ICS Flashcards
1
Q
What are the 2 types of autopsy?
A
Hospital (very few)
Medico-legal (most, coronial and forensic)
2
Q
Which deaths are referred to the coroner?
A
Presumed natural
Presumed iatrogenic
Presumed unnatural
3
Q
Who can make a referral to the coroner?
A
Doctors (common law duty)
Registrars of BDM (statutory duty)
Relatives, police, anatomical pathology physicians
4
Q
What are the 4 questions to be answered by a coronial autopsy?
A
Who
When
Where
How
5
Q
What is the structure of an autopsy?
A
History/scene, external examination, evisceration, internal examination, reconstruction
6
Q
What is looked for in an external examination in an autopsy?
A
Gender, age, jewellery, body mods…
Injuries
Signs of disease/treatment
7
Q
What happens in evisceration?
A
Y-shaped incision
Open all body cavities
Examine then remove thoracic and abdominal organs and brain
8
Q
Give a (rough) definition of inflammation
A
reaction to injury or infection involving certain cells
9
Q
When can inflammation be good?
A
Injury
Infection
10
Q
When can inflammation be bad?
A
Autoimmunity
When involved in over-reaction to a stimulus
11
Q
What are the two classes of inflammation?
A
Acute and chronic
12
Q
Give some characteristics of acute inflammation
A
Sudden onset
short duration
usually resolves
13
Q
Give some characteristics of chronic inflammation
A
Slow onset or sequel to acute
Long duration
May never resolve
14
Q
What are the main cells involved in inflammation?
A
Neutrophil polymorphs Macrophages lymphocytes endothelial cells fibroblasts
15
Q
Give some features of neutophil polymorphs
A
First on the scene of acute inflammation
Short lived
Usually die onsite (=pus)
Cytoplasmic granules full of enzymes to destroy bacteria
release chemicals to attract other inflamm cells
16
Q
Give some features of macrophages
A
Weeks to months phagocytic properties ingest bacteria and debris may present antigen to lymphocytes many types eg Kupffer cells Single big nucleus
17
Q
Five some features of lymphocytes
A
Years Produce chemicals to attract other inflamm cells Immunological memory (t) Control inflammation Mostly nucleus in appearance b cells produce antibodies
18
Q
Give features of endothelial cells in inflammation
A
Become ‘sticky’ so inflammatory cells can adhere
Becomes porous so inflammatory cells ca pass into tissue
Grow into areas of damage to form new capillaries
Precapillary sphincters open
19
Q
Give some features of fibroblasts in inflammation
A
Long lived
form collagen in areas of chronic inflammation and repair
20
Q
Give an example of acute inflammation
A
Acute appendicitis
21
Q
Give an eg of chronic inflammation
A
tuberculosis
22
Q
What is a granuloma?
A
Collection of epitheliod cells (macrophages but pale)
23
Q
What can granuloma suggest?
A
The appearance of granulomas may be augmented by the presence of caseous necrosis (as in tuberculosis)
The association of granulomas with eosinophils often indicates a parasitic infection (e.g. worms)
Small traces of elements such as beryllium induce granuloma formation
24
Q
Name the 4 macroscopic appearances of acute inflammation
A
Rubor (redness)
Calor (heat)
Tumor (swelling)
Dolor (pain)
25
What causes rubor in inflammation?
Dilation of small blood vessels
26
What causes calor in inflammation?
Only in superficial parts
| Hyperaemia leads to dilation of blood vessels leads to increased flow of hot blood
27
What causes tumor in inflammation?
Proteins leak out meaning fluid will not move back in at end of capillary bed
28
what causes dolor in inflammation?
stretching and distortion of tissues
| some chemical mediators (bradykinin, prostaglandins, serotonin)
29
Name a fifth feature of acute inflammation
Loss of function
30
Name steps of acute inflammation.
Changes in vessels and flow
increased vascular permeability
formation of exudate fluid
migration of neutrophil polymorph cells to extravascular space
31
Name some causes of acute inflammation
```
Microbial infection (virus=death of cells, bacteria= release of toxins)
Hypersensitivity (xs immune reaction to change in immunological responsiveness)
Physical agents (damages tissues)
Chemicals
Tissue necrosis (peptides from dying tissue)
```
32
Name some systemic effects of inflammation
```
pyrexia
weight loss
reactive hyperplasia
haematologial changes
amyloidosis
```
33
Name the four outcomes of acute inflammation
Resolution
Suppuration
Repair and organisation
Chronic inflammation
34
Name some causes of chronic inflammation
Primary chronic inflammation
Transplant rejection
Progression from acute inflammation
Recurrent episodes of acute inflammation
35
Name some macroscopic features of chronic inflammation
```
Chronic ulcer
Chronic abscess cavity
Thickening of the wall of a hollow viscus
Granulomatous inflammation
Fibrosis
```
36
Name some microscopic features of chronic inflammation
The cellular infiltrate consists characteristically of
lymphocytes plasma cells and macrophages.
