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Flashcards in Path Final Additional cards Deck (477):
1

What is hypertrophy?

1) General increase in the bulk, not due to tumor formation2) increase in size of cells not #

2

What happens to tissue once it stretches or stress is put on a tissue?

It will adapt to the stress

3

What is atrophy or hypotrophy?

wasting of tissue from death and reabsorption of cells, diminished cellular proliferation, decreased cellular volume, pressure, ischemia or malnutrition that leads to lessened function or hormonal changes

4

What causes atrophy in the brain?

Aging and reduced blood supply

5

How does a brain that has undergone atrophy appear grossly?

The brain has narrowed gyri and widened sulci

6

What causes atrophy of the thyroid gland?

Longstanding autoimmune disease

7

What is hyperplasia?

increase in # cells excluding tumor formation

8

What causes endometrial hyperplasia?

Estrogen.

9

What causes calluses on the heels of feet?

Stresses due to constant wear on feet (ie: tight shoes)

10

What is BPH?

Benigh Prostatic hyperplasia

11

What is hypoplasia?

incomplete development of tissue (ie: neural fold defects)

12

What is metaplasia?

reversible replacement of one differentiated cell type with another differentiated cell type (ie: barrett's esophagus where cells have migrated from the stomach to the esophagus due to constant stress)

13

What is anaplasia?

A change in the structure of cells and a change in their orientation to each other.

14

What is aplasia?

The defective development, or congenital absence of an organ or tissue

15

What is dysplasia?

Abnormal tissue growth with loss of cell orientation, shape, and size

16

What is dysplasia?

Abnormal tissue growth with loss of cell orientation, shape, and size

17

Dysplasia is always what?

Pre-cancerous

18

What type of cell injury is found with lysosome swelling and rupture?

Irreversible as necrosis will occur

19

What cell injury occurs when fat calcification begins?

Irreversible

20

What happens to reversible damaged cells when looking at them with light microscope?

They have fatty changes (steatosis).

21

Is nuclear clumping the same as nuclear condensation?

NO!

22

What is the difference between necrosis and apoptosis?

Necrosis- common after ischemia and chemical injury CELL SWELLING. Apoptosis- is programmed cell death and CELL SHRINKAGE.

23

Does necrosis or apoptosis has neighbor or adjacent cell inflammation?

Usually necrosis

24

What happens to the plasma membrane during necrosis?

It is disrupted

25

What happens to the plasma membrane during apoptosis?

Intact/altered.

26

What happens with the cells contents with necrosis ?

enzymatically digested

27

What happens with the cells contents with apoptosis?

intact and packaged to be phagocytosed

28

What causes necrosis?

Inavriably pathologic

29

What causes apoptosis?

Often physiological

30

What does serum CK-MB check for?

Cardiac tissue ischemia

31

What does serum CK-BB check for?

Brain Tissue ischemia

32

What does serum CK-MM check for?

Generic muscle ischemia

33

What does cytochrome c do once it is outside of the mitochondrial membrane?

It induces secondary apoptotic effects

34

What are the sources of internal calcium?

1) mitochondrial damage2) cell injury (external calcium enters cell)3) ER damage

35

Where will Vitamin E be doing free radical protection?

In the membranes.

36

Glutothione is stored mostly where and to do what?

Stored in the retina to protect against all redox reactions.

37

What is the role of P-450?

Detox. It is enzymes that increase the solubility of compounds and help excrete them.

38

What is the down side of P-450?

While detoxing it can make some reactive oxygen intermediates which can injure cells.

39

Where are the P-450 enzymes found?

In the Smooth ER of hepatocytes.

40

What process is NADPH oxidase found in?

Pentose Shunt

41

Is iron required in the human body?

yes but excess can cause oxidative changes

42

Is copper required in the human body?

Yes but only in trace amounts

43

Free radical injury is induced through what?

membrane lipid peroxidation, protein modification, DNA breakage.

44

How are free radicals degraded?

Through enzymes, spontaneous decay, and antioxidants.

45

Why is homogenated milk bad for us?

Xanthine oxidase is better absorbed in body and causes more free radicals in circulation

46

Reperfusion after anoxia (an abnormally low amount of oxygen in the body tissues) induces what?

Free radical production.

47

What are some free radicals found in the body?

Super oxide, peroxide, hydroxide and nitrous oxide

48

What are some antioxidants that neutralize the free radicals in the body that are found in the cytosol?

Superoxide dismutaseGlutathionePeroxidaseFerritinCeruloplasminQuercitin

49

What is the function of ferritin?

Moves iron around the body

50

What is the function of ceruloplasmin

Transports copper around the body

51

Where is quercitin found?

in orange peel (white part)

52

What can initiate injury via free radicals?

Radiation exposure, metabolism of drugs (phase I), redox reaction, nitric oxide, transition metals, leukocyte oxidative burst

53

How do free radicals cause cell injury?

Through membrane lipid peroxidation, protein modification and DNA breakage

54

What are the different types of necrosis?

1) Coagulative2) Liquefactive3) Caseous4) Fat5) Fibrinoid6) Gangrenous

55

Coagulative necrosis happens with necrosis to what areas?

Heart, liver, and kidney.

56

Coagulative necrosis is a result of what?

Protein denaturation.

57

What will coagulative necrosis look like?

Preservation of basic cell outline for several days.

58

Liquefactive necrosis happens where?

Brain

59

Liquefactive necrosis is characteristic of what 2 things?

1. Bacterial infection. 2. CNS stroke.

60

Liquefactive necrosis is a result of what?

Enzymatic digestion.

61

Gangrenous necrosis is associated with what area?

Limbs and GI tract.

62

Gangrenous necrosis usually results in what?

limb with loss of blood and Coagulation necrosis.

63

What is wet gangrene?

Coagulation necrosis with liquifactive action of bacterial infection and attracted leukocytes.

64

Caseous necrosis occurs due to what?

It is seen in tuberculosis infections.

65

What is the appearance of caseous necrosis?

Cheesy white appearance.

66

Caseous necrosis is a distinct form of which type of necrosis?

