CIS questions

Question 1

what is the name of the process that gives the appearance of cachexia?

Answer 1

atrophy

Question 2

chemical mediator that leads to cachexia?

Answer 2

TNF

elevated TNF-alpha:
-increased gluconeogenesis, lipolysis and proteolysis

• decreased protein, lipid and glycogen synthesis
• decreased appetite and early satiety

Question 3

precocious puberty

Answer 3

pathologic hypertrophy and hyperplasia

defined as puberty with breast development in a girl less than 6-8 years of age

Question 4

aging process in breast tissue?

Answer 4

atrophy physiologic

with aging there is a lot of deposition of fat instead of fibrous tissue

Question 5

process in pregnancy in the breast

Answer 5

physiologic hyperplasia (lobular)

Question 6

colonic polyps

what is the process occurring

Answer 6

pathologic hyperplasia

Question 7

what is the name of the process that gives overall expansion of the subcutaneous tissue - obesity

Answer 7

hyperplasia and hypertrophy of the adipose tissue

Question 8

name the processes that will occur in a fractured area? (3)

Answer 8

necrosis
inflammation
repair

Question 9

fat cells acquired at an early age….

Answer 9

are there for life

Question 10

2 month history of left arm pain and associated painful hard mass in his arm

what is the diagnosis

what process gave rise to this lesion

Answer 10

calcified mass inside of muscle on histology

the histo stain shows –> calcium which stains blue so it shows bony spicules

diagnosis- myositis ossificans
process:
-inflammation, hyperplasia, metaplasia

Question 11

myocytes are terminally differentiated

what cells give rise to myocytes in injury

Answer 11

satellite cells

Question 12

2 hour history of chest pain
left arm pain
mild difficulty breathing
diaphoresis
becomes unresponsive
stops breathing
no palpable pulse

ECG reveals ventricular fibrillation

diagnosis
process?

Answer 12

MI

ischemic cell injury

decrease in oxidative phosphorylation
leads to decrease in ATP:
-rigor (b/c you can’t relax)
-decreased Na pump–> swelling

• membrane injury–> leakage of enzymes (CK, LDH, increase in ca2+ influx)
• lipid deposition (b/c there is decreased protein synthesis)
• clumping of nuclear chromatin

blebs

Question 13

what occurs in the first 24 hours in a MI

Answer 13

changes only at the cellular level:
reversible:
-sarcoplasmic edema
-mild swelling of mitochondria

irreversible:
20-30 min of ischemic time***
markedly swollen mitochondria
amorphous Ca2+ deposits in mitochondria from Ca2+ influx
nuclear clumping and margination of chromatin

muscle fiber:
wavy muscle fibers**
deeply eosinophil (red) ** by end of day 1 due to low pH (4-24 hours)
proteins at low pH precipitate so stain is picked up much better

few neutrophils (12-24 hours)

enzyme:
CK around 2 hours

Question 14

how the neutrophils get to the infarct?

what is the process

Answer 14

stasis
margination

rolling via selectins (upregulated by cytokines)

activation (via cytokines)
adhesion via integrins

diapedesis- across endothelium, BM and into tissues

migration

Question 15

why does protein denaturation happen in an acute MI

Answer 15

this is because there is hypoxia/ischemia
so there is a build up of lactic acid b/c of glycolysis

the low pH causes protein denaturaiton and makes the cells very eosinophilic (red)

Question 16

what nuclear change is predominately present in myocytes in an MI

Answer 16

karyyolysis

Question 17

what nuclear change is present in the neutrophils in an MI

Answer 17

karyorrhexis

Question 18

what occurs 1-3 days out in acute MI

what cells are present
what happens to myocytes

Answer 18

PMN’s attracted to necrotic myocytes
neutrophils reach maximum levels at 2-3 days***
begin to undergo karryorhexis

myocyte necrosis more prominent
-nuclei disappear
striations less prominent

Question 19

do enzymes go up with apoptosis of hepatocytes?

Answer 19

yes!

as well as with necrosis

Question 20

3-10 days out after acute MI

what cells and tissues are present

Answer 20

shift from PMN’s to chronic inflammatory cells
-macrophages digesting dead muscle fibers
lymphcoytes

• granulation tissue***
• proliferation of fibroblasts that begin to lay down collagen
• vascular proliferation

Question 21

10-14 days after acute MI

what is present

Answer 21

scar tissue replaces granulation tissue from periphery inward

Question 22

what would you see in an 8 hour old MI

Answer 22

coagulative necrosis with wavy fibers
hypereosinophilia
increased space b/w the myocytes b/c edema/transudate (fluid separating the cells)

Question 23

2-8 week old MI

Answer 23

more recessation of infallmation
increased collagen
small capillaries that developed with early granulation tissue disappear

Question 24

8 week old MI

Answer 24

dense scar

Question 25

what do you see in a viral infection of the heart

Answer 25

lymphocytic myocarditis (infiltrate of lymphocytes rather than neutrophils)

Question 26

dry gangrene is a type of what necrosis

Answer 26

coagulative necrosis no inflammatory cells

Question 27

what do you see in the periphery in liquefactive necrosis

Answer 27

macrophages eating brain stuff (fat mostly)

Question 28

in what type of fat necrosis do we typically see saponification

Answer 28

pancreatitis | b/c we need the enzymes to break down the fat to combine with the calcium salts

Question 29

what is the properties required of malignant cells in order to invade and spread to single cells?