Some of the macrophages may form multinucleate giant
cells.
Exudation of fluid is not a prominent feature, but there may be production of new fibrous tissue from granulation
tissue.
There may be evidence of continuing destruction
at the same time as tissue regeneration and repair.
Tissue necrosis may be a prominent feature, especially in granulomatous conditions such as tuberculosis.
37
In resolution of damage is the initiating factor removed?
Yes
38
In repair of damage is the initiating factor removed?
no
39
When would resolution occur after damage?
WHen tissue is undamaged
| When tissue is able to regenerate
40
When would repair occur?
If tissue is damaged and unable to regenerate
41
Can hepatocytes regenerate? And so can liver 'grow back' if part cut out?
yes
| yes
42
What happens if continuous damage occurs to liver?
Repair occurs leading to cirrhosis
43
What happens in lobar pneumonia?
Acute inflammation of single lobe, air spaces filled with neutrophil polymorphs
44
With treatment, can lobar pneumonia resolve?
Yes
45
Do skin wounds usually go back to normal?
no due to fibrosis leaving a scar
46
What are the types of skin wound resolution?
Abrasion
Healing by 1st intention
Healing by 2nd intention
47
Does an abrasion wound usually heal well?
Yes as usually don't remove all epithelium and hair cells
48
What is healing by 1st intention?
Sewing up a wound if the two 'ridges' can be pulled together.
Produces neat scar
Faster
Weak fibrin clot forms then fibroblasts produce collagen forming scar
49
What is meant by healing by 2nd intention?
Can't suture two edges together so has to be left un-sutured
Heals slowly and messy big scar formed
Capillaries and fibroblasts grow p from bottom of injury and plug pit
50
Give a definition(ish) of repair
Replacement of damaged tissue by fibrous tissue. Occurs in tissues where cells can't regenerate
51
Name some cells that can regenerate
Hepatocytes, pneumocytes, all blood cells, gut epithelium, skin epithelium and oseocytes
52
Name some cells that can't regenerate
Myocardial cells
| Neurons
53
Name 2 factors that prevent clots forming in health
```
Laminar flow (blood only in centre of vessel)
Endothelial cells aren't 'sticky' in health
```
54
What is thrombosis?
solid mass of blood constituents formed within intact vascular system in life
55
What would you use to diagnose a thrombus?
Doppler ultrasound
56
State how a thrombus is formed
Endothelial lining of vessel is disrupted, exposing collagen fibres
Platelets bind and aggregate, releasing platelet aggregation factor leading to more platelets binding
Thrombus begins to grow which disrupts laminar flow, trapping some RBCs
Platelets also release clotting factors leading to fibrin mesh forming
Positive feedback for the gainz (in thrombus size)
57
How could a thrombosis occur in vein when resting for long periods?
Vein flow is slow and non pulsitile
Vein blood flow (in legs especially) heavily relies on skeletal muscle pump
When resting this reduces flow even more meaning disruption of laminar flow
More likely for platelets to bind to collagen
58
Name the three main causes of thrombosis
Change in vessel wall
Change in blood constituents
Change in blood flow
59
Name the possible outcomes of a thrombus
Broken down (consider damage to organ)
Organisation (vessel collapses and scars over)
Re-canalisation (capillaries grow through clot)
Embolism
60
Name some ways of avoiding thrombosis
Exercise (to keep blood flowing)
Stockings (push blood out of legs)
Aspirin (reduces aggregation)
61
What is an embolus?
Mass of material in vascular system able to become lodged in a vessel and block it
62
Name some common emboli
Usually a thrombus
| cholesterol crystal, air, tumour, amniotic fluid and fat
63
Where will an embolus usually end up if in the venous circulation?
Lodge in pulmonary arteries
64
Where will an embolus go in the arterial circulation?
Anywhere downstream
65
What is ischaemia?
Reduction of blood flow to a tissue w/ no other complications
Cells further from capillaries more likely to be 'unhappy'
66
What is a re-perfusion injury?
Reintroduction of blood to tissue with severe limitation of blood flow leads to 'nasties' being produced, like superoxide radicals, that damage cells
67
What is infarction?
Death of cells due to lack of blood supply
| It is a subset of ischaemia
68
What is end artery supply?
When an organ has only one artery supplying it
69
Name some organs with dual arterial supply
liver lungs and some parts of the brain
70
What are watershed areas?
When tissue has two blood supplies but is at the end of both these areas, like some areas of the brain
71
Which cancer never metastasises?
Nasal cell carcinoma of skin
72
What is the name of a malignant rumour of striated muscle?
Rhabdomyosarcoma
73
```
Which of the following rarely metastasises to bone?