Coagulative necrosis

67

What is makes caseous necrosis a special form of coagulative necrosis?

Tissue architecture is obliterated unlike coagulative necrosis

68

How does Caseous necrosis look microscopically?

1) amorphus granular debris of fragmented coagulated cell2) amorphus granular debris enclosed within distinctive inflammatory border (granulmatous reaction)

69

Can scarring from caseous necrosis be seen via x-ray? And how long does scarring last?

Yes it can be seen in x-ray and the scarring remains with the patient for life

70

Fat necrosis occurs where?

In the pancreas

71

Is fat necrosis a typical necrosis pattern?

No

72

What will fat necrosis look like under microscope?

Foci of shadowy outlines of fat cells with basophilic calcium deposits surrounded by inflammatory reaction.

73

What will fat necrosis look like grossly?

Chalky area due to fat saponification

74

Is fat necrosis focal or widespread?

Focal area of fat destruction usually due to lipase release

75

What does P-450 do? What is an unfortunate result?

P-450 neutralizes toxins but creates free radicals

76

What is the stimulus for coagulative necrosis?

Hypoxia, toxins

77

What is the stimulus for apoptosis?

Physiologic and pathologic

78

What is the histology of the coagulative necrosis?

Cellular swellingcoagulative necrosisorganelle disruption

79

What is the histology for apoptosis?

Cellular shrinkageChromatin condensationApoptotic bodies

80

What is the DNA Breakdown in coagulative necrosis?

Random, diffuse

81

What is the DNA Breakdown in apoptosis?

Internucleosomal

82

What are the mechanisms of coagulative necrosis?

ATP depletionMembrane injuryFree radical damage

83

What are the mechanisms of apoptosis?

Gene activationEndonucleasesProteases

84

What is the tissue reaction of coagulative necrosis?

Inflammation

85

What is the tissue reaction of apoptosis?

No inflammationPhagocytosis of ABs

86

During what instances does apoptosis occur?

1) Embryogenesis2) hormone induction (menstruation)3) immune cell-mediated death4) injurious stimuli (ie: radiation, hypoxia)5) regulation of cell population and tumor suppression6) atrophy (ie: endometrial lining during menopause)

87

Which type of cell death is more controlled?

Apoptosis

88

Which type of cell death involves more cells?

Necrosis

89

What are the two types of pathologic calcification?

Dystrophic calcificationMetastatic calcification

90

Where does Dystrophic calcification occur?

Deposition occurring locally in dying tissue

91

What happens to the serum calcium level of the dystrophic calcification?

Nothing, it is normal serum calcium level

92

Is there any calcium metabolism pathology associated with dystrophic calcification?

No, no calcium metabolism pathology

93

What are some examples of dystrophic calcification?

Atherosclerosis of arteries, damaged heart valves

94

Where does metastatic calcification occur?

Deposition in otherwise normal tissue

95

What happens to the serum calcium level of the metabolic calcification?

Systemic elevation calcium levels in the blood and all tissues

96

What usually causes metastatic calcification?

Usually due to secondary hypercalcemia

97

What happens to calcium levels in injured cells with dystrophic calcification?

The calcium levels will increase due to release from ER and mitochondria

98

What happens to mitochondrial initiation with dystrophic calcification?

The mitochondrial permeability transition increases and therefore calcium diffuses through into the cell.

99

What is arachidonic acid?

Arachidonic acid is derived from phospholipids through the action of phospholipases

100

How is arachidonic acid metabolized?

1) Lipoxygenase pathway2) Cyclooxygenase pathway

101

What are the 5 arachidonic acid derivatives?

1) Leukotrienes2) Lipoxins3) Thromboxane4) Prostacyclin5) Prostaglandins

102

What is the function of leukotrienes?

Chemoxtaxis, vascular permeability and bronchospasm

103

What is the function of lipoxins?

vasodilatation, inhibition of neutrophil chemotaxis, and monocyte adhesion

104

What is the function of thromboxane?

Platelet aggregation, thrombosis

105

What is the function of Prostacyclin?

Opposes the effects of thromboxane

106

What is the function of Prostaglandins?

Smooth muscle contraction

107

Is Omega 3 fatty acids (fish oil) a good substrate for conversion?

No it is a poor substrate

108

Are animal fats good for conversion to substrate?

Yes, animal fat is a good substrate

109

Generally, what lymphokines are released with macrophage activation and lead to inflammation?

Interleukin-1 and Tumor Necrosis factor

110

What are the acute-phase reactions activated by interleukin-1 and tumor necrosis factor?

1) Fever2) increased sleep need3) decreased appetite4) Increased acute-phase proteins5) hemodynamic effects (shock)6) Neutrophilia (attract neutrophils)

111

What are the endothelial effects activated by interleukin-1 and tumor necrosis factor?

1) increased leukocyte adherence2) Increased prostacyclin synthesis3) Increased procoagulant activity4) decreased anticoagulant activity5) Increased Interleukin and platelet derived growth factor

112

What are the fibroblast effects activated by interleukin-1 and tumor necrosis factor?

1) increased proliferation2) increased collagen synthesis3) increased collagenase4) increased protease5) increased prostaglandin synthesis

113

What are the leukocyte effects activated by interleukin-1 and tumor necrosis factor?

Increased cytokine secretion (interleukin 6 and 8)

114

What does long term tumor necrotic factor production lead to?

Cachexia (wasting away syndrome)

115

What leads to the pathogenesis of fever?

TNF and IL-1 that changes the set point of internal temperature in the hypothalamus

116

What are two types of edema?

Exudate and Transudate

117

What is exudate made of?

It is rich in protein and blood cells and are typical of inflammation

118

What is transudate made of?

- Contains less protein and fewer cells
- an ultra-filtrate of plasma fluid

119

What is a typical cause of transudate?

Typical of hydrostatic or osmotic pressure pathology

120

What is the specific gravity of transudate?

Specific gravity is usually less than 1.012 and a protein content of less than 2gm/100mL

121

What are some factors towards the pathogenesis of Edema?

