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Path Exam 1 Flashcards

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1
Q

hyperplasia

A

increase in # cells resulting in increased volume of the organ or tissue

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2
Q

where can hyperplasia be initiated?

A

in a cell pop that is capable of division and proliferation

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3
Q

what kind of adaptation is the lactating breast?

A

hormonal hyperplasia

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4
Q

what kind of adaptation is post-hepatectomy regeneration?

A

compensatory hypertrophy

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5
Q

what is the stimulus for liver regeneration after a hepatectomy?

A

growth factor produced by residual hepatocytes

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6
Q

what causes follicular hyperplasia of lymph nodes?

A

exposure to an infectious agent leads to B cell proliferation in the follicles of lymph nodes

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7
Q

what causes benign prostatic hyperplasia?

A

testosterone metabolite, dihydrotestosterone induces nodular enlargement of the gland

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8
Q

what causes squamous hyperplasia?

A

response to chronic inflammation, squamous mucosa thickens

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9
Q

what is the molecular mediator of squamous hyperplasia?

A

TGF-alpha

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10
Q

hypertrophy

A

increase in size of cells leading to increased tissue volume

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11
Q

alveolar spaces

A

terminal air spaces within the lung

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12
Q

autoimmune disease

A

a disease where immune response incorrectly attacks normal tissue

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13
Q

chemotaxis

A

directed movement of leukocytes or other cells in a specific direction

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14
Q

cytokines

A

protein mediators which activate and orchestrate the inflammatory response

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15
Q

leukocytes

A

white blood cells from bone marrow

critical part of inflammatory response

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16
Q

endothelial cells

A

cells that line blood vessels

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17
Q

hyperemia

A

increased blood flow inside vasculature

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18
Q

integrin

A

molecules on surface of white blood cells responsible for their adherence to the lining of blood vessels

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19
Q

margination

A

moving to the edge

usually leukocytes moving from center of bloodstream to edge

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20
Q

opsins

A

proteins that bind the outside of bacteria or dead tissue

usually antibodies or complement fragments

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21
Q

selectins

A

adhesion molecules that direct leukocytes to sites of inflammation

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22
Q

atrophy

A

shrinkage of a tissue due to loss of a cell substance/#

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23
Q

what drives atrophy?

A

imbalance between protein degradation and syntesis

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24
Q

what pathway is responsible for proteolysis in atrophied tissues?

