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Flashcards in Pathology Deck (94):
1

Pyknosis

irreversible condensation of chromatin in the nucleus of a cell undergoing apoptosis

2

Karyorrhexis

destructive fragmentation of a dying cell (cell undergoing apoptosis); irreversible

3

Karyloysis

Dissolution of the chromatin/Fading of the nucleus of a dying cell; part of apoptosis; irreversible

4

Apoptosis vs Necrosis

Apoptosis-->no inflammation; form apoptotic bodies, which are phagocytosed
Necrosis --> swelling and inflammation; intracellular components extravasate

5

Cell injury that's reversible with oxygen:

-decreased ATP synthesis
-Cellular swelling (ie no ATP --> impaired Na/K pump)
-Nuclear chromatin clumping
-decreased glycogen
-fatty change
-ribosomal detachment (decreased protein synthesis)