1) increase in hydrostatic pressure2) Increase in wall permeability3) Decrease oncotic pressure (decrease albumin concentration)4) Lymphatic obstruction

122

Is transudate hypocellular or cellular?

Hypocellular

123

Is transudate protein rich or poor?

Protein poor

124

What is the specific gravity of transudate?

Specific gravity <1.012

125

What is transudate due to?

Increased hydrostatic pressureDecreased Oncotic pressureNa+ retention

126

Is exudate hypocellular or cellular?

Cellular

127

Is exudate protein rich or poor?

Protein rich

128

What is the specific gravity of exudate?

Specific gravity >1.020

129

What is exudate due to?

Lymphatic obstruction or Inflammation

130

What are the 4 mechanisms of MMP regulation?

1. regulation of synthesis by growth factors or cytokines. 2. Inhibition of synthsis by corticosteroids or TGF-beta. 3. secreted in inactive form. 4. Blockage of the enzymes by specific tissue inhibitors of metalloproteinase.

131

The inflammation phase of wound healing lasts how long?

3 days.

132

The granulation tissue phase of the healing process takes place when?

0.3 days until 10 days.

133

The wound contraction phase of the healing process takes place when?

3 days to 30 days.

134

What will clean up an injured site after the healing process?

Macrophages.

135

What type of scaring occurs with primary intention healing?

Minimal scarring

136

What type of scaring occurs with secondary intention healing?

Broader scar result of granulation

137

What type of scaring occurs with tertiary intention healing?

Wound is purposely left open

138

What type of injury is primary intention healing?

Little tissue loss.

139

Most surgical wounds heal by which intention?

Primary intention healing. (wound edges are directly next to each other)

140

How is a primary intention wound is closed?

By sutures, staples or adhesive.

141

What is allowed to happen to the wound with secondary intention healing?

It is allowed to granulate.

142

Why can the healing process be slower with secondary intention healing?

Due to the presence of drainage from infection and surgeons may pack the wound with gauze or use a drainage system.

143

How long will a tertiary intention scar be left open?

4-5 days.(where the wound is initially cleaned, debrided and observed before closure)

144

What is Keloid?

Excess collagen deposition in the skin forming a raised scar.

145

What is inflammation?

The reaction of the blood vessels, leading to the accumulation of fluid and leukocytes in the extravascular tissues

146

What is the function of inflammation?

A protective response- eliminate microbes and toxins- eliminate necrotic cells and tissues- prepare for tissue repair

147

What do neutrophils do?

First responder (acute inflammation) bacterial or fungal infection

148

What forms pus?

Increased activity and death of neutrophils

149

What general percentage of WBC's do neutrophils make up?

60%

150

What do lymphocytes do?

Chronic inflammation- T cell and B cell response/activation

151

What general percentage of WBC's do lymphocytes make up?

30%

152

What do monocytes do?

Long lived Phagocyte that present pathogen parts to T cells

153

What are monocytes when they are in tissue?

Macrophages

154

What general percentage of WBC's do monocytes make up?

5-6%

155

What do eosinophils do?

Parasite and Allergic response

156

What general percentage of WBC's do eosinophils make up?

2-3%

157

What do basophils do?

Allergic and antigen response and releasing the chemical histamine

158

What are basophils when they are in tissue?

Mast Cells

159

What general percentage of WBC's do basophils make up?

<1%

160

What is the order from largest to smallest of the WBC's?

NeutrophilsLymphocytesMonocytesEosinophilsBasophils(Never Let Monkeys Eat Bananas)

161

Where do T lymphocytes mature?

Thymus

162

Where do B lymphocytes mature?

Bone maroow

163

Are thrombocytes WBCs?

No they are platelets

164

What is the function of thrombocytes?

To plug up holes

165

What is the life span of an RBC?

120 days

166

What is the life span of WBC?

days to years

167

What is the life span of a platelet?

8 days

168

What are the two types of inflammation?

Acute and Chronic

169

What is the duration and onset speed of acute inflammation?

Rapid onset and short duration (min/hours/days)

170

Is there edema with acute inflammation?

Yes

171

What type of leukocyte is predominantly present with acute inflammation?

Predominantly neutrophils, but also eosinophils and antibody mediated

172

What is the duration and onset speed of chronic inflammation?

Slower onsetLong duration (wks, months, years)

173

What are some characteristic appearances of chronic inflammation?

Presence of new blood vessels, fibrosis, and tissue necrosis

174

What type of leukocyte is predominantly present with chronic inflammation?

Predominantly macrophages and lymphocytes

175

What are the key signs and symptoms of acute inflammation?

1) Redness2) Heat3) Swelling4) Pain5) Loss of function

176

What is the Latin term for redness?

Rubor

177

What is the Latin term for heat?

Calor

178

What is the Latin term for swelling?

Tumor

179

What is the Latin term for Pain?

Dolor

180

What is the Latin term for Loss of function?

Functio laesa

181

What vascular changes occur with inflammation?

1) Vascular dilation and increased blood flow (causing erythema and warmth)2) Extravasation and deposition of plasma fluid and proteins (edema)3) Leukocyte emigration and accumulation in the site of injury

182

What is the net flow of fluid of microvasculature in normal circulation?

Small flow out of the precapillary arteriole but returned in the precapillary venuole

183

What happens to the net flow of the microvasculature with acute inflammation?

Arteriole pressure is increased and the mean capillary pressure is increased due to arteriolar dilation. The venous pressure increases and the osmotic colloidal pressure is reduced due to protein leakage across the venule which results in an excess of extravasated tissue

184

What is oncotic pressure?

Pressure bringing in fluid into vasculature from tissue due to albumin concentration

185

What causes oncotic pressure?

Albumin concentration

186

What controls arteriole pressure?

Sphincters of muscles that clamp off blood flow

187

What collects the small flow out of the capillary bed?

Lymphatic system

188

What is hyperemia?

Increased blood flow

189

What occurs with the precapillary sphincter during normal circumstances?

The precapillary sphincters are closed

190

What occurs with the precapillary sphincter during acute inflammation?