Answer 29

collagenase | must lose their adhesive molecules and detach from neighbors

Question 30

what is the adhesion molecule classically lost in lobular carcinoma of the breast?

Answer 30

E-cadherin in the breast lobular is distinguished from ductal b/c ductal doesn't invade as single cells and don't lose e-cadherin

Question 31

what is the function of cadherins and integrins ? specifically cadherins, what cells do they interact with?

Answer 31

cadherins and integrins link cell surface to the cytoskeleton cadherin. is calcium dependent adhesion protein participates in interactions between cells of the same type connect plasma mebmranes of adjacent cells found in zonula adherens and desmosomes

Question 32

overdose on paracetomal (Acetominophen) nausea and right upper abdominal pain slightly icteric bile present in the urine began hyperventilating markedly icteric died ``` labs: low blood glucose WBC high ALT high bili high ``` diagnosis? what process occurred ?

Answer 32

acetaminophen intoxication process occurred: chemical cell injury (necrosis) Acetominophen reduces glutathione leads to ROS and Nitrogen species that cause oxidative stress alterations in calcium homeostasis initiation of signal transduction responses mitochondrial permeability transition loss of mitochondrial membrane potential--> loss of ATP production--> necrosis

Question 33

man with hemoptysis smoker losing weight chest x-ray shows white stufff diagnosis? what process gives rise to this process? what tests should be done next?

Answer 33

TB process: necrosis caseating epitheloid granulomas with langhan-type giant cells take sample of sputum biopsy

Question 34

Ziehl-Neelson stain (AFB stain)

Answer 34

showing acid fast bacteria as little red strings

Question 35

cellulitis is what type of inflammation

Answer 35

purulent suppurative inflammation

Question 36

what are the 5 types of purulent/suppurative inflammation?

Answer 36

1> cellulitis 2. lymphangitic 3. abscess *large collection of neutrophils 4. ulcerative 5. pseudo membranous

Question 37

what is the subtype of serous inflammation

Answer 37

urticarial

Question 38

``` 18 month old boy recurrent severe bacterial skin infections lymphadenopathy hepatosplenomegaly foci of skin hypopigmentation silvery hair noted ``` what do you do next?

Answer 38

Chediak-Higashi syndome on peripheral slide: giant granules in neutrophils anemia-> red blood cells are destroyed

Question 39

what is defective in chediak higashi syndrome ?

Answer 39

autosomal recessive defective: lysosomes of leukocytes leading to infections dense bodies of platelets leading to bleeding melanosomes leading to hypopigmentation neurons leading to cognitive impairment and peripheral neuropathy The gene LYST codes for lysosomal trafficking and regulator protein associated with microtubule formation treat--> hematopoietic stem cell or bone marrow transplantation

Question 40

42 year old male SOB doused by formaldehyde breathing improved but then 2 hours it became suddenly much worse the patient expired diagnosis? etiology?

Answer 40

acute respiratory distress syndrome (hyaline membrane disease) etiology: chemical injury protein leaked out, precipitated on the alveolar membranes--> now oxygen exchange cannot occur

Question 41

what is acute respiratory distress syndrome characterized by

Answer 41

high levels of IL-1 and TNF diffuse damage to alveolar walls- capillaries marked increase in vascular permeabiltiy with protein-rich exudate into alveolar spaces which later form hyaline membranes decreased diffusion capacity, hypoxia often results in death or heals with scarring

Question 42

congo red stain

Answer 42

amyloid is a series of proteins that pick up congo red stain apple green birefringence is a diagnosis of amyloidosis

Question 43

viral illnesses such as influenza often produce chronic inflammation that shows up as what in the lungs

Answer 43

interstitial infiltrates ** non productive cough NOT pleural effusions (this is more seen with heart failure, neoplasia or empyema)

Question 44

what is the difference b/w viral and bacterial inflammatory response?

Answer 44

viral--> lymphocyte infiltrates bacterial--> neutrophil infiltrate

Question 45

anthracotic pigment

Answer 45

black color comes from carbon pigments in dust particles inhaled over many years, engulfed by macrophages and sent via lymphatics to the lymph nodes looks bad but does not compromise lung function. smokers have more of this

Question 46

what color are metastatic lesions?

Answer 46

firm and white

Question 47

what are russel bodies

Answer 47

intracellular accumulations of immunoglobulins in plasma cells

Question 48

what might happen in Vitamin A deficiency to the lungs

Answer 48

Vitamin A is necessary to maintain epithelia, and squamous metaplasia of the respiratory tract may occur if there is vitamin A deficiency. The stratified squamous epithelium does not function as well as the normal pseudostratified columnar respiratory epithelium, and there is an increased risk for respiratory infections.

Question 49

if someone has a traumatic blow to their arm and 3 months go by and they have pain and tenderness and an x-ray that shows brightness what is wrong?

Answer 49

myositis ossificans --> calcification from osseous metaplasia of CT that developed in the healing process

Question 50

is nuclear pyknosis reversible?

Answer 50

no its irreversible whereas nuclear chromatin clumping is reversible

Question 51

trauma to the breast can result in what finding on biopsy

Answer 51

fat necrosis

Question 52

IL-10

Answer 52

also dampens immune response