A

ubiquitin-proteasome pathway

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25
autophagic vacuoles
lysosomes that contain fragments of cell components
26
residual bodies
shrunken lysosomes that contain lipofuscin
27
brown atrophy
residual bodies cause atrophic organs to appear brown
28
metaplasia
reversible change in which one adult cell type is replaced by another
29
what does metaplasia result from?
reprogramming of tissue stem cells by actions of cytokines and growth factors
30
causes of reversible cell injury
cellular swelling | fatty change
31
what causes cellular swelling (cell level)?
loss of function of PM energy dependent ion pumps that leaves the cytoplasm distended but membranes intact
32
what causes cellular swelling(body level)?
anoxic injury | hepatocyte injury due to viral infection
33
what causes fatty change in cells?
excessively stressing the fat metab process in the liver | leads to accumulation in vacuoles in hepatocytes
34
what is the appearance of necrosis ultrastructurally?
disruption/fragmentation of cell membranes that can form myelin bodies absence of nucleus
35
what injury would cause coagulative necrosis?
ischemic injury | MI
36
what is the ultrastructural appearance of coagulative necrosis?
ghost outlines of cells preserved due to Ca infusion and denaturation of proteins eosinophilia
37
what injury causes liquefactive necrosis?
bacterial infection | infarction of CNS
38
what is the appearance of fat necrosis ultrastructurally?
formation of soap due to release of FA from the necrotic tissue
39
fibrinoid necrosis
deposits of complexes of antigens and antibodies with fibrin in the vessel wall
40
what usually causes ATP depletion in cells?
anoxia
41
what does accumulation of free radicals in the cell cause?
membrane damage from lipid peroxidation denaturation of structural pro and NZs DNA damage
42
mechanism of apoptosis
activation of caspases
43
what do caspases do?
denature cytoskeleton and nuc | activate DNAses
44
extrinsic pathway of apoptosis
ligands engage death receptors
45
what is the receptor of the extrinsic path of apoptosis
TNF type 1
46
intrinsic pathway of apoptosis
anti-apoptotic proteins are replaced by pro-apoptotic pro in the mito matrix, which leads to increased membrane perm which causes cytochrome C to bind to Apaf-1 leading to the caspase cascade
47
inflammation
host response to injury or infection
48
what cells respond first in inflammation?
neutrophils
49
length of acute inflammation
0-7 days
50
length of sub acute inflammation
7-30 days
51
length of chronic inflammation
>30 days
52
cellular infiltrate of chronic inflammation
macrophages | lymphocytes
53
5 aspects of inflammation
``` recognition of the offending agent recruitment of cells and mediators removal of offending agent regulation of inflammation resolution ```
54
granulocytes
neutrophils basophils eosinophils
55
helper T cells
CD4 | help B cells produce antibodies and activate macrophages thru secretion of cytokines
56
cytotoxic T cells
CD8 | kill virally infected cells
57
B cells
mature in bone marrow become plasma cells secrete antibodies
58
where do macrophages originate?
in bone marrow as monoblasts
59
what do alternatively activated macrophages do?
shut off inflammatory process | induce fibrosis
60
where are eosinophils found?
local sites of inflammation in individuals with allergies
61
what activates basophils and mast cells?
binding of antigen of surface bound IgE
62
components of the innate humoral immune system
cytokines | complement
63
components of the innate cellular immune system
``` neutrophils NK cells mast cells dendritic cells eosinophils ```
64
components of the adaptive humoral immune system
antibodies
65
components of the adaptive cellular immune system
T cells | B cells
66
which cells are the best APCs?
dendritic
67
when are tissues considered inflamed?
when leukocytes are present where they aren't normally found
68
4 cardinal signs of acute local inflammation
rubor- redness tumor- swelling calor- heat dolor- pain
69
cell derived mediators
produced within cells and then exported
70
plasma protein derived mediators
generated from proteins found in plasma and normally circulate in the blood
71
3 basic steps of acute inflammation
hyperemia increased vascular permeability emigration, accumulation, activation of leukocytes
72
hyperemia
dilation of blood vessels
73
vasoactive amines
histamine | serotonin
74
where is histamine stored?
mast cells basophils platelets
75
histamine actions
arteriolar dilation | increased venule permeability
76
what causes release of histamine?
``` trauma/heat reactions with IgE C3a C5a leukocyte derived histamine releasing proteins neuropeptides cytokines ```
77
where is serotonin stored?
platelets
78
arachidonic acid metabolites
prostaglandins leukotrienes lipoxins
79
action of prostaglandins
vasodilation
80
action of thromboxane
vasoconstriction
81
action of leukotrienes
increased permeability
82
action of LTB4 and HETE
chemotaxis
83
action of NO
vasodilation
84
how is NO synthesized?
from L-arginase and oxygen by NO synthase
85
what is PAF derived from?
membrane phospholipids
86
actions of PAF
``` platelet aggregation vasoconstriction bronchoconstriction leukocyte oxidative burst leukocyte adhesion chemotaxis ```
87
actions of PAF at low concentrations
vasodilation | increased vascular permeability
88
bradykinin
vasoactive peptide derived from plasma proteins
89
bradykinin actions
vascular permeability contraction of smooth muscle dilation of blood vessels pain
90
mediators of vasodilation
prostaglandins NO histamine
91