The precapillary sphincters are open

191

During normal flow how are the RBC's and platelets and neutrophils distributed?

Scattered

192

Where in a circulatory vessel is the flow the fastest?

The middle because of laminar flow

193

What is the term for the stacking of RBCs as they move towards laminar flow?

Rouleaux of RBC

194

What does marginalization of neutrophils refer to?

When the neutrophils are pushed aside and moving towards the endothelium

195

What is the rouleaux relation to erythrocyte sedimentation rate?

It elevates the ESR

196

What are the steps of leukocyte extravasation?

1) Margination2) Pavementing3) Extravascular migration

197

What is the main leukocyte of margination?

Neutrophils

198

What are the parts of the pavementing stage of leukocyte extravasation?

1) rolling2) tight binding3) diapedesis/migration

199

What are some parts of tight binding of the pavementing stage of leukocyte extravasation?

1) integrin activation2) stable adhesion

200

What occurs in extravascular migration?

Chemokines and cytokines direct the leukocyte to go to specific area

201

What are the 3 steps of phagocytosis of a particle?

1) recognition and attachment- microbes bind to phagocyte receptors2) engulfment- phagocyte membrane zips up around microbe3) killing and degradation- fusion of phagosome with lysosome- killing of microbes by lysosomal enzymes in phagolysosome

202

What 2 groups are the mediators of inflammation divided into?

1) plasma derived2) cell derived

203

Do mediators of inflammation act only on a single cell?

No, they are multifunctional and act on many cells and tissues

204

Are mediators of inflammation biochemically the same or diverse?

Biochemically diverse including biogenic amines, peptides and arachidonic acid derivatives

205

What is a histamine?

Biogenic amine that is from a cell derived source (stored in cell)

206

Where histamines released from?

Platelets and mast cells

207

What is the function of histamine?

Stimulates retraction of endothelial cells of the venules and leads to gaps therefore increased permeability

208

Is the action of histamine short or long and why?

The action of histamine is short because it is inactivated by histaminase

209

What vitamin stabilizes mast cells?

Vitamin C, during an acute response

210

What is bradykinin?

Plasma protein in the liver that is derived from kininogen through the enzymatic action of kallikrein?

211

what is Kallikrein do and what is it activated by?

Kallikrein acts on the clotting and fibrinolytic systems of the blood and activated by Hageman factor

212

What does bradykinin induce?

Pain

213

What is the relationship between bradykinin and histamine?

They both have a similar action

214

What were the mast cells called before they exited the blood vessel?

Basophils

215

What does neoplasia mean?

New Growth

216

What does tumor mean?

Swelling, formation of masses

217

What does cancer mean?

Tissue invasion appearance like crawling crab

218

What does oncology mean?

Study of Swelling

219

What does carcinoma in situ mean?

Means "in its place" but is a tumor that has not penetrated the basement membrane

220

Are all tumors a neoplasia?

Yes

221

Is a neoplasia always a tumor?

No, sometimes there's no distinct mass as in leukemia or malignant disease of bone marrow

222

What are the 3 types of reversible plasias?

1) Hyperplasia2) Metaplsia3) Dysplasia

223

What are the 3 types of irreversible plasias?

1) anaplasia2) neoplasia3) desmoplasia

224

What is anaplasia?

Irreversible Abnormal cells lacking differentiation; like primitive cells equated with undifferentiated malignant neoplasms

225

What is desmoplasia?

Irreversible Fibrous tissue formation in response to neoplasm

226

What are the two classifications of tumors?

BenignMalignant

227

How are tumors classified?

Histologically

228

How do the growths of benign and malignant tumors differ?

Benign tumors are slow and expansive and malignant tumors are fast and invasive

229

Are both benign and malignant tumors metastatic?

No, Benign tumors are not metastatic

230

How do the external surface features of benign and malignant tumors differ?

Benign = smoothMalignant = irregular

231

Do both benign and malignant tumors have capsules?

No, only benign tumors have capsules

232

Are both benign and malignant tumors capable of necrosis?

No, only malignant tumors are capable of necrosis

233

Are both benign and malignant tumors capable of hemorrhage?

No, only malignant tumors are capable of hemorrhage

234

How does the architechture of benign and malignant tumors differ?

Benign = resembles normal tissue of originMalignant = Does not resemble normal tissue of origin

235

How does the cells of benign and malignant tumors differ?

Benign = well differentiatedMalignant = Poorly differentiated

236

How do the nuclei of benign and malignant tumors differ?

Benign = normal size and shape; uniformMalignant = pleomorphic (variable in shape)

237

How does the mitosis of benign and malignant tumors differ?

Benign = few in mitosisMalignant = many and irregular

238

What is a regular nuclear to cytoplasmic ratio?

1:06

239

What does a nuclear to cytoplasmic ratio of 1:2 or 1:3 signify?

It means they are neoplastic

240

What does metastasis mean?

Change in position

241

What are the main pathways of metastasis?

1) lymphatics2) blood (hematogenous spread)3) Seeding surface of body cavities (transcoelomic spread)

242

What are some other pathways of metastasis?

Intraepithelial

243

What are the steps of hematogenous metastatic cascade?

1) primary tumor2) metastatic clone evolves3) proliferation of the clone and invasion of vessel4) transport by circulation5) emobilization6) invasion7) new tumor formation at the site of metastasis

244

What is transcoelomic spreading?

Direct seeding of a cavity by neoplastic cells within that cavity therefore there is no plane of resistance to spreading

245

What is intraepithelial spread?

1) Tumor cells infiltrate between the cells of normal epithelium without invading the underlying stroma

246

What is the best example of intraepithelial spread?

Paget's disease of the nipple where cells of ductal carcinoma in situ grow into nipple skin and resemble eczema

247

What is tumor-induced angiogenesis?

The biologic role of tumors to overcome limitation of nutrient and oxygen delivery

248

What do mesenchymal tumors with the -oma ending mean?

It stands for a mesenchymal benign tumor

249

What do mesenchymal tumors with the -sarcoma ending mean?