Breast
Lung
Prostate
Liposarcoma
```
Liposarcoma
74
What term describes a cancer that hasn’t invaded the basement membrane?
Carcinoma in situ
75
What is the name of a benign rumour of glandular epithelium?
Adenoma
76
What is the time course for atherosclerosis?
Fatty streak builds from around 20 years and symptoms are around 50 years
77
Is there much atherosclerosis in the pulmonary arteries?
No as lower pressure
78
Name some contents of a plaque
lipids
fibrous tissue
cholesterol
lymphocytes
79
Name some risk factors associated with atherosclerosis
```
smoking
hypertension
diabetes (uncontrolled)
hyperlipidemia
being male
lower se background
```
80
How does smoking increase the risk of atherosclerosis?
Smoke contains chemicals that damage the endothelium of vessels
81
How does hypertension increase the risk of atherosclerosis?
Shearing forces on endothelium damage
82
How is vaping better than smoking
Less free radicals and NO BUT same nicotine
83
How does uncontrolled diabetes increase the risk of atherosclerosis?
Produces chemicals that damage endothelium
84
How does hyperlipidemia increase the risk of atherosclerosis?
Damages endothelium
85
Which theory is the correct theory for atherosclerosis?
Endothelial damage theory
86
Describe endothelial damage theory
Damage to endothelium causes platelet aggregation and disruption of laminar flow, catching blood constituents
This heals over (endothelium grows over) and forms lump in lumen
This process of endothelium damage repeats
Chronic inflammation
Atheroma builds up and hardens
87
Suggest a preventative measure for atheroma
asprin as decreases platelet aggregation
88
Name some complications of atherosclerosis
infarcts
gangrene
ischaemia
89
What is the difference between atherosclerosis and thrombosis?
Atherosclerosis is defined as a condition where cholesterol plaques are developed on the endothelium of the blood vessels.
Thrombus refers to a blood clot which is attached to the inner walls of the blood vessels without getting calcified like atherosclerotic plaques.
90
What is apoptosis?
Programmed cell death in which no cellular contents are released, so no inflammatory reaction
91
Name the main cause for apoptosis
DNA damage
92
State the different ways dna can be changed to cause apoptosis
single strand break
double strand break
base alteration
cross linkage
93
Which protein is responsible for checking for DNA damage
p53
94
What does apoptosis look like microscopically?
Death of individual cell
95
Name the two ways apoptosis can be induced
```
Bax protein (intrinsic pathway)
Fas ligand binding to fas receptor (extrinsic)
```
96
Which protein can reduce apoptosis?
BCL2
97
Which enzymes are primarily responsible for apoptosis?
Caspases
98
Describe briefly how apoptosis occurs
Enzymes destroy cell into vesicles
| Macrophages mop up
99
Name a way apoptosis is used in development
Fingers becoming unwebbed
100
How does Juliet maintain a constant body temperature?
Romeostsis
101
Name a function of apoptosis in health
death of cells in tissues with high cell turnover rg. the gut
102
Name a function of apoptosis in disease
Lack of apoptosis in cancer
| Too much apoptosis in HIV
103
What is necrosis? :(
Poorly controlled form of cell death in which membrane integrity is lost w/ leakage of contents = inflammatory response
traumatic cell death of big swathes of tissue
104
What would necrosis (generally) look like microscopically?
Large swathes of cells dying
105
Name some clinical egs of necrosis
```
toxic spider venom
frostbite
cerebral infarction
avascular necrosis of bone (scaphoid and head of femur)
pancreatitis
```
106
Name the types of necrosis
Caseous
liquefactive
coagulative
107
What is caseous necrosis
most common type
loss of nuclei but preservation of underlying structure
macroscopically = pale and firm
108
What is liquefactive necrosis
Complete loss of cell structure
Macroscopically= liquidy
Usually following cerebral infarction
109
What does caseous necrosis look like?
Cream cheese
110
What condition is caseous necrosis associated with?
TB
111
Why is there many disorders of development?
Many steps so many places to go wrong
112
What percentage of fertilisations survive to 1 month?
35%, deaths usually due to chromosomal abnormalities
113
What is spina bifida?
Missing spinous process on vertebrae
114
What a meningocele?
Meninges protruding out during development, can usually be treated
115
What is a myleomeningocele?
Meninges and spinal cord protruding out of fetus, usually results in paralysis of lower body
116
Name some developmental disorders
spina bifida
cleft palate
ventriculoseptal defect
Down's syndrome
117
What are homeobox genes?
Highly conserved genes which code for specific body parts
118
What is Down's syndrome?
Trisomy 21
119
Which chromosome is the gene for beta amyloid on?