mediators of increased vascular permeability
``` histamine serotonin C3a C5a bradykinin leukotrienes PAF ```
92
mediators of chemotaxis, leukocyte recruitment and activation
``` TNF IL-1 chemokines C3a C5a leukotriene B4 bacterial products ```
93
mediators of fever
IL-1 TNF prostaglandins
94
mediators of pain
prostaglandins | bradykinin
95
mediators of tissue damage
lysosomal NZs of leukocytes ROS NO
96
what causes swelling?
leakage of proteins from plasma to interstitium
97
where does leakage of proteins from plasma occur?
microcirculation, post-cap venules
98
transudate
fluid that passes due to hydrodynamic forces
99
what does the presence of transudate imply?
endothelial barrier to passage of plasma proteins is intact
100
exudate
fluid that escaped from the blood vasculature, usually as a result of inflammation
101
what does the presence of exudate imply?
damage of inflammatory changes to vascular endothelium
102
edema
accumulation of fluid within the interstitium of tissues
103
is edema transudate or exudate?
can be either
104
effusion
accumulation of fluid in a sealed body cavity
105
is effusion transudate or exudate?
can be either
106
serous exudate
contains few cells and resembles serum
107
what does a serous exudate suggest?
mild vascular injury
108
purulent exudate
cloudy appearance, pus
109
what does a purulent exudate suggest?
large concentration of neutrophils due to bacteria
110
hemorrhagic exudate
contains RBCs due to cap damage
111
fibrinous exudate
typically see on serosal surfaces | white layer of fibrin occurs as a result of polymerization of fibrin
112
what is the most important histologic sign of inflammation?
leukocyte infiltration
113
steps of leukocyte recruitment to tissues
margination rolling tight adhesion migration
114
margination
leukocytes must move into the margin of the bloodstream to come into contact with the vascular wall
115
what regulates the specificity of cellular inflammation?
rolling phase
116
what mediates rolling?
selectins and integrins
117
what allows tight adhesion?
ability of integrin molecules to rapidly increase molecular avidity for integrin ligands on endothelial cell surface
118
neutrophil chemotactic agents
``` bacterial products C5a Leukotriene B4 IL-8 CXC chemokines PAF ```
119
vascular effects of C3a and C5a
release histamine from mast cells --> vasodilation, increased permeability
120
C5a roles
chemotaxis | activation of lipoxygenase pathway of
121
C3b role
opsonize bacteria for phagocytosis
122
what causes fever?
pyrogens
123
what are the sources of pyrogens?
macrophage derived cytokines: IL-1 IL-6 TNF-alpha
124
leukocytosis
increased number of leukocytes in peripheral blood
125
neutrophil extracellular nets
strands of chromatin derived from the neutrophil contain antimicrobial peptides and kill bacteria
126
causes of chronic infection
prolonged exposure to tissue injury, irritants, toxins autoimmune diseases allergic diseases persistent infections
127
inflammatory mediators of chronic inflammation
acute phase proteins cytokines- TNF IL-6
128
what synthesizes acute phase proteins?
hepatocytes
129
what induces synthesis of acute phase proteins?
IL-6
130
ESR
erythrocyte sedimentation rate | clinically measures inflammation
131
what synthesizes IL-6?
macrophages fibroblasts endothelial cells activated T cells
132
actions of IL-6
stimulates synthesis of acute phase reactants fever growth of B cells
133
granuloma
aggregate of macrophages arranged concentrically around a pathogen or irritant
134
characteristic cell of granuloma
epitheloid macrophage
135
epitheloid macrophage
large cell with abundant, pale, granular cytoplasm | in center of granuloma
136
distinctive feature of granuloma
multinucleated giant cells
137
causes of granuloma
bacterial inflammation fungal/parasitic infections aseptic foreign bodies unknown causes
138
angiogenesis
formation of new blood vessels via extension or remodeling from existing cap
139
where are continuous cap?
skeletal muscle heart lung brain
140
where are fenestrated cap?
endocrine glands intestinal villi glomeruli
141
where are discontinuous cap?
liver spleen bone marrow
142
what do endothelial cells secrete?
``` prostacyclin thrombomodulin heparin plasminogen activator tissue factor ```
143
angiogenesis
formation of new blood vessels via extension or remodeling from existing cap
144
steps of sprouting angiogenesis
``` increase vessel perm loosening of pericytes degradation of BM EC proliferation directed migration sprouting/tubulogenesis creation of lumen pericytes attach fuse with other sprouts ```
145
steps in vessel sprouting
``` tip/stalk cell selection tip cell navigation stalk cell proliferation stalk elongation tip cell fusion lumen formation perfusion and vessel maturation ```
146
what do tip cells form in response to VEGF?
filopodia
147
what regulates filopodia formation?
Cdc42 ephrinB2 VEGFR-2
148
what stabilizes the stalk cells?
notch activity
149
____ signaling promotes stabilization of the endothelial layer through the inhibition of SRC
Robo4/UNC5B
150
contact btwn cells that express Notch and Jagged1 induces expression of ____ in mural cell
Notch3 | Jagged1
151
_____ are the major regulators of angiogenesis
VEGF ligands
152
____ promotes expression of VEGF
hypoxia
153
non-sprouting angiogenesis
involves formation of blood vessels by a splitting process in which elements of interstitial tissue invade existing vessels to form transvascular tissue pillars
154
vasculogenesis
de novo blood vessel development from vascular progenitor cells
155
what are hemangioblasts derived from
mesodermal cells
156