It means that it is a mesenchymal malignant tumor

250

What do epithelial tumors with the adenoma ending mean?

It is a benign epithelial tumor

251

What do epithelial tumors with the carcinoma ending mean?

It is a malignant epithelial tumor

252

What are the three exceptions to the "oma" being benign rule? Why?

LymphomaMultiple myelomaGliomaBecause they only exist via blood cells, lymph system and glial cells

253

What is common between squamous cell carcinoma and adenocarcinoma?

They both are surrounded by non-neoplastic stroma

254

What are some tumors of blood cells and lymphocytes?

LeukemiaLymphomaMultiple Myeloma

255

What are some tumors of neural cells?

GanglioneuromaNeuroblastoma

256

What are some tumors of glial and nueral suporting cells?

Glioma and meningioma

257

What are some germ cell tumors?

Teratoma, embryonal carcinoma and seminom/dysgerminoma

258

What are blastomas?

Blastomas are malignant tumors composed of embryonic cells originating from embryonic primordia

259

What is a teratoma?

Teratomas are derived from germ cells and contain tissues that are formed from all three germ layers: etoderm, mesoderm and endoderm

260

What are eponymic tumors?

These tumors carry the name of physicians who have described them first

261

What does Hodgkin's disease affect?

lymph nodes

262

What does Ewing's sarcoma affect?

Bones

263

What does Kaposi's sarcoma affect?

Skin

264

What is tumor staging based on?

Clinical assessment during gross examination, surgery, x-ray examinations

265

What is the grading of tumors based on?

Based on histologic examination

266

What does the TNM system of staging take account for?

T = size of tumorN = presence of lymph node metastasesM = Distant metastases

267

What is the grading scale of the TNM system?

0-4 in each category TNM

268

What grading of M signifies metastases?

a 1 represents metastasis

269

What do the roman numeral stages of tumor range from?

0 to IV

270

What is a stage 0 tumor?

A carcinoma that is in situ

271

What is a stage I cancer?

Cancer that is localized to one part of the body

272

What is a stage II cancer?

A locally advanced (same as stage III but specific criteria differ according to diagnosis)

273

In Hodgkin's disease what is the difference between stage II and stage III?

Stage II: lymph nodes on only one side of the diaphragmStage III: lymph nodes above and below the diaphragm

274

What is a stage IV cancer?

Canvers that have metastasized or spread to other organs or throughout the body

275

what is the Ann Arbor staging for? and what stages are there?

For lymphomas ranging from stage I - IV

276

What is a stage I in the Ann arbor staging?

Cancer is located in a single region, usually one lymph node and the surrounding area. Stage I often will not have outward symptoms

277

What is a stage II in the Ann arbor staging?

Cancer is located in two separate regions, an affected lymph node or organ within the lymphatic system and a second affected area, and that both affected areas a confined to one side of the diaphragm (ie: both are above the diaphragm or both are below the diaphragm)

278

What is a stage III in the Ann arbor staging?

Cancer has spread to both sides of the diaphragm, including one organ or area near the lymph nodes or the spleen

279

What is a stage IV in the Ann arbor staging?

Diffuse or disseminated involvement of one or more extralymphatic organs, including any involvement of the liver, bone marrow, or nodular involvement of the lungs

280

What does the tumor grades range from?

Grade I - III

281

What is tumor grading based on?

Histologic examination

282

What is a grade I tumor?

well differentiated

283

What is a grade II tumor?

Moderately well differentiated

284

What is a grade III tumor?

undifferentiated

285

Overall, which has more predictive value, grading or staging of tumors?

Staging

286

Is the difference between normal and malignant cells qualitative or quantitative?

Quantitative

287

Are cancer cells more or less adapted to survive unfavorable conditions and are they more or less differentiated than normal cells?

Cancer cells are less differentiated and more adapted to survive under unfavorable conditions as they require less oxygen to survive

288

In which gender has deaths from lung cancer plateaued? and which is continuing to rise?

Males = plateauFemales = rise

289

Is cancer the leading cause of death in the US?

No it is number 2, heart disease is 1st

290

Define Incidence

The number of new cases that have been registered over a specific time in a defined population

291

Define prevalence

The number of all cases, new and old, within a defined population at a defined time

292

Define Mortality

The number of deaths attributed to cancer during a specified period in a defined population

293

Define morbidity

number suffering from a disease that has been registered over a specific time in a defined population

294

What is the most important risk factor and most common initial symptom for lung cancer?

Smoking -> Cough

295

What is the most important risk factor and most common initial symptom for breast cancer?

Family history of cancer -> lump

296

What is the most important risk factor and most common initial symptom for colon cancer?

Family history of colonic polyps -> blood in stool

297

What is the most important risk factor and most common initial symptom for cervix cancer?

Promiscuity (early intercourse or multiple partners) -> vaginal bleeding (spotting)

298

What is the most important risk factor and most common initial symptom for uterus cancer?

Hormonal: imbalance and treatment -> vaginal bleeding

299

What is the most important risk factor and most common initial symptom for skin cancer?

Sun exposure -> sun lesion

300

What is the most important risk factor and most common initial symptom for prostate cancer?

Old age -> dysuria

301

What cancer has the highest incidence in men?

Prostate

302

What cancer is the second highest incidence in men and women?

Lung & bronchus

303

What cancer is the third highest incidence in men and women?

Colon & rectum

304

What cancer has the highest incidence in women?

Breast

305

What cancer has the highest mortality in men and women?

Lung & bronchus

306

What cancer has the third highest mortality in men and women?

Colon & rectum

307

What cancer has the second highest mortality in men?

Prostate

308

What cancer has the second highest mortality in women?

Breast

309

Where does metastatic cancers usually travel to?

LiverLungBrainBone

310

What does metastatic cancer usually indicate?

A poor pronosis

311

How does the insertion part of viral carcinogens?

Slow transforming oncogenic RNA viruses, insert into the genome and activate a latent cellular oncogene, which is then capable of transforming the normal cell into a malignant cell

312

What are the different types of human carcinogenic viruses?