21
120
What is mendelian inheritance?
single gene inheritance
121
Name an example of autosomal recessive condition
Cystic fibrosis
122
Name an autosomal dominant condition
polycystic kidney disease
123
Name an autosomal co-dominant example
blood groups
124
What is polygenic inheritance
many genes contribute to one feature or condition
125
Are more diseases polygenetic or monogenetic
poly
126
What does congenital mean?
Present at birth (can be environmental or genetic)
127
What does inherited mean?
Caused by inherited genetic abnormality, may not manifest until later in life however eg. huntingdon's
128
What does acquired mean?
Caused by non-genetic factors, however may be congenital
129
Name a congenital acquired condition
Fetal alcohol syndrome
130
Name some conditions of growth
Growth hormone deficiency, and too much GH
131
What is hypertrophy?
Increase in size of tissue caused by increased size of cells, as cells can't replicate
132
Name main organ where hypertrophy occurs
Skeletal muscle (gainz)
133
Which gene prevents muscle growth after a certain size?
Myostatin
134
What is hyperplasia?
Increase in size of tissue due to increased number of constituent cells
135
Name some common examples of where hyperplasia occurs
prostate
smooth muscle
endometrium (too much oestrogen:progesterone)
136
During pregnancy does the uterus undergo hyperplasia or hypertrophy?
LOL-both
137
What is atrophy?
Decrease in size of tissue caused by a decrease in number OR size of constituent cells
138
Can nerves atrophy?
Oui Oui
139
What is metaplasia?
Change in differentiation of cell from one to another fully differentiated cell
140
Give an example of metaplasia
When smoking, in bronchi ciliated columnar to squamous (like skin)
So resistant to irritants but doesn't produce mucus or sweep mucus
141
What is dysplasia?
Imprecise term for morphological changes seen in cells in the progression to becoming cancer
142
What is neoplasia?
Abnormal and excessive growth of cells, can be benign or malignant
143
Name something that doesn't age
Plasmodium as just divides by binary fission
144
Why do multicellular organisms show ageing?
Many cells in highly ordered structures
| Some cells can't divide and order becomes less ordered
145
Do elderly cells have as much potential t divide as younger cells?
Yes
146
Do elderly cells divide as much as younger cells (of the same type)?
No
147
What is progeria?
A progressive genetic disorder where symptoms of ageing are manifested at an early age
148
In dividing cells, why does ageing occur?
Telomeres shorten over life meaning there's a limit as to how many times a cell can divide
149
In non-dividing cells, how does change occur with time?
Cells can't divide so born with all you'll ever have
| Free radicals, loss of DNA repair mechanisms, damage to DNA... all lead to loss of cells meaning lower functioning
150
Is there a way to slow ageing in non-dividing cells?
Yes, calorie restricted diet
151
What causes dermal elastosis?
UV-B causes protein cross linking= wrinkles
152
What causes osteoporosis?
Reduction in bone matrix due to increased bone resorption and decreased bone formation
Due to lack of oestrogen
153
What causes cataracts?
Foggy lens due to UV-B causing proteins to cross-link and become opaque
154
What causes senile dementia?
Atrophy of brain, especially memory parts
| Plaques, amyloid and tangles
155
What causes sarcopenia (lack of muscle)?
Decrease growth hormone and testosterone
| increase in catabolic cytokines
156
What causes deafness in ageing?
Cilia/ hair cells in ear (non-replaceable) destroyed
157
Does basal cell carcinoma spread to other parts of the body?
No it only invades locally
158
What is a complete cure for basal cell carcinoma?
Surgical removal
159
What causes basal cell carcinoma?
UV light, increased risk if have had it previously
160
Will a tumour of white blood cells spread?
Yes as WBC circulate
161
Where do carcinomas primarily spread to?
Lymph nodes that drain the site
162
Can carcinomas spread through the blood to bone/lung?
Yes
163
Which cancers most commonly spread to the bone?
Breast, prostate, lung, thyroid and kidney
164
What can be left behind even if a tumour is completely excised?
Micro-metastases
165
What is adjuvant therapy?
Extra treatment given after surgical excision to try to clear micro-metastases
166
What is leukaemia?
Cancer of WBC
167
Give some systemic symptoms of leukaemia
Weight loss, fever, frequent infection
168
Give symptoms of leukaemia related to the lung
Easy shortness of breath
169
Give symptoms of leukaemia related to the muscles
Weakness
170
Give symptoms of leukaemia related to the bones
Pain/ tenderness
171
Give symptoms of leukaemia related to psychology
fatigue and decreased appetite
172
Give symptoms of leukaemia related to the lymph nodes and spleen/liver
Enlargement
173
Give symptoms of leukaemia related to the skin
Night sweats
easy bleeding and bruising
purplish patched and spots
174
Describe the plan of treatment for breast cancer
- Confirm diagnosis
- Has it spread to axilla? YES= axillary node clearance, NO and YES= has it spread to rest of body
- Has it spread to rest of body? YES=systemic (chemo) therapy, NO= surgery (with or without lymph node clearance depending on above)
175
Name some ways of confirming breast cancer diagnosis
Needle core biopsy
| Screening/ mammograms
176
Why do we need to confirm diagnosis in plan of treatment for cancer?