what causes mesodermal cells to differentiate into hemangioblasts?
high conc of bone morphogenetic proteins
157
phase 1 of vasculogenesis
mesodermal cells become hemangioblasts that condense into blood islands
158
phase 2 of vasculogenesis
angioblasts multiply and differentiate into endothelial cells
159
phase 3 of vasculogenesis
endothelial cells form tubes and connect to form the primary cap plexus
160
arteriogenesis
formation of mature blood vessels | differentiation into veins and arteries
161
2 elements of tissue repair
regeneration | fibrosis
162
labile cells
continuously dividing cells
163
stable cells
infrequently dividing cells
164
permanent cells
rarely or non dividing cells
165
tissue repair steps
inflammation cell proliferation and migration synthesis of ECM remodeling of ECM
166
inflammation is equivalent to what layer of the chronic peptic ulcer?
necrosis and acute inflammatory exudate
167
cell proliferation and migration is equivalent to what layer of the chronic peptic ulcer?
granulation tissue
168
synthesis of ECM is equivalent to what layer of the chronic peptic ulcer?
granulation tissue and ECM
169
remodeling of ECM is equivalent to what layer of the chronic peptic ulcer?
fibrous scar
170
tissue elements of layer 1 acute inflammation and necrosis
fibrin neutrophils macrophages platelets
171
molecular elements of layer 1 acute inflammation and necrosis
cytokines- IL, interferons, TNF | growth factors- PDGF, FGF
172
cellular elements of layer II granulation tissue
capillaries fibroblasts macrophages
173
molecular elements of layer II granulation tissue
``` EGF/TGF-alpha PDGF FGF VEGF TGF-beta angiopoietins ```
174
growth factors
polypeptides that signal cells to proliferate, migrate, and differentiate
175
EGF/TGF-alpha
bind ERB-B1 cell membrane receptors which generate a signal with tyrosine kinase that induces a wide variety of cells to divide
176
PDGF
dimer with A and B side chains where each molecule binds to 2 membrane receptors alpha and beta
177
where is PDGF stored?
platelet alpha granules
178
what produces PDGF?
``` platelets activated macrophages smooth muscle cells endothelial cells some tumor cells ```
179
effects of PDGF
migration and proliferation of fibroblasts and endothelial cells
180
FGFs
produced by a variety of cells and recognized by a family of cell surface receptors that have intrinsic protein kinase activity
181
FGF actions
macrophage, fibroblast, endothelial cell migration | angiogenesis
182
VEGF
family of growth factors essential to new blood vessel formation
183
VEGF action
increased vascular permeability
184
TGF-beta
family of homodimeric proteins that interact with cell surface receptors and trigger phosphorylation of Smads
185
what produces TGF-beta
platelets endothelial cells lymphocytes macrophages
186
actions of TGF-beta
inhibits epithelial proliferation stimulates fibroblasts chemotaxis production of collagen and fibronectin
187
2 distinct domains of the ECM
basal membrane | interstitial matrix
188
what produces the basal membrane?
epithelial cells | some mesenchymal cells
189
what composes the basal membrane?
``` non-fibrillary collagens laminin heparan sulfate proteoglycan glycoproteins ```
190
interstitial matrix
fills spaces btwn cells and is the predominant element in CT
191
what composes the interstitial matrix?
``` fibrillary and non-fibrillary collagens elastin adhesive glycoproteins fibronectin gel of proteoglycans and hyaluronate ```
192
what are the 3 groups of macromolecules that make up the ECM?
fibrous structural proteins cell adhesion proteins gel of proteoglycans and hyaluronan
193
collagen
triple helix of 3 polypeptide alpha chains that have gly-x-y repeating sequence
194
elastin
central core of elastin surrounded by a micro-fibrillary network of fibrilin
195
cell adhesion proteins
glycoproteins that link cells and ECM components to each other
196
cadherins
ca dependent adherence proteins that connect PM of adjacent cells
197
how are cadherins linked to the cytoskeleton?
alpha and beta catenins
198
integrins
family of cell surface receptors that mediate cell attachment to ECM by binding to CAMs
199
fibronectin
large, adhesive glycoprotein that binds to ECM proteins and and to cells
200
what produces fibronectin
fibroblasts endothelial cells monocytes
201
laminin
spans the BM and binds specific cell surface receptors to collagen type IV and heparan sulfate
202
proteoglycans
core of proteins linked to 1 or more disaccharide polymers
203
role of proteoglycans
regulating ECM structure and permeability
204
hyaluronan
large molecule consisting of numerous repeats of simple disaccharide
205
role of hyaluronan
binds to water to give tissues turgor pressure
206
how is remodeling achieved in layer IV?
degradation of collagen and pro by metalloproteinases and resynthesis
207
what causes wound contraction?
myofibroblasts
208
NK cells
large, non-phagocytic granular lymphocytes that kill abnormal host cells
209
how do NK cells kill their target?
release perforins, granzymes and other cytotoxic chemical that induce apoptosis
210
how do NK cells recognize their targets?
killer activation receptors
211
origin of mast cells
bone marrow stem cells
212
function of mast cells
mediates inflammatory process
213
life span of mast cells
few months
214
distribution of mast cells
CT conc along small blood vessels | subepithelium of resp and GI
215
prestored mediators of mast cells
heparin histamine chondriotin sulfate proteases
216
heparin action
prevents clotting at site of infection
217
lipid mediators of mast cells
prostaglandins cysteinyl leukotrienes PAF
218
cytokines and chemokines of mast cells
