Exam 3 Flashcards
What does the word Lentigo mean?
small, pigmented spots on the skin with a clearly-defined edge and surrounded by normal-appearing skin
What is meant by the word nevus?
Melanocytic nevi are nests of multi-layered melanocytes found in moles.
What characteristics indicate that a nevus may be dysplastic?
ABCD Asymmetric Borders (irregular) Color (varied) Diameter (increasing size)
What can Acanthosis Nigricans be an indication of?
Acanthosis nigricans can be indicative of hyperinsulinemia (associated with obesity but rarely with malignancy).
What is the sign of Leser-Trelat?
Sign of Leser-Trelat is the sudden development of multiple lesions, possibly accompanying an underlying malignance. Seen in seborrheic keratosis where there is a “stuck-on” appearing of keratin-filled epidermal pseudocysts.
What are the tests called you can use on physical exam to evaluate for Psoriasis and Pemphigus?
Psoriasis - Ausptiz Sign - removal of a scale that results in pinpoint bleeding
Pemphigus - Nikolski’s Sign - manual force to break blister indicates pathology (Microscopically, net-like patterns of IgG between epidermal keratinocytes create bullae, disrupting cellular adhesions
What is the relationship between topical steroids and Tenia infections of the skin?
Topical steroids are NOT used in conjunction with antifungals
This decreases the efficacy of the antifungal because corticosteroids suppress the immune system; although provides immediate relief of symptoms for the patient.
What is the difference between Erythema Nodosum and Erythema Multiforme?
Erythema multiforme is a hypersensitivity skin reaction to infections or drugs. It is characterized by vesicles, bullae, and “targetoid” erythematous lesions (like Lyme). Stevens - Johnson Syndrome is the most severe form, characterized by extensive involvement of skin and mucous membranes. Erythema nodosum causes raised, erythematous, painful nodules of subcutaneous adipose tissue. Sometimes it is associated with granulomatous diseases and strep.
What layers are involved with the following: BCC, SCC, Melanoma
Squamous Cell Carcinoma (SCC) is characterized by nests of atypical keratinocytes that invade the dermis. They rarely metastasize and complete excision is usually curative. Rapidly-growing, dome- shaped nodules with a keratin-filled center are indicative of keratoacanthoma.
Basal Cell Carcinoma (BCC) is the most common tumor in the western world. Typically only locally invasive and characterized by a pearly borders and papules; arises from basal cells of hair follicles. Invasive nests of basaloid cells with a palisading growth pattern.
Define pathology.
the study of the essential nature and characteristic of disease (S&S, complications, pathogenesis, etc).
Define disease.
impairment of the normal states (known from distinguishing S&S, etc).
Define homeostasis.
he maintenance of a harmonious environment within the body.
Define morbidity.
sequelae/effects of a disease.
Define Comorbidity.
property of a disease that gives it a specific virulence/ sequelae.
Define Iatrogenic.
doctor-acquired.
Define idiopathic
we don’t know the cause.
Define signs and symptoms.
Symptoms are subjective and according to what the patient may feel.
Signs are objective and what the doctor observes.
Define subclinical.
he immune system is doing its job and taking care of the infection - not clinically detectable.
Define illness.
unhealthy condition of the body or mind (sickness/disease).
Define etiology.
underlying cause of disease.
Define pathogenesis.
course that a disease takes from start to finish.
Define morphology.
the presence/conformation of damaged cells and tissues from the infection.
Define functional disease.
what happens when we know the disease exists, but have not discovered any gross or microscopic morphologic changes at this time.
Define syndrome.
group of signs and symptoms that occur together and characterize a particular abnormality or condition.
On an H&E stain, what structures turn blue, and which red?
Eosin stains the cytoplasm, RBCs, and collagen pink-red. Hematoxylin stains nuclei and bacteria to blue-purple.
Cellular injury can cause necrosis or apoptosis, know the difference between the two.
Necrosis is cell death characterized by inflammation and dead tissue
Apoptosis is programmed cell death, regulated by genes, not involving inflammatory response
What are common causes of cellular injury?
Hypoxia is the most common cause of cellular injury, resulting in the inability to synthesize sufficient ATP by aerobic oxidation (ie ischemia).
Infections cause injury by direct infection, toxins, and inflammatory responses of the host. Immunologic reactions
congenital disorders
chemical injury
physical injury - anorexia, obesity/excessive caloric intake.
What disease may be caused by vit A deficiency?
squamous metaplasia, immune deficiency, night blindness
What disease may be caused by vit C deficiency?
scurvy
What disease may be caused by vit D deficiency?
rickets and osteomalacia
What disease may be caused by vit K deficiency?
bleeding diathesis (used in clotting cascade)
What disease may be caused by vit B12 deficiency?
megaloblastic anemia, neuropathy, spinal cord degeneration
What disease may be caused by vit B9 (folate) deficiency?
megaloblastic anemia and neural tube defects
What disease may be caused by vit B3 (niacin) deficiency?
pellagra (diarrhea, dermatitis, dementia, and death)
When does cloudy swelling occur?
Cloudy swelling occurs when intracellular proteins accumulate in the serum; leaking occurs due to hypoxia and other forms of cellular degeneration. AST, ALT, ferritin, AP, GGT with liver; CK-MB, LDH, troponin T in heart. Cellular swelling occurs when cells are incapable of maintaining ionic and fluid homeostasis. There is a decreased ATP concentration and Na-pump activity, causing Na, Ca, and water to accumulate intracellularly.
Where do free radicals come from?
Many free radicals are oxygen-derived; processes such as UV light, metabolism, inflammation, smoking, ionizing radiation, and air pollution also create free radicals.