The lump could be one of many things, with different degrees of severity
177
How to check if cancer has spread to axilla?
Ultrasound of axilla, then can needle core biopsy the nodes
178
How to check if cancer has spread to rest of body?
Bone scan
| CT liver and lungs
179
After surgery for breast cancer, what can be done if probability that tumour could recur/still there is high?
ADJUVANT therapy
Radiotherapy (recommended in all breast cancer pts)
Tests on tumour to see if express receptors
- if oestrogen receptor +ive, use antioestrogen treatment
HER2 protein stain
180
Define carcinogenesis
Transformation of normal cells to neoplastic cells through PERMANENT genetic alterations or mutations
181
Does carcinogenesis apply to benign tumours?
Nae
182
What process applies to both malignant and benign tumours?
Oncogenesis
183
Is carcinogenesis a single step process
NOOOOO
184
What is a carcinogen?
An agent known or suspected to cause tumours/cancer
185
What does carcinogenic mean?
Cancer causing
186
What does oncogenic mean?
Tumour causing
187
What do carginogens act on?
DNA
188
What percentage of cancer risk is environmental?
85%
189
What factors make identifying carcinogens hard?
Carcinogens take tens of years to take effect
V complex environment= many potential ones
Ethical constraints, can't pour asbestos on people to see what happens
190
What evidence can be used to try to identify carcinogens?
Epidemiological- then look for links
Experimental
Direct evidence
191
Give an example of using epidemiological evidence to ID a carcinogen
Increased liver cancer in areas with high prevalence of Hep. B and C
192
What are the advantages of experimental evidence in identifying carcinogens?
Can explore incidence in lab animals
| Can test in cultures
193
What are the -ives of experimental evidence in IDing carcinogens?
Different metabolism to species using in lab
A bacterial mutation may not lead to cancer, where as it may in hoomans
Multicellular vs. singlecellular organisms
194
Name some examples of direct evidence in IDing carcinogens
Thyrotrast- used to be used for imaging for vasc. system but caused cancer
Thyroid irridation -Chernobyl
195
Name the 5 classifications of carcinogens
```
Chemical
Viral
Radiation (ionising and non)
Biological (hormones, parasites and mycotoxins)
Miscellaneous
```
196
State features of chemical carcinogens (4)
No common structural features
Some act directly
Most require conversion from pro- to ultimate-
Enzyme required to convert may be confined to organs
197
What cancer are polycylic aromatic hydrocarbons associated with? And whats their source?
Lung cancer smoking
| Skin cancer Mineral oils
198
What cancer are aromatic amines associated with? And whats their source?
Bladder rubber/dye workers
199
What cancer are nitrosamines associated with? And whats their source?
Gut cancer Processed meats
200
What cancer are alkylating agents associated with?
Leukaemia small risk
201
Name some examples of radiant energy as a carcinogen
UVA/B
X-rays (radiographers)
Lung cancer in uranium miners (uranium converts to radon)
Chernobyl (thyroid)
202
Name some examples of biological carcinogens
```
Increased oestrogens = mammary/endometrial cancer
Increased anabolic steroids= herpatocellular carcinoma
Alfatoxin B1 (mycotoxin)= herpatocellular carcinoma
Chlonorchis sinensis (parasite) = cholangiocarcinoma (bile duct)
```
203
Name some miscellaneous carcinogens
Asbestos
| Metals eg arsenic
204
What host factors can have an impact on risk of developing cancer?
```
Race
Constitutional
Premalignant tumours
Diet
Transplacental exposure
```
205
What is tumour?
Any abnormal swelling
206
Give some examples of tumour
Neoplasm
Inflammation
hypertrophy
hyperplasia
207
Define neoplasm
A lesion resulting from the autonomous or relatively autonomous abnormal growth of cells which persists after the initiating stimulus has been removed (new growth)
208
Give the key words for neoplasm
Autonomous
Abnormal
Persistent
New
209
Why are neoplasms such a big issue?
25% of population affected, of all ages
Risk increases with age
High death/mortality rate
20% of all death
210
What are the two spectra of disease for neoplasms?
Malignant/borderline/benign
| Fatal/subclinical (may have but don't know)
211
What are the two components of a neoplasm
Neoplastic cells
| Stroma
212
State some characteristics of neoplastic cells in the neoplasm (4)
Derive from nucleated cells
Usually monoclonal at start
Growth pattern related to parent
Synthetic activity related to parent (eg. collagen, mucin, keratin, hormones)
213
State some characteristics of the stroma of a neoplasm (4)
Connective tissue framework
Mechanical support
Nutrition
Not neoplastic or autonomous, grow due to growth factors from neoplastic cells
214
What does a stroma consist of
Fibroblasts and blood vessels
215
What is angiogenesis in relation to neoplasms
Tumour becoming vascularised, malignant tumour often tends to outgrow rate of angiogenesis and die
216
Why do we classify neoplasms?