DNA viruses and RNA viruses

313

What are some examples of human carcinogenic DNA viruses?

- Human Papilloma virus- Epstein-Barr virus- Hepatitis B and C virus- Kaposi's sarcoma-associated herpesvirus

314

What are the types of HPV that can cause cervical, penile/anal carcinoma?

16 and 18

315

What can epstein-barr virus cause?

Burkitt's lymphoma (B cell neoplasia)Nasopharyngeal carcinoma

316

What can Hepatitis B and C virus cause?

Liver cancer

317

What can Kaposi's sarcoma-associated herpesvirus cause?

Kaposi's sarcoma, a type of skin cancer

318

What is a type of RNA virus and what can it cause?

Human T-cell leukemia/lymphoma virus and it can cause adult T cell leukemia (HIV group)

319

What are human oncogenes?

Homologous to viral oncogenes and thus called cellular oncogenes

320

What do human oncogenes represent?

Represent activated normal genes (proto-oncogenes)

321

How does an oncogene function?

An oncogene has gained function and becomes a cancer-inducing agent

322

How many damaged allele does it require to activate an oncogene?

Only 1 damaged allele

323

What are different ways of transformation of proto-oncogenes into oncogenes?

1) point mutation2) gene amplification3) chromosomal rearrangement4) insertion of viral oncogene

324

What do tumor suppressor genes do?

Protect the cells against activated or newly acuired oncogenes

325

What happens to a tumor suppressor gene that has lost function?

It is no longer a cancer-inhibiting agent

326

How many tumor suppressor gene alleles out of the two need to be lost in order for expression of disease?

Both alleles

327

What are different types of Hereditary cancer?

1) Neurofibromatosis type 12) familial adenomatous polyposis coli3) Wilms' tumor4) Skin tumors in xeroderma pigmentosum5) chromosomal fragility syndromes (Bloom's syndrome, Fanconi's syndrome)

328

What are some cells that pose an immune response to tumors?

1) Natural Killer Cell2) Macrophage3) Neutrophil4) B lymphocyte5) Cytotoxic T lymphocyte

329

What is the immunotherapy of Cancer?

1) some tumors involute spontaneously under the influence of immune factors2) BcG (attenuated tuberculosis bacillus of calmette and Guerin) is used for treatment of bladder cancer3) Tumor vaccines are used for treatment of melanoma and renal cell carcinoma

330

Should tumor markers be used as a primary tool for cancer diagnosis?

No

331

What should tumor markers be used for?

Confirming a diagnosis, to monitor for tumor recurrence and to monitor response to therapy

332

What is the Tg tumor marker detect?

Thyroglobulin. Thyroid cancers

333

What is active hyperemia?

Dilatation of arterioles leading to blushing, exercise, inflammation

334

What is passive hyperemia?

Venous back pressure; often associated with hydrostatic edema, cyanosis- heart failure - pulmonary edema and heart failure cells

335

What does a chronic passive congestion of lungs lead to?

Leads to edema and RBC extravasation into alveoli

336

What is a chronic passive congestion of lungs accompanied by?

Accompanied by anoxia & often results in pulmonary fibrosis

337

In a chronic passive congestion of the lungs, what does an alveolar macrophage do?

Alveolar macrophages take up RBC & degrade hemoglobin = hemosiderin accumulation

338

Cardiac hemorrhage is often what? And what is it caused by?

- often fatal
- MI, Gun Shot Wound, stabbing wound

339

What is an aortic hemorrhage caused by?

- MVA (organs kee moving at a high speed and rips off part of aorta via ligamentum arteriosum - weakness due to copper deficiency -> aneurysm

340

What will an arterial hemorrhage look like? What causes it?

- penetrating wound, fractured bones
- presents as a bright red, pulsating/squirting

341

What will cause a capillary hemorrage? What does it do to venous pressure?

- Trauma, weakness due to vitamin C (scurvy) -increase in venous pressure

342

With the venous, how does it present as a hemorrhage?

Dark/bluish color, oozing

343

In a hemorrage what are some signs and symptoms?

- Intracerebral hemorrhage
- Hematemesis or hemoptysis
- Cardiac hemorrhage
- Venous hemorrhage
- Aortic hemorrhage
- Capillary hemorrhage
- hematochezia or melena (from anus)
- Hematuria

344

What are some clinically important forms of hemorrhage?

- skin/surface hemorrhage
- large accumulation of blood in body cavities/space
- hemoptysis
- epistaxis

345

What are some different types of skin/surface hemorrhage?

- petechia
- purpura
- ecchymosis

346

What is a petechia?

<1 mm and speckles of blood vessels

347

What is purpura?

Between 1 mm- 1cm and larger blotches

348

What is ecchymosis?

Large/blotchy bruises

349

What are some large accumulation of blood in body cavities/spaces?

Hemothorax, hemopericardium, hemoperitoneum, or hemarthrosis

350

What is a hemoptysis?

Respiratory tract/expectoration of blood

351

What is a epistaxis?

Nose bleed

352

What is hematemesis?

Vomiting blood

353

What is hematochezia

anorectal bleeding

354

what is melena

passage of black blood in stool

355

what is hematuria

blood in urine

356

What is metrorrhagia?

bleeding not related to normal monthly menses

357

what is menorrhagia?

Profound menstrual bleeding

358

What happens in a massive hemorrhage?

Blood loss, hypovolemic shock, exsanguination, death

359

If <500 ml of blood is lost what happens?

homeostatic compensation but it is reversible

360

If 1000-1500 ml of blood is lost what happens?

Circulatory shock

361

If >1500 ml of blood is lost what happens?

Lethal

362

What are some of the types of hemorrhage?

- Massive hemmorhage
- Hematoma
- Intracerebral hemorrhage
- Chronic hemorrhage

363

What can an intracerebral hemorrhage lead to?

Stroke, death

364

What can a chronic hemorrhage lead to?

Slow blood loss, iron deficiency anemia (70 ml for normal menstruation)

365

Which hemorrhage has a better outcome, Subdural or epidural hemorrhage?