``` leukotrienes- IL-4,5,6 thromboxanes TNF-alpha eosinophil chemotactic factor neutrophil chemotactic factor ```
219
general functions of mast cell mediators
``` recruitment of immune cells activation of immune cells phagocytosis antimicrobial activity tissue repair vascular permeability toxin degradation ```
220
primary granules of neutrophils
lysosomes that contain myeloperoxidase | acid hydrolases
221
myeloperoxidase
forms ROS that are toxic to bacteria
222
specific granules of neutrophils
alkaline phosphatase collagenase lactoferrin bacterial phagocytins lysozyme
223
lysozyme
degrades components of bac cell walls
224
tertiary granules of neutrophils
cathepsins gelatinase for cell migration
225
what do eosinophilic granules contain
major basic protein
226
major basic protein roles
potent toxin for helminth worms induces histamine release activates neutrophils and platelets bronchospasm
227
function of eosinophil
parasitic infestations | allergies
228
primary granules of basophiles
``` heparin chondriotin sulfate histamine proteases eosinophil chemotactic factor neutrophil chemotactic factor ```
229
secondary granules of basophils
leukotrienes- IL-4,5,6 thromboxanes PAF TNF-alpha
230
monocytes are characterized by a high level expression of _____ surface receptor
CD14
231
lacrimal apparatus
continual washing and blinking prevents microbes from settling on eye surface
232
transferrins
iron binding proteins in blood that inhibits bacterial growth by reducing available iron
233
pattern recognition receptors
receptors of the innate immune system that recognize broad structural motifs not in host but present on microbes
234
what do pattern recognition receptors recognize?
pathogen associated molecular patterns
235
pathogen associated molecular patterns
molecules associated with groups of pathogens | recognized by innate immune system
236
toll like receptor role
mediate generation of defensive responses
237
what triggers TLR
binding to a PAMP on an infectious organism
238
stimulation of TLR leads to production of
inflammatory cytokines-IL-6,10,12 type I IFNs chemokines
239
B cells
recognize antigens via membrane bound IgM as part of the B cell R complex
240
CD4 T cells interact with APCs expressing ___
MHC II
241
CD4 T cell role
activate macrophages | activate B lymphocytes
242
CD8 T cells interact with APCs expressing ___
MHC I
243
CD8 T cell role
directly kill virus infected or tumor cells
244
pleiotropic effects
1 cytokine can have diverse effects on many cell types
245
redundant effects
multiple cytokines may have the same activity
246
proinflammatory cytokines
IL-1 IL-6 TNF
247
anti inflammatory cytokines
IL-10 | TGF-beta
248
growth factor cytokines
IL-2 secreted by helper T cells
249
main chemokine cytokine
IL-8
250
interferons
antiviral proteins that interfere with viral multiplication
251
alpha and beta interferons
produced by virus infected cells and diffuse to neighboring cells to cause infected cells to produce antiviral proteins
252
what produces gamma interferon
lymphocytes
253
what does gamma interferon do?
causes neutrophils to kill viruses and some bacteria
254
major histocompatibility complex
tightly linked cluster of genes whose products are associated with intracellular recognition and self/nonself discrimination
255
what do class I MHC genes mediate?
immune responses against endogenous antigens
256
what alleles encode class I MHC?
HLA-A,B,C
257
what do class II MHC genes mediate?
immune response against exogenous antigens
258
what encodes class II MHC?
HLA-D allele | DP, DQ, DR subregions
259
where are MHC class II found?
APC cells
260
professional APCs
dendritic cells macrophages B cells
261
main function of dendritic cells
process antigen material and present it on the cell surface of the T cells of the immune system
262
where are dendritic cells?
tissues that are in contact with the environment
263
antigen processing
formation of peptide-MHC complexes that require a protein antigen be degraded into peptides and displayed within the cleft of the MHC molecule on the cell membrane
264
antigen presentation
display of transported peptide-MHC molecules on the cell membrane
265
cytokines produced by TH1 cells
IFN-g
266
cytokines produced by TH2 cells
IL-4,5,13
267
cytokines produced by TH17 cells
IL-17,22 | chemokines
268
immunologic reactions triggered by TH1
macrophage activation stimulation of IgG antibody production
269
TH1 role in disease
immune-mediated chronic inflammatory diseases
270
immunologic reactions triggered by TH2
stimulation of IgE production | activation of mast cells and eosinophils
271
TH2 role in disease
allergies
272
immunologic reactions triggered by TH17
recruitment of neutrophils, monocytes
273
TH17 role in disease
immune-mediated chronic inflammatory diseases
274
IL-4 action
stimulates B cells to differentiate into IgE secreting plasma cells
275
IL-5 action
activates eosinophils
276
IL-13 action
activates mucosal epithelial cells to secrete mucus and expel microbes activates macrophages to secrete growth factors important for tissue repair
277
chemotaxis
phagocytes are chemically attracted to site of infection
278
complement system
large group of serum proteins that participate in the lysis of foreign cells, inflammation, phagocytosis
279
classical pathway of complement activation
initiated by an immune reaction of antibodies
280
alternative pathway of complement activation
initiated by direct interaction of complement proteins with microbial polysaccharides
281
cytolysis
formation of a membrane attack complex that causes lesions in microbial membranes