To determine appropriate treatment
| Provide prognostic info
217
What are the two methods of classifying tumours
Behavioural (malignant/benign)
| Histogenic (cell of origin)
218
Are benign tumours invasive
nah
219
Benign tumour growth rate and mitotic activity
Slow and low
220
Does benign tumour look close to normal tissue?
Yes look at borders to distinguish difference
221
Are benign tumours circumscribed?
Yah
222
Are necrosis and ulceration rare in benign tumours?
Yas
223
Which way do benign tumours grow on mucosal surfaces?
Up and out (exophytic)
224
Name some dangers/effect of benign tumours (5)
```
Pressure on adj. structures
Obstruct flow
Produce hormones
go malignant
anxiety
```
225
Are malignant tumours invasive?
YES, they must be, can be metastatic
226
Growth rate and mitotic activity of malignant tumours?
Fasttttt and high
227
Does malignant tumour look like normal?
Variable
228
Are malignant tumours well defined?
No, irregular border
229
What makes malignant tumour nuclei stand out?
Hyperchromatic and pleomorphic
230
Are necrosis and ulceration common in malignant tumours?
Yas
231
Which way do malignant tumours grow on mucosal surfaces?
In and down (endophytic)
232
Name some dangers of malignant tumours (8)
```
Encroach upon and invade surrounding structures
Metastasise
Poorly circumscribed
Blood loss from ulcers
Para-neoplastic effects
Anxiety and pain
Hormone production
Obstruction of flow
```
233
What is histogenesis?
The specific cell origin of a tumour
234
Where may a neoplasm arise from (3)
Epithelial cells
Connective tissue
Lymphoid/haemopoietic organs
235
What is the main ending for neoplasms?
-oma
236
What are (generally) the two types of benign epithelial neoplasms?
Papilloma and adenoma
237
What tissue does a papilloma originate from?
Non-glandular or secretory epithelium (BENIGN)
238
What suffix is used for papillomas and adenomas?
Cell of origin
239
What tissue does an adenoma originate from?
Glandular or secretory epithelium (BENIGN)
240
What are the two main malignant epithelial neoplasms?`
Carcinoma and adenocarcinoma
241
What tissue does a carcinoma stem from?
Non glandular or secretory epithelium (MALIGNANT)
242
What tissue does an adenocarcinoma come from?
Glandular epithelium (MALIGNANT)
243
What is the general rule for benign connective tissue neoplasm?
Tissue it looks like -oma
244
What is rhabdomyoma?
Benign of striated muscle
245
What is neuroblastoma?
Benign neoplasm of nerves
246
What is leiomyoma?
Benign neoplasm of smooth muscle
247
What is hibernoma?
Benign neoplasm of brown fat
248
What is angiolipoma?
Benign neoplasm of blood vessels and adipocytes
249
What is the general rule for malignant connective tissue neoplasms?
Cell it looks like-sarcoma
250
What are carcinomas and sarcomas further graded by?
Degree of differentiation
251
What is anaplastic?
Cell type unknown/ doesn't look like any cell
252
Name some exeptions to the general classification rule by Burton
Not all -omas are neoplasms (granuloma, tuberculoma)
Not all malignant are carcinoma or sarcoma (lyphoma, mesothelioma)
Eponymous named (Burkitt's lymphoma, Ewing's sarcoma, Grawitz tumour)
Teratoma
Embryonal blastomas
Mixed tumours
APUDomas
Carcinosarcomas
253
Name the main effector cell in acute inflammation
Neutrophil polymorph
254
What is the name of the cell that produces collagen in fibrous scarring?
Fibroblast
255
Give an example of acute inflam?
Appendicitis
256
What crystals are deposited into joints in gout?
Uric acid, body tries to 'gobble up' leads to acute inflam
257
Name some conditions in which granulomatous inflammation occurs
Chron's diesease
TB
Sarcoidosis
258
What type of inflammation occurs in lobar pneumonia?
Acute
259
What is the name of calcification in diseased tissues?
Dystrophic calcification
260
Name a condition that is chronic inflam from the start
Infectious mononucleosis
261
What cells produce antibodies?
Plasma cells
262
What do cancer cells use to invade basement membrane?
```
Proteases
Collagenase
Cathepsin D
Urokinase-type activator
Cell motility
Basically stuff to 'chew through basement membrane'
```
263
Name the seven steps involved in metastases
```
Invasion of basement membrane
Tumour cell motility
Inravasation
Evasion of host immunity
Extravasation
Growth at metastatic site
Angiogenesis
```
264
What causes tumour cell motility?