A subdural hemorrhage because the lower pressure veins bleed more slowly than arteries

366

What Is the different types of pathogenesis causes of Edema?

1) Inflammatory2) Hydrostatic3) Oncotic4) Obstructive5) Hypervolemic

367

Why does inflammatory lead to the pathogenesis of edema?

Increases permeability & hyperemia

368

How does hydrostatic lead to the pathogenesis of edema?

Increased arterial pressure (hypertension)Increased venous back pressure (heart failure)

369

How does the oncotic pressure lead to the pathogenesis of edema?

Hypoalbuminemia due to:-loss/proteinuria- decreased protein synthesis

370

How does the obstruction lead to the pathogenesis of edema?

- Most often b tumor or chronic inflammation- Filaria (worm) -> elephantiasis

371

How does hypovolemia lead to the pathogenesis of edema?

Usually d/t sodium and water retention:- kidney function, renin, angiotensinogen, & aldosterone- Kidney disease -> increased renin release -> angiotensinogen -> increased aldosterone -> increased Na retention -> increased water retention

372

What are some clinical forms of edema?

1)Cerebral edema2) Pulmonary edema (d/t left-sided heart failure, post-surgery)3) Pitting edema of the lower extremities4) Periorbital (facial) edema5) Hydrothroax6) Hydropericardium7) Hydroperitoneum (ascites)8) Anasarca (Extremegeneralized edema)

373

What is TORCH(ES) syndrome?

a medical acronym for a set of perinatal infections (i.e. infections that are passed from a pregnant woman to her fetus).

374

When should we test for TORCH(ES) syndrome?

Early in pregnancy.

375

What will the T in Torches syndrome stand for and how do we get it?

Toxoplasma we get it from cat shit so stay away from Julie.

376

What will the O in TORCHES syndrome stand for?

Others that are less common like Epstein-Barr virus, Varicella virus, Listeria monocytogenes, leptospira.

377

What will the R in TORCHES syndrome stand for?

Rubella.

378

What will the C in TORCHES syndrome stand for?

Cytomegalovirus (CMV).

379

What will the H in TORCHES syndrome stand for?

Herpesvirus.

380

What will the (ES) in TORCH(ES) syndrome stand for?

Syphylis.

381

What does rubella cause?

1) Small (microcephaly)/strucuraly abnormal brain2) Heart defects.

382

What will Toxoplasma cause?

1) Microcalcification of basal ganglia and dilation of lateral ventricles (hydrocephalus)2) CNS defects.

383

What will cytomegalovirus (CMV) cause?

The same as Toxoplasma.

384

What will herpesvirus affect?

1) CNS defects2) Skin lesions.

385

What are 2 types of chromosomal anomalies?

Structural and numerical anomalies

386

What is Aneuploidy?

Loss or gain of chromosomes.

387

What are 2 types of aneuploidy?

Hyperdiploidy- 46+1 or 46+2. Hypodiploidy- 46-1 or 46-2.

388

What is monosomy?

Missing one chromosome

389

What is Trisomy?

Gaining an extra chromosome (3 of one chromosome)

390

What is the most common risk factor for Down syndrome?

Paternal age increases risk of having a baby born with down syndrome

391

What disorder is associated with Down syndrome?

Trisomy 21 (D= drinking age 21)

392

What disorder is associated with Edward's syndrome?

Trisomy 18 (E = election age 18)

393

What disorder is associated with Patau's syndrome?

Trisomy 13 (P = puberty age 13)

394

Of the 3 disorders Down, Edward's and Patau's, which one is most common?

Down Syndrome

395

What happens to a baby's hands with down syndrome?

Simian crease.

396

Down syndrome or trisomy 21 leads to what mental issues?

Most commonly leads to mental retardation

397

How will down syndrome affect the head?

Flat facial profile and epicanthic folds

398

How will down syndrome affect the heart?

Congenital heart defects like septum primum due to endocardial cushion defects.

399

How will down syndrome affect the limbs and feet?

HypotoniaA gap between first 2 toes.

400

What is the life expectancy with edwards sydnrome aka trisomy 18?

less than 1 year.

401

What will edwards syndrome cause?

Severe mental retardation.

402

How will edwards syndrome affect the head?

1) Prominent occiput2) micrognathia (small jaw)3) low set ears.

403

How will Down syndrome affect the umbilicus and intestines?

Causes umbilical hernia and intestinal stenosis

404

What is the incidence of down syndrome?

1 in 700 births

405

How will edwards syndrome affect the heart?

Congenital heart defects will be present.

406

How will edwards syndrome affect the hands and feet?

Hands- Clenched hands Feet- Rocker-bottom feet.

407

What is the life expectancy with down syndrome?

45-50 years old

408

What is the incidence of Edward's syndrome?

1 in every 8000 births

409

What some limb changes with Edward's symptoms

Limited hip abductionRocker bottom feet

410

What is the incidence of Edward's syndrome?

1 in 8000

411

What are some neurological issues with patau symptoms?

Microcephaly and mental retardation

412

What are some head changes with patau symptoms?

Cleft lip and palateMicrophthalmia

413

What are some limb issues with patau symptoms?

1) Polydactylyl2) Focker -bottom feel

414

What is the incidence of Patau syndrome?

1 in 15000

415

What is the life expectancy of Down syndrome?

45-50

416

What is the life expectancy of Edwards syndrome?

<1 year

417

What is the life expectancy of Patau syndrome?

<1 year

418

In which disorder(s), (Downs, Edwards, Patau) does mental retardation occur?

Yes, severe in Edwards and Patauand the most common cause is Down Syndrome

419

What are some other disease risks for Down Syndrome?

ALL, Alzheimer's >age 35

420

What are two disorders that are caused by abnormalities of sex chromosomes?

1) Turner syndrome2) Klinefelter syndrome

421

Who can get turner's syndrome and who can get Klinefelter's syndrome?

They are abnormalities of sex chromosomes so only females can get Turners and Only males can get Klinefelter's syndrome.

422

Pathogenesis of sex chromosome abnormalities are due to what?

Nondisjunction.

