What organ does NOT undergo coagulative necrosis after ischemic infarction?

Answer 25

brain (liquefactive necrosis)

Question 26

What pattern of necrosis is coagulative but resembles mummified tissue?

Answer 26

gangrenous necrosis

Question 27

What pattern of necrosis is due to enzymatic lysis of cells and protein?

Answer 27

Liquefactive necrosis

Question 28

What two types of necrosis are seen in pancreatitis?

Answer 28

liquefactive necrosis of parenchyma | fat necrosis peripancreatic fat

Question 29

What pattern of necrosis is soft and friable with a "cottage-cheese like appearance"?

Answer 29

caseous necrosis

Question 30

Caseous necrosis is characteristic of which types of inflammation?

Answer 30

granulomatous inflammation due to Tb or fungal infection

Question 31

What does fat necrosis look like?

Answer 31

chalky white due to deposition of calcium

Question 32

What is saponification?

Answer 32

example of dystrophic calcification in which calcium deposits on dead tissue (in the setting of NORMAL serum calcium and phosphate)

Question 33

What causes endometrial shedding (cellular level) during menses?

Answer 33

apoptosis

Question 34

What happens to virally infected cells?

Answer 34

recognized by CD8+ T cells and signaled to undergo apoptosis

Question 35

Why is apoptosis NOT followed by inflammaiton?

Answer 35

apoptotic bodies are consumed by macrophages

Question 36

What is the MAJOR mediator of apoptosis? What does it do?

Answer 36

caspases (activate proteases that break down the cytoskeleton and activates endonucleases that break down DNA)

Question 37

List the 3 pathways of apoptosis.

Answer 37

- Intrinsic mitochondrial pathway - Extrinsic receptor-ligand pathway - CD8+ T cell-mediated pathway

Question 38

What is involved in the intrinsic mitochondrial pathway of apoptosis?

Answer 38

Bcl2 inactivated by stress, Cytochrone c is allowed to leak from mitochondria to the cytoplasm to activate caspases

Question 39

What is involved in the extrinsic receptor-ligand pathway of apoptosis?

Answer 39

FAS ligand binds FAS death receptor (CD95) on target cell and activates caspases OR TNF binds to TNFR on target cell and activates caspases

Question 40

What is involved in the CD8+ T cell-mediated pathway of apoptosis?

Answer 40

CD8+ T cells recognize Ag on MHC Class 1, release perforins to create pores in membrane of target cells and granzymes to enter these pores and activate caspases

Question 41

What is the most damaging free radical?

Answer 41

hydroxyl free radical

Question 42

What causes oxygen to become superoxide?

Answer 42

partial reduction

Question 43

What causes superoxide to become hydrogen peroxide?

Answer 43

superoxide dismutase

Question 44

What causes hydrogen peroxide to become hydroxyl free radical?

Answer 44

catalase

Question 45

What causes Hydroxyl free radical to change into H2O and GS-SG?

Answer 45

Glutathione Peroxidase

Question 46

Why does CCl4 lead to fatty change in the liver?

Answer 46

decreased apolipoprotein synthesis occurs (due to cellular injury) and fat is allowed into the liver but cannot get out

Question 47

What are the 2 major features shared by all amyloid?

Answer 47

- Beta-pleated sheet configuration | - Congo red staining and apple green birefringence with polarized light

Question 48

What is deposited in primary amyloidosis?

Answer 48

AL amyloid (from immunoglobulin light chain)

Question 49

What is deposited in secondary amyloidosis?

Answer 49

AA amyloid (from SAA acute phase reactant)

Question 50

In what AR disease do you see an increase in SAA and increaed risk of AA amyloidosis?

Answer 50

Familial Mediterranean Fever (mimics serosal inflammation like appendicitis)

Question 51

What is the most common organ involved in amyloidosis?

Answer 51

Kidney (nephrotic syndrome)

Question 52

What is deposited in Senile cardiac amyloidosis?

Answer 52

non-mutated serum transthyretin

Question 53

What is deposited in familial amyloid cardiomyopathy?

Answer 53

mutated serum transthyretin

Question 54

What is deposited in Alzheimer disease?

Answer 54

A-beta amyloid

Question 55

What is deposited in dialysis-associated amyloid?

Answer 55

beta-2 microglobulin (what supports MHC class 1)

Question 56

How do you biopsy the thyroid?

Answer 56

fine needle aspiration