Tumour cell derived motility factors
| Breakdown of extracellular matrix
265
what happens in intravasation?
Tumour cell moved into vessel using collagenases and cell motility
266
How does the tumour cell evade host immunity?
Aggregation w/ platelets
Shedding of surface antigens
Adhesion to other tumour cells
267
What happens in extravasation?
Tumour cell uses adhesion receptors, collagenases and cell motility to move out of vessel
268
What allows growth at metastatic site?
Growth factors produced by tumour
| Can grow up to 1mm diameter until need blood supply
269
What happens in the angiogenesis step of metastasis?
Blood vessels grow into tumour to provide support
Promoters- vascular endothelial growth factors, basic fibroblast growth factors
Inhibitors- Angiostatin, endostatin, vasculostatin
270
State 3 main routed of metastasis
Vena cava -> heart->lungs (small capillaries filter)
Intestines-> liver via hepatic portal vein
Tumours to bone
271
Name common tumours to metastasise to lungs
Sarcomas, any common cancers
272
Name some common tumours to metastasise to liver
Colon, stomach, pancreas and carcinoid tumours of intestine
273
Name some common tumours that metastasise to bone
Prostate breast thyroid lung kidney
| Some eat holes in bone some produce new bone
274
What is vinblastine?
Conventional chemo. Antimicrotubule agent
275
What is etoposide ?
Conventional chemo. inhibits topoisomerase ii
276
What is ifosamide?
Conventional chemo, binds to dna and prevents replication by cross linking
277
What is cisplatin?
Conventional chemo, binds to dna and prevents replication by cross linking
278
Is conventional chemo selective for cancer cells?
No, only fast dividing cells
279
What can conventional chemo cause?
Myelosupression, hair loss, diarrhoea, vomiting fatigue
280
What is conventional chemo good for?
Fast dividing tumours
281
Name some fast dividing tumours
Germ cell of testis, acute leukaemias, lymphomas, embryonal paediatric tumours and choriocarcinoma
282
What is conventional chemo not so good for?
Slower dividing tumours
283
How is targeted chemo different from conventional chemo?
Targeted exploits some differences between normal cells and cancer cells
284
Name 3 ways we can identify differences in tumour cells
Gene arrays
Proteomics
Tissue microarrays
285
How do cells usually increase proliferation?
Growth factor binds to receptor
Receptor releases intracellular signalling proteins
This causes transcriptional upregulation
286
Name two ways in which cancer cells greatly increase proliferation, evasion and angiogenesis
Over-expression of growth factor receptor
| Constitutive activation of growth factor receptor (receptor always on)
287
Name two ways of blocking cancer cells from increasing proliferation
Monoclonal antibodies against the receptor
| Small molecular inhibitor of growth factor receptor
288
How do monoclonal antibodies against gf receptor work
Bind to extracellular component of receptor blocking gf from binding
289
How do small molecular inhibitors work?
Bind to the intracellular component of the receptor, preventing release of intracellular signalling molecules
290
What is Cetuximab (erbitux)?
Monoclonal antibody against epidermal growth factor receptor (EGFR)
Chimeric IgG humanised monoclonal antibody
Blocks production of VEGF, interleukin 8 and bFGF
291
What is herceptin (trastuzumab)?
Monoclonal antibody against epidermal growth factor receptor 2 (Her-2)
Chimeric mouse-human monoclonal antibody
292
How does herceptin work?
Her-2 receptors need to 'bum' into eachother or into Her-3 with ligand to work
Herceptin binds to Her-2 and causes endolytic removal and antibody cell cytotoxicity (lymphocytes kill Her-2)
Decreases chance of bumping
293
What breast cancers is Her-2 associated with?
```
Her-2 amplified in 20-30% of breast cancers
Large size
High grade
Anaploidy
Negative oestrogen receptor status
Independent adverse prognostic factor
```
294
What is gleevec?
Small molecular inhibitor of C-kit
Inhibitor of c-kit tyrosine kinase
Works on mutated receptor and over-expressed receptor
295
State some ways to detect protein amplification
Fluorescent in-situ hybridisation (FISH)- looking for gene (Gene for Her-2 on ch 17)
Immunohistochemistry - look for protein
296
What is anti PD1?
Anti programmed cell death protein 1
Includes pembrolizumab and nivolumab
PD1 usually surprsses immune response to prevent autoimmune diseases, but also stops killing cancer cells, removing it allows to kill cancer
297
Name some other cancer treatments
EGFR TK- gefitinib (inhibitor of EGFR tyrosine kinase)
| Chimeric T cell receptors (dna into viral vector, produce t cell which react with antigens on cancer cells to kill them)
298
What are the big names in lung cancer?
Small cell lung cancer (BAD)
Squamous cell carcinoma
Adenocarcinoma
299
What do TNM and R stand for in cancer grading?
```
Tumour
Node
Metastases
Recection
higher number = worse
```
300
What is the main factor to reduce bleeding immediately?
Vessel spasm due to damage
301
Which neoplasm never metastasises?
Basal cell carcinoma
302
What is the name of malignant tumour of striated muscle
Rhabdomyosarcoma
303
```
Which does not commonly metastasise to bone?
Breast
lung
prostate
liposarcoma
```
Liposarcoma
304
What term describes a cancer that hasn't invaded a basement membrane
Carcinoma in situ
305
What is the name of a benign tumour of glandular epithelium
Adenoma
306
```
Which of these does not have a screening programme
breast
colorectal
cervical
lung
```
Lung
307
```
Which of the following is not known to be a carcinogen
Aspergillus niger
Hap. c
ionising radiation
aromatic amines
```
Aspergillus niger
308
What is a benign tumour of fat cells called
lipoma
309
What is a malignant tumour of glandular epithelium called
Adenocarcinoma
310
```
Which is not a feature of malignant tumour
Vascular invasion
metastasis
increased cell division
growth related to overall body growth
```
Last one
311
A transitional cell carcinoma of bladder is malignant?
True
312
A leiomyoma is a benign tumour of smooth muscle
True
313
Radon gas is a cause of lung cancer?
True
314
Asbestos is a human carcinogen?
True
315
```
Which lifestyle factor is most likely to cause cancer
Wine bevs
Being obese
Running
SMoking
```
Smoking
316
```
Which has the shortest median survival
Basal cell carcinoma
Malignant melanoma
Breast cancer
Anaplastic carcinoma of thyroid
```
Anaplastic carcinoma of thyroid
317
Ovarian cancer commonly spreads to peritoneum
True
318
What must the immune system do?
discriminate self from non self
319
State some features of innate imunity (4)
Does not depend on lymphoctes
Present from birth
Instinctive
Non-specific
320
State some features of adative immunity (3)
Acquired/learned immunity
requires lymphocytes
antibodies
321
What are the three layers of blood sample when centrifuged?
```
Upper layer (plasma, straw coloured, water, electrolytes, proteins, lipids and sugars)
Buffy coat (WBC)
Lower layer (RBC and platelets)
```
322
What is serum
Plasma without fibrinogen and other clotting factors
323
What are leukocytes?
```
White cells
lymphocytes
phagocyte
neutrophil
eosinophil
basophil
```
324
What are the types of lymphocytes? and what soluable mediators do they secrete?
B (produces antibodies)
T (cytokines)
Large granular lymphocytes (=> cytokines)
325
What are the types of phagocytes? and what soluable mediators do they secrete?
mononuclear phagocyte (cytokines and complement)
neutrophil
eosinophil
326
What are the types of axillary cells? and what soluable mediators do they secrete?
Basophil
Mast cell
Platelts
All secrete inflammatory mediators
327
Which soluble mediators do tissue cells secrete?
Interferons
| Cytokines
328
What is the origin of blood cells
Multipotent haemopoietic stem cell (haemocytoblast)
329
What two cells are produced by haemocytoblasts?
Common myeloid progenitor cells
| Common lymphoid progenitor cells
330
Which cells do common myeloid progenitor cells produce?
magakaryocyte (platelets)
erythrocyte
myeloblast
331
Which cells do common lymphoid progenitor cells produce?
Lymphocytes (B and T)
332
Which are the polymorphonuclear leukocytes?
Neutrophil eosinophil basophil
333
Which cells are the mononuclear leukocytes?
Monocytes (=> macrophage)
t cells (=>tregs, thelper and cytotoxic)
bcells (plasma)
334
Name two types of antigen presenting cells?
Macrophages and dendritic cells
335
What is complement C'?
20 serum proteins secreted by liver that need to be activated
As part of immune response
336
What are the outcomes of the complement system?
Direct lysis
Attract more leukocytes
Increase opsonisation and increase phagocytosis
337
What do antibodies do?
Bind specifically to antigens
338
What are immunogobulins?
Soluable secreted glycoproteins bound to antibodies as part of B-cell antigen receptor
339
What are the 5 classes of Ig
G, M, A, D and E
340
Which are the most numerous Ig's?
G and M
341
What are the functions of IgG?(3)
Binds to pathogen (agglutination and osponisation)
Activates classical pathway of complement system
Neutralises toxins
342
Where are IgMs mainly found?
In the blood as too big to cross endothelium
343
What is the function of IgM
Initial contact with antigen
344
Describe IgA
Most is in monomer form
| Main Ig in mucous secretion (breast milk, tears and sputum)
345
Where is IgD present
Bcells
346
Where are IgE receptors found?
Mast cells and basophils
347
What does binding of IgE to receptors cause?
Release of histamine