423

What is nondisjunction?

Failure of paired chromosome to separate.

424

How common is Turners syndrome?

1 in every 3,000 female births.

425

What are the symptoms of Turners syndrome? (It's super long, sorry)

1) Short stature2) heart- shaped face3) low posterior hairline4) webbing of neck5) heart disease and coarctation of aorta6) broad chest and widely spaced nipples7) pigmented nevi (moles)8) cubitus valgus(elbows turned in)9) streak ovaries, hypoplastic uterus, amenorrhea10) peripheral lymphedema at birth.

426

Are Turner's considered male or female?

Female presentation

427

What symptoms will Klinefelter's syndrome present with?

1) Tall long arms and legs2) lack of beard body hair and pubic hair3) gynecomastia4) female like hips5) testicular atrophy.

428

Is Klinefelter syndrome considered male or female?

Male presentation (based on penis presentation)

429

What type of disorder is spherocytosis?

A congenital RBC membrane disorder. IT is an autosomal dominant disease.

430

What are 3 possible symptoms of spherocytosis?

anemia, jaundice, splenomegaly.

431

How is spherocytosis diagnosed?

requires demonstration of increased RBC osmotic fragility and negative direct antiglobulin test.

432

How often will spherocytosis patients less than 45 years old need a splenectomy?

Rarely.

433

With spherocytosis what causes RBC abnormalities?

Alterations in membrane proteins.

434

What alternations in membrane proteins of RBC happens with spherocytosis?

Surface area is decreased disproportionately to the intracellular content.

435

What will decreased surface area of a RBC membrane cause?

Flexibility needed for the cell to traverse the spleen's microcirulation.

436

With western treatments how will spherocytosis be cured?

Splenectomy.

437

Presence of spherocytes in the peripheral blood smear suggest what?

1. Hereditary spherocytosis (HS). 2. Autoimmune hemolytic anemia (AIHA).

438

When there are spherocytes in the peripheral blood smear how can you distinguish between hereditary spherocytosis or autoimmune hemolytic anemia?

Coomb's test.

439

What will a negative and positive Coomb's test mean?

Negative- Hereditary spherocytosis. Positive- Autoimmune hemolytic anemia.

440

Huntington's disease is what type of disorder?

An autosomal dominant characterized by chorea and progressive cognitive deterioration.

441

How will Huntington's disease be diagnosed?

Genetic testing.

442

What is treatment of Huntington's disease like?

Supportative.

443

What type of relatives of patients with Huntington's disease should be tested?

first-degree relatives.

444

Will Huntington's disease effect males or females more?

Both equal.

445

What parts of the CNS will Huntington's disease effect?

Caudate nucleus atrophies, medium spiny neurons in the corpus striatum degenerate, and levels of neurotransmitters gamma aminobutyric acid and substance P decrease.

446

What genes are effected with Huntington's disease?

Gene on chromosome 4.

447

The gene on chromosome 4 (Huntington's disease) will lead to what?

Abnormal repetition of DNA sequence CAG that codes for amino acid Glutamine.

448

The gene product of abnormal CAG codes that make glutamine leads to what?

a large protein called huntingtin and it has large stretches of polyglitamine residue.

449

How will the huntingtin protein lead to huntington's disease?

Unknown.

450

The more CAG repetitions means what?

The earlier the disease begins and the more severe the effects.

451

What will huntington's disease be like from generation to generation?

over time it leads to more severe phenotype and more CAG codes that make more polyglitamine residues.

452

How do Symptoms of Huntington's disease develop?

Insidiously (inconspicuous or seemingly harmless way ).

453

When do Signs and symptoms of Huntington's disease develop?

start between 35-50, but can develop before adulthood.

454

What are the signs and symptoms of Huntington's disease?

Dementia or psychiatric disturbances, abnormal movements including tongue protrusion.

455

Death usually occurs how long after the first signs and symptoms of Huntington's disease appear?

13-15 years.

456

What will the cause of death usually be with Huntington's disease?

Coronary heart disease or pneumonia

457

What is the secondary or aquired immunodeficiency?

AIDS aquired immunodeficiency syndrome.

458

What will cause severe combined immunodeficiency, and what type of immunodeficiency is it?

It is primary and caused by a defect of lymphoid stem cells pre-B, Pre-T cells.

459

What is the most common type of primary immunodeficiency diseases?

Isolated deficiency of IgA.

460

What % of people have Isolated deficiency of IgA?

1 out of every 700 people

461

What is isolated deficiency of IgA like in the population?

Often asymptomatic.

462

What type of immunodeficiency disease is DiGeorge's syndrome and what causes it?

It is a primary one caused by T-cell deficiency related to aplasia of thymus associated with aplasia of parathyroid glands.

463

What type of virus is HIV aka Human immunodeficiency virus?

RNA retrovirus.

464

AIDS infects what?

T helper Cells (CD4+).

465

Where is AIDS stored at?

Macrophages and related phagocytic cells.

466

What are the clinical presentations of HIV/AIDS?

acute illness, asymptomatic infection, persistent generalized lymphadenopathy.

467

What are 5 pahtologic findings in AIDS?

1. Lymphadenopathy. 2. Kaposis sarcoma. 3. Nephrophaty. 4. Weakness. 5. oral thresh.

468

What type of infections happen with AIDS?

Opportunistic.

469

What 3 places are prone to opportunisitic infections?

1. Lungs. 2. GI tract. 3. CNS.

470

What are the 3 tumors that develop with AIDS?

1. Lymphoma of lymph nodes or GI tract. 2. Lymphoma of the CNS. 3. Kaposis sarcoma.

471

All antibodies are composed of what?

Light and heavy chains.

472

Which chains of antibodies are changeable and which chain is the same?

Light- same. Heavy are specific for each Ig.

473

What is another name for light and heavy chains?

Light-Fc. Heavy-Fab.

474

What is the largest Ig?

IgM.

475

What is the function of the IgM?

To neutralize microorganisms.

476

The IgM has how many complement binding sites?

five.

477

What is the first Ig to appear?

IgM.