282
which part of the complement system is involved in opsonization?
C3b
283
type I hypersensitivity
allergies
284
what mediates type I hypersensitivity
IgE antibodies that activate mast cells
285
cells involved in type I hypersensitivity
``` B lymphocytes plasma cells mast cells basophils neutrophils eosinophils ```
286
type II hypersensitivity
antibody mediated diseases
287
what causes type II hypersensitivity
antibodies directed against antigens present on cell surfaces or the extracellyular matrix
288
autoantigen of myasthenia gravis
ACh R
289
myasthenia gravis consequence
skeletal muscle weakness due to impaired contraction
290
myasthenia gravis treatment
pyridostigmine (ACh inhibitor)
291
autoantigen of immune thrombocytopenic purpura
platelet surface antigens
292
Immune thrombocytopenic purpura consequence
premature destruction of platelets
293
Thrombocytopenia
low levels of platelets
294
Pemphigus vulgaris antibodies
formed against desomosomes
295
Pemphigus vulgaris consequence
layers of skin separate and blisters form
296
type III hypersensitivity
immune complex diseases
297
type III hypersensitivity cause
antibodies formed against antigens leading to the formation of immune complexes
298
3 possible factors precipitating type III HSR
Persistence of low grade microbial infection Extrinsic environmental antigen Autoimmune process
299
type IV hypersensitivity
T cell mediated
300
type IV hypersensitivity cause
tissue injury by T cell mediated response without formation of antibodies
301
2 classes of type IV hypersensitivity
delayed type hypersensitivity | direct cell mediated cytotxicity
302
delayed type hypersensitivity is characterized by ___
perivascular accumulation of CD4 T cells and macrophages
303
TB test is what kind of HSR?
type IV
304
hashimoto's thyroiditis
condition characterized by autoimmune destruction of thyroid
305
pathophysiology of hashitmoto's
destruction of thyroid tissue by CD8 T cells and macrophages
306
hashimoto's symptoms
``` Weight gain Fatigue Paleness or puffiness of face Constipation Cold intolerance Difficulty getting pregnant Joint and muscle pain Hair loss Depression ```
307
central tolerance
antigen induced deletion of self-reactive T and B cells during maturation
308
mechanisms of peripheral tolerance
anergy suppression by Treg activation induced cell death
309
anergy
functional inactivation
310
type II autoimmune disease
antibodies against cell surface or matrix antigens
311
examples of type II autoimmune diseases
``` autoimmune hemolytic anemia immune thrombocytopenic purpura Goodpasture's syndrome pemphigus vulgaris Graves disease myasthenia gravis ```
312
symptoms of autoimmune hemolytic anemia
fatigue exertional dyspnea palpitation
313
autoantigen of autoimmune hemolytic anemia
RBC surface antigens
314
autoimmune hemolytic anemia consequene
premature destruction of RBC by complement and phagocytes leading to anemia
315
how do you diagnose autoimmune hemolytic anemia
Coombs test
316
immune thrombocytopenic purpura autoantigen
platelet surface antigens
317
immune thrombocytopenic purpura consequence
premature destruction of platelets
318
Goodpasture's syndrome autoantigen
non-collagenous domain of BM collagen type IV
319
Goodpasture's syndrome consequence
pulmonary hemorrhage | glomerulonephritis
320
pemphigus vulgaris autoantigen
epidermal cadherin
321
pemphigus vulgaris consequence
blistering of skin
322
Grave's disease autoantigen
thyroid stimulating hormone receptor
323
Grave's disease consequence
hyperthyroidism
324
myasthenia gravis autoantigen
ACh R
325
myasthenia gravis consequence
progressive weakness
326
type III autoimmune disease
immune complex disease
327
type III autoimmune disease examples
systemic lupus erythematosus
328
systemic lupus erythematosus pathophysiology
autoantibodies form circulating immune complexes that deposit in tissues and cause a type III HSR
329
systemic lupus erythematosus autoantigen
``` DNA histones ribosomes snRNP scRNP ```
330
systemic lupus erythematosus consequence
glomerulonephritis vasculitis arthritis systemic inflammation
331
type IV autoimmune disease
T cell mediated disease
332
type IV autoimmune disease examples
type 1 diabetes rheumatoid arthritis multiple sclerosis Sjogren syndrome
333
type 1 diabetes autoantigen
pancreatic beta cell antigen
334
type 1 diabetes consequence
beta cell destruction
335
rheumatoid arthritis autoantigen
unknown synovial joint antigen
336
rheumatoid arthritis consequence
joint inflammation and destruction
337
rheumatoid arthritis treatments
anti TNF-a monoclonal antibodies | antibody dependent cell mediated cytotoxicity treatment
338
multiple sclerosis autoantigen
myelin basic protein | proteolipid protein
339
multiple scleorsis consequence
demyelination brain degradation paralysis
340
Sjogren syndrome autoantigen
unknown antigens in ductal epithelial cells of exocrine glands
341
Sjogren syndrome consequence
destruction of lacrimal and salivary glands
342
what causes Sjogren sydnrome
CD4+ T cell reactions | systemic B cell hyperreactivity
343
what is the dominant factor affecting susceptibility to autoimmune disease?
HLA
344
sympathetic ophthalmia
physical trauma to 1 eye results in release of sequestered intraocular protein antigen --> T cell attack antigen in both eyes
345
what is the most hazardous time for infant disease?
neonatal period | first 4 weeks of life
346
congenital abnormalities
structural defects present at birth
347
malformations
primary errors of morphogenesis | intrinsic abnormal developmental processes
348
3 major causes of malformation
genetic environmental multifactorial