Describe the basic pathway in an injured cell that begins with mitochondrial dysfunction and leads to cellular swelling
Mitochondrial dysfunction leads to a decrease in oxidative phosphorylation and decreased in ATP, making the mitochondria highly permeable, releasing cytochrome c, triggering apoptosis. The Na/K ATPase pumps start to fail, causing influxes of Na and water, efflux of K, cellular and ER swelling. Other nuclear changes: pyknosis is the degeneration and condensation of nuclear chromatin; karyorrhexis is nuclear fragmentation; karyolysis is the dissolution of the nucleus
What is the significance of anaplasia, what are the two chief findings of anaplasia?
De-differentiation of cells is anaplasia and will show a “brick-like” pattern and a dramatic increase of the nuclear:cytoplasmic ratio.
What is the difference between primary, secondary, and tertiary (delayed closure) intentions
Primary - approximate wound edges and close; decreases scarring and heals well.
Secondary - wound edges do not become approximated and become filled with granulous tissue and fibrin.
Tertiary (delayed) - keep open for a period of time in order to prevent infection or edema.
What is the difference between hypoplasia and agenesis?
Hypoplasia is a defective formation or incomplete development of a part whereas agenesis is the absence or failure of formation.
What are the different basic types of stem cells, and which basic tissue types are they found in?
Labile cells (primary stem cells) = continuously dividing and found in the epidermis, GI tract, etc. Stable cells - low level of replication and can be induced to divide; they are found in hepatocytes, renal tubular epithelia, alveoli, and pancreatic acini. Permanent cells - do not ever divide and are found in nerve cells, cardiac myocytes, and skeletal muscle.
What are the three stages of fracture healing?
Procallous - hematoma that provides anchorage but no structural integrity. Fibrocartilaginous callous - characterized by a fibrous ball around the fracture.
Osseus callous - formation of bone.
What is the difference between a traumatic fracture and a pathologic fracture?
Pathologic fracture - caused by disease sequelae, etc, or from trauma that shouldn’t fracture bone
Traumatic fractures - ‘normal’ fractures of bone, including transverse, linear, non-displaced, comminutes, greenstick, spiral, compound, etc, due to some traumatic impact
What is a karyotype and what is an ideogram (remember that mutations have to be larger than 4mb to be seen on a karyotype)
Karyotype - the number and visual appearance of the chromosomes in the cell nuclei of an organism or species
Ideogram - schematic representation of chromosomes showing the relative size of the chromosomes and their banding patterns
What are the parts of a chromosome (long arm, short arm, etc.)?
Chromosomes are made of DNA with nucleotide base pairs in a long sequence
p (short) arm and q (long) arm are attached by a centromere
How may pairs of autosomes, and how many sex chromosomes do humans have?
Humans have 22 pairs of autosomes and 1 pair of sex chromosomes, making 23 pairs total
How does the medical and general usage of the word “gene” differ?
Genes used to be called only protein-coding sequences of DNA
Now, any functional unit of a chromosome is a “gene”
What is a locus?
Locus is the exact physical location of a gene on a chromosome. It is the same in all people and marked by a p/q-# and usually given acronyms.
What are alleles?
Alleles are the term to describe the 2+ variations in a gene within a population.
What is the difference between genotype and phenotype?
Genotype - the particular combination of alleles that a person has for a certain locus. We typically will have two copies of a gene, as we have chromosome pairs.
Phenotype - the physical, observable reflection of a genotype; also, the presence or absence of certain traits
What is a SNP?
single-nucleotide polymorphisms - DNA sequence variations occurring when a single nucleotide differs between members of a species or paired chromosomes in an individual. Almost all common SNPs only have two alleles. Genomic distribution of SNPs is not homogenous and occurs more frequently in non-coding regions.
What is the difference between imprinting of the X chromosome, and imprinting of the autosomes?
Imprinting - a small number of genes are transcriptionally active only when transmitted by one of the two sexes/parents while homologous locus in the other parent is rendered “transcriptionally inactive” and will be maintained in all somatic cells of the offspring (epigenetic modifications of turning on/off genes)
Imprinting of the X Chromosome: in females this is a natural process called “X- inactivation.” Only one of the two X chromosomes will be active within a cell, although two cells may express different X chromosomal traits, etc.
Imprinting of autosomes can lead to pathology (prader-willi and angelman syndromes)
What are the 5 points of control for gene expression? Which is most studied?
Chromatin stage (most studied) Transcriptional stage Translational stage Post-translational control into cytoplasm Post-translational modification
Why does DNA naturally wrap around histones, and what epigenetic changes can occur to histone tails to encourage or discourage winding/unwinding?
DNA naturally wraps around histones due to Van Der Waals attractive forces of opposite charges (negative DNA with positive protein)
Histone Methylation at CpG islands down-regulates transcription
Histone Acetylation up- regulates transcription
What is a promoter region on a gene, and why are promoter regions generally not methylated?
Promoter regions are beginning sequences of genes that call polymerase to bind and transcribe
If promoter is methylated, then gene will be silenced - this could be the cause/method of treatment for some cancers
What is the difference between exudates and transudates and which of those cause non-pitting edema?
Transudates - low protein content and lower specific gravity - NON-PITTING EDEMA
Exudates - fluid with high protein content and cells and a higher specific gravity
What is Virchow’s triad?
Hypercoaguability
Stasis
Vascular wall injury
What are examples of the diseases/conditions contributing to stasis, vascular injury, and hypercoagulability?
Hypercoagulability - clotting disorders, oral contraceptives, malignancy, pregnancy, sepsis, thrombophilia, IBD
Stasis - atrial fibrillation, immobility, venous obstruction, venous insufficiency/varicose veins
Vascular Wall Injury - trauma/surgery, venepuncture, heart valve disease/replacement, atherosclerosis, catheters
