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Pathology - Kaplan > Chapter 2 - Cellular Injury and Adaptation > Flashcards

Chapter 2 - Cellular Injury and Adaptation Flashcards

1
Q

Most common cause of cell injury

A

Hypoxia

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2
Q

Major mechanisms leading to hypoxia

A

Ischemia, cardiopulmonary failure, and decreased oxygen-carrying capacity of the blood (e.g., anemia)

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3
Q

Vitamin deficiencies: A

A

Night blindness, squa- mous metaplasia, immune deficiency

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4
Q

Vitamin deficiencies: C

A

Scurvy

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5
Q

Vitamin deficiencies: D

A

Rickets and osteomalacia

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6
Q

Vitamin deficiencies: K

A

Bleeding diathesis

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7
Q

Vitamin deficiencies: B12

A

megaloblastic anemia, neuropathy, and spinal cord degeneration),

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8
Q

Vitamin deficiencies: folate (B9)

A

Megaloblastic anemia and neural tube defects

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9
Q

Vitamin deficiencies: Niacin (B3)

A

Pellagra (diarrhea, dermatitis, and dementia)

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10
Q

Critical intracellular targets that are susceptible to injury

A

DNA

Production of ATP via aerobic respiration

Cell membranes

Protein synthesis

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11
Q

Damage to DNA, proteins, lipid membranes, and circulating lipids (LDL) can be caused by Oxygen-derived free radicals, which are:

A

Superoxide anion (O2 –)

Hydroxyl radical (OH•)

Hydrogen peroxide (H2O2).

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12
Q

ATP depletion can cause … and increase …

A

Disruption of Na+/K+ or Ca++ pumps

Anaerobic glycolysis that leads to a decrease in cellular pH

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13
Q

Influx of calcium can cause problems because calcium is a second messenger, which can activate a wide spectrum of enzymes, like…

A

Proteases (protein breakdown), ATPases (contributes to ATP depletion), phospholipases (cell membrane injury) and endonucleases (DNA damage)

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14
Q

Mitochondrial dysfunction causes…

A

Decreased oxidative phosphorylation and ATP production

Formation of mitochondrial permeability transition (MPT) channels

Release of cytochrome c (a trigger for apoptosis).

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15
Q

Protective factors against free radicals include:

A

• Antioxidants
Vitamins A, E, and C

• Superoxide dismutase
Superoxide → hydrogen peroxide

• Glutathione peroxidase
Hydroxyl ions or hydrogen peroxide → water

• Catalase
Hydrogen peroxide → oxygen and water

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16
Q

Myocardial injury rises the levels of

A

Troponin

CPK-MB

Lactate dehydrogenase (LDH)

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17
Q

Features of Reversible cell injury:

A

Decreased synthesis of ATP by oxidative phosphorylation.

Decreased function of Na+K+ATPase membrane pumps, which in turn causes influx of Na+ and water, efflux of K+, cellular swelling (hydropic swelling), and swelling of the endoplasmic reticulum

Switch to anaerobic glycolysis

Decreased protein synthesis leads to detachment of ribosomes from the rough endoplasmic reticulum

Plasma-membrane blebs and myelin figures

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18
Q

Features of Irreversible cell injury:

A

Severe membrane damage with a massive influx of calcium and efflux of intracellular enzymes and proteins

Marked mitochondrial dysfunction

Rupture of the lysosomes → activation of acid hydrolases → autolysis

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19
Q

Nuclear changes seen in Irreversible cell injury:

A

Pyknosis (degeneration and condensation of nuclear chromatin)

Karyorrhexis (nuclear fragmentation)

Karyolysis (dissolution of the nucleus)

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20
Q

Morphologic types of necrosis: concept

A

Cell death in living tissue, often with an inflammatory response

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21
Q

Most common form of necrosis, most often due to ischemic injury (infarct):

A

Coagulative necrosis

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22
Q

Coagulative necrosis, is caused by…

A

Denaturing of proteins within the cytoplasm

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23
Q

In coagulative necrosis, microscopic examination shows…

A

Loss of the nucleus but preservation of cellular shape

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24
Q

Coagulative necrosis does not occur in the…

A

Brain

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25
Q

Liquefaction necrosis is caused by…

A

Hydrolytic enzymes, leading to autolysis (release of proteolytic enzymes from injured cells) and heterolysis (release of proteolytic enzymes from inflammatory cells).

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26
Q

Liquefaction necrosis occurs in…

A

Abscesses, brain infarcts, and pancreatic necrosis

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27
Q

Caseous necrosis gross appearance is:

A

soft, friable and “cheese-like”

28
Q

Caseous necrosis is characteristic of…

A

Granulomatous diseases

29
Q

Fat necrosis is caused by…

A

action of lipases on adipocytes

it’s characteristic of acute pancreatitis

30
Q

Fat necrosis: gross examination

A

Chalky white appearance.