349
Zika
severe malformations of the CNS
350
rubella embryopathy
cataracts heart defects deafness mental retardation
351
what characterizes fetal alcohol syndrome?
``` growth retardation microcephaly short palpebral fissures maxillary hypoplasia psychomotor disturbances ```
352
what is associated with nicotine (teratogen)
``` spontaneous abortions premature labor placental abnormalities low birth weight SIDS ```
353
what does exposure of heavy doses of radiation during the period of organogenesis lead to?
microcephaly blindness skull defects spina bifida
354
incidence of malformations in diabetic mothers
6-10%
355
what does maternal hyperglycemia-induced fetal hyperinsulinemia result in?
fetal macrosomia cardiac anomalies neural tube defects CNS malfunctions
356
multifcatorial causes
implies the interaction of environmental influences with 2+ genes of small effect most common genetic cause of congenital malformations
357
2 phases of intrauterine development
embryonic | fetal
358
when is the embryo susceptible to teratogenesis?
btwn 3-9 weeks | peaks at 4 and 5
359
what does valproic acid disrupt?
expression of HOX proteins- implicated in patterning of limbs, vertebrae, craniofacial structures
360
syndactyly
fusion of digits
361
polydactyly
extra digits
362
what characterizes hand-foot-genital syndrome
distal limb and urinary tract malformations
363
absence of all trans retinoic acid causes
many malformations including eyes, genitourinary, CVS, diaphragm, lungs
364
excess of all trans retinoic acid causes
reinoic acid embryopathy- CNS, CVS, craniofacial defects
365
prematurity
Infants born before completion of the normal gestational period or who have failed to grow normally during gestation have higher morbidity and mortality rates than full-term infants
366
what defines prematurity
gestational age <37weeks | weight <2500g
367
major risk factors of prematurity
Preterm premature rupture of placental membranes. - Intrauterine infection leading to inflammation of placental membranes (chorioamnionitis) . - Structural abnormalities of the uterus, cervix, and placenta (placenta previa, and abruptio placentae) . - Multiple gestation (twin pregnancy).
368
what complications are premature babies vulnerable to?
 Respiratory distress syndrome of the newborn (RDS)  Necrotizing enterocolitis (NEC)  Intraventricular and germinal matrix hemorrhage  Sepsis
369
respiratory distress syndrome of the newborn cause
immaturity of the lungs
370
main defect of RDS
deficiency of pulmonary surfactant leading to collapsed lungs, progressive atelectasis and reduced lung compliance resulting in a protein/fibrin-rich exudate in the alveolar spaces with the formation of hyaline membranes
371
treatment
maternal steroids before birth | artificial surfactant
372
Necrotizing enterocolitis presentation
abdominal distention absent bowel sounds bloody stools
373
what do abdominal radiographs of infants with NEC show
gas within the intestinal wall (pneumatosis intestinalis)
374
Germinal Matrix-Intraventricular Hemorrhage
Subependymal (germinal matrix) hemorrhage, with secondary bleeding into the ventricles
375
SIDS
the sudden death of an infant under 1 year of age which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history
376
most common findings in SIDS autopsies
petechiae on the thymus, visceral and parietal pleura, and epicardium
377
most important modifiable risk factors in SIDS
prone sleeping position sleeping on soft surfaces thermal stress
378
fetal hydrops
accumulation of edema fluid in the fetus during intrauterine growth
379
causes of fetal hydrops
hemolytic anemia due to Rh blood group incompatibility between the mother and fetus (immune hydrops) and nonimmune hydrops
380
immune hydrops
antibody-induced hemolytic disease in the newborn caused by blood-group incompatibility between mother and fetus
381
causes of non immune hydrops
cardiovascular defects, chromosomal anomalies, and fetal anemia
382
kernicterus
brain is enlarged and edematous and on cut section shows deposit of bright yellow pigment (bilirubin) particularly in the basal ganglia and brain stem
383
2 types of hemangiomas
capillary | cavernous
384
where are most hemangiomas located in children
skin- face and scalp
385
von-Hippel-Lindau syndrome
autosomal dominant disorder with retinal angiomas, CNS hemangioblastomas, renal cell carcinomas; pheochromocytoma, tumors of the pancreas; endolymphatic sac tumors; and renal, pancreatic, and epididymal cysts
386
Sturge Weber syndrome
congenital neurological and skin disorder associated with port-wine stains of the face, glaucoma, seizures, mental retardation, and ipsilateral leptomeningeal angioma (cerebral malformations and tumors)
387
microscopic appearnace of lymphangiomas
cystic and cavernous spaces with pale fluid content lined by endothelial cells surrounded by lymphoid aggregates
388
where do lymphangiomas mainly occur
deeper regions of the neck, axilla, mediastinum and retroperitoneum
389
most common germ cell tumors of childhood
Sacrococcygeal Teratomas
390
neuroblastoma defintions
tumor of the sympathetic ganglia and adrenal medulla
391
how are neuroblastomas classified?
by neural differentiation
392
Neuroblastoma
primitive stroma
393
Ganglioneuroblastoma
primitive stroma and ganglion cells
394
Ganglioneuroma
schwannian stroma and ganglion cells
395
stage 1 Neuroblastoma
Localized tumor completely excised, with or without microscopic residual disease; representative ipsilateral non-adherent lymph nodes negative for tumor (nodes adherent to the primary tumor may be positive for tumor)
396
stage 2A Neuroblastoma
Localized tumor with incomplete gross resection; representative ipsilateral non-adherent lymph nodes negative for tumor microscopically
397
stage 2B Neuroblastoma
Localized tumor with or without complete gross excision, ipsilateral non-adherent lymph nodes positive for tumor; enlarged contralateral lymph nodes, which are negative for tumor microscopically.
398
stage 3 Neuroblastoma
Unresectable unilateral tumor infiltrating across the midline with or without regional lymph node involvement; or localized unilateral tumor with contralateral regional lymph node involvement
399
stage 4 Neuroblastoma
Any primary tumor with dissemination to distant lymph nodes, bone, bone marrow, liver, skin, and/or other organs
400
stage 4S Neuroblastoma
Localized primary tumor (as defined for Stages 1, 2A, or 2B) with dissemination limited to skin, liver, and/or bone marrow (<10% of nucleated cells are constituted by neoplastic cells; >10% involvement of bone marrow is considered a stage 4). Stage 4S is limited to infants <1 yr.
401
Children younger than ___ of age have a more favorable outlook for neuroblastomas
18 mo
402
favorable histologic pattern of neuroblastomas
evidence of schwannian stroma or gangliocytic differentiation
403
the greater the # of copies of ___ indicates a worse prognosis for neuroblastomas
N-myc
404
what DNA ploidy is more favorable in neuroblastomas
hyperdiploid
405
what mutations are unfavorable in neuroblastomas
ALK
406
expression of. ___ is favorable in neuroblastomas
TrkA
407
Approximately 40% of cases of retinoblastoma are associated with a germline mutation of the ___
RB1 gene
408
retinoblastoma presentation
poor vision strabismus a whitish hue to the pupil (“cats eye reflex”) pain, tenderness in the eye
409
median age of presentation of retinoblastoma
2 years
410
most common sites of metastases of retinoblastomas
central nervous system skull distal bones lymph nodes
411
Wilms Tumor
nephroblastoma
412
Most cases of Wilms tumor occur in children between ages
2-5 years old
413
WAGR syndrome
characterized by Wilms tumor, aniridia, genital anomalies, and mental retardation
414
Denys-Drash syndrome
gonadal dysgenesis and renal abnormalities | extremely high risk for Wilms tumor
415
Beckwith-Wiedemann syndrome
atients have an increased risk for the development of Wilms tumor exhibit enlargement of individual body organs (organomegaly: tongue, kidneys or liver) or entire body segments (hemihypertrophy), and enlargement of adrenal cortical cells (adrenal cytomegaly)
416
Beckwith-Wiedemann syndrome in an example of a disorder of ____
genomic imprinting
417
genetic locus of Beckeith-Wiedemann
genetic locus is in band p15.5 of chromosome 11 distal to the WT1 locus
418
___are precursor lesions of Wilms tumors
nephrogenic rests
419
treatment of Wilms tumor
nephrectomy | chemotherapy
420
benign pediatric tumors
hemangioma lymphangioma teratoma
421
malignant pediatric tumors
neuroblastoma retinoblastoma wilms tumor
422
first and second most common causes of neonatal mortality
congenital anomalies | prematurity
423
RDS is most commonly observed in?
male preterm infants delivered by C-section
424
what does RDS lead to?
increased surface tension collapsed lungs progressive atelectasis reduced lung compliance
425
fetal hydrops CV causes
malformations tachyarrhytmia high-output failure
426
fetal hydrops chromosomal causes
turner syndrome trisomy 21- down syndrome trisomy 18- edward syndrome
427
fetal hydrops infection causes
cytomegalovirus syphilis toxoplasmosis
428
fetal hydrops fetal anemia causes
homozygous alpha-thalassemia parvovirus B19 immunhydrops (Rh and ABO)
429
what does parvovirus B19 attack
erythroblasts
430
major causes of non immune hydrops
- Cardiovascular defects | - Chromosomal anomalies - Fetal anemia
431
capillary type of hemangioma
occurs in the skin, subcutaneous tissue, mucous membranes of the oral cavity and lips, liver, spleen and kidneys. Many instances they spontaneously regress
432
cavernous type of hemangioma
less well circumscribed and more frequently involve deep structures may be locally destructive and show no spontaneous tendency to regress, so surgery may be required
433
cavernous hemangiomas are a component of ____
Hippel-Lindau disease
434
Simple (capillary) lymphangiomas
composed of small lymphatic channels predominantly occurring in the head, neck, and axillary subcutaneous tissues
435
Cavernous lymphangiomas (cystic hygromas)
typically found in the neck or axilla of children and rarely occur in the retroperitoneum
436
what are cavernous lymphangiomas associated with?
turner syndrome
437
what are neuroblastomas derived from?
derived from primordial neural crest cells that populate these sites
438
blueberry muffin baby
in neonates disseminated neuroblastomas may present with multiple cutaneous metastases with deep blue discoloration to the skin
439
overexpression of N-MYC is associated with ___
rapid tumor progression
440
treatment of neuroblastomas
retinoids | inhibitors of ALK
441
where is the RB allele located?
chromosome 13q14
442
prognostic factors of retinoblastoma
stage of cnacer age of pt likelihood vision can be saved size and # of tumors
443
retinoblastoma treatments
``` enucleation radiation cryotherapy thermotherapy chemotherapy ```
444
wilms tumor presentation
huge, palpable flank mass | hematuria
445
anaplasia
Presence of cells with large, hyperchromatic, pleomorphic nuclei and abnormal mitoses
446
what causes wilms tumor
Deletion of tumor suppressor gene WT1 on chromosome 11.

MAMS (8 decks)

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