31
Q

Fibrinoid necrosis is a form of necrotic…

A

connective tissue that histologically resembles fibrin

32
Q

On microscopic examination fibrinoid necrosis has an…

A

Eosinophilic (pink) homogeneous appearance

33
Q

Fibrinoid necrosis is often due to…

A

Acute immunologic injury and vascular hypertensive damage

34
Q

Dry gangrene has … for the microscopic pattern

A

Coagulative necrosis

35
Q

Wet gangrene has … for the microscopic pattern

A

Liquefactive necrosis

36
Q

Apoptosis: concept

A

Programmed cell death without inflammatory response.

37
Q

Apoptosis: in morphologic appearance…

A

the cell shrinks in size and has dense eosinophilic cytoplasm

38
Q

Nuclear changes in apoptosis

A

Pyknosis and karyorrhexis

39
Q

Stimuli for apoptosis include

A

Cell injury and DNA damage,

Lack of hormones, cytokines, or growth factors

Receptor-ligand signals: Fas binding → Fas ligand; tumor necrosis factor (TNF) → TNF receptor 1 (TNFR1)

40
Q

Function of Protein bcl-2

A

Inhibiting apoptosis

41
Q

How does the Protein bcl-2 inhibit apoptosis?

A

Preventing release of Cytochrome C from mitochondria

Binding pro-apoptotic protease activating factor (Apaf-1)

42
Q

Function of protein p53

A

Stimulates apoptosis

43
Q

How does the protein p53 stimulate apoptosis?

A

Arresting the cell cycle

If DNA repair is impossible, p53 stimulates apoptosis.

44
Q

Protein p53 is elavated by…

A

DNA injury

45
Q

Execution of apoptosis is mediated by…

A

a cascade of caspases (cysteine aspartic acid proteases).

46
Q

Function of caspases in apoptosis

A

Digest nuclear and cytoskeletal proteins

activate endonucleases

47
Q

Physiologic examples of apoptosis:

A

Embryogenesis

Menstrual cycle

Selective death of lymphocytes

48
Q

Pathologic examples of apoptosis:

A

Viral diseases (viral hepatitis [Councilman body])

Graft-versus-host disease

Cystic fibrosis (duct obstruction and pancreatic atrophy).

49
Q

Atrophy: concept

A

Decrease in cell size and functional ability

50
Q

Causes of atrophy

A

Decreased workload/disuse (immobilization)

Ischemia (atherosclerosis)

Lack of hormonal or neural stimulation

Malnutrition

Aging

51
Q

Atrophy: Light microscopic examination shows…

A

Small shrunken cells with lipofuscin granules

52
Q

Atrophy: Electron microscopy shows…

A

Decreased intracellular components and autophagosomes.

53
Q

Hypertrophy: concept

A

Increase in cell size and functional ability due to increased synthesis of intracellular components

54
Q

Cell types that are unable to exhibit hyperplasia:

A

Nerve, cardiac, skeletal muscle cells

55
Q

Increased expression of growth-promoting genes (proto-oncogenes) is related to…

A

Hyperplasia

56
Q

Metaplasia: concept

A

Reversible change of one fully differentiated cell type to another

57
Q

Pathologic accumulation: Russell bodies

A

Intracytoplasmic accumulation of immunoglobulins in plasma cells

58
Q

Lipofuscin

A

Perinuclear yellow-brown pigment

Due to indigestible material within lysosomes

Common in the liver and heart

59
Q

Melanin is derived from…

A

Tyrosine found in melanocytes and substantia nigra

60
Q

Hemosiderin

A

Golden yellow-brown granular pigment found in areas of hemorrhage or bruises

61
Q

Examples of intracellular hyaline:

A

Renal proximal tubule protein reabsorption droplets

Russell bodies

Mallory’s hyaline (alcoholic)

62
Q

Examples of extracellular hyaline:

A

Hyaline arteriolosclerosis

Amyloid

Hyaline membrane disease of the newborn

63
Q

Examples of Dystrophic calcification:

A

Fat necrosis (saponification)

Psammoma bodies (laminated calcifications that occur in meningiomas and papillary carcinomas of the thyroid and ovary)

Mönckeberg medial calcific sclerosis in arterial walls

Atherosclerotic plaques.

64
Q

Dystrophic calcification is the precipitation of calcium phosphate in…

A

Dying or necrotic tissues

65
Q

Metastatic calcification is the precipitation of calcium phosphate in…

A

Normal tissue due to hypercalcemia

66
Q

Causes of hypercalcemia:

A

Hyperparathyroidism

Renal failure

Paraneoplastic syndrome

vitamin D intoxication

Milk-alkali syndrome

Sarcoidosis

Paget disease

Multiple myeloma

Pathology - Kaplan (4 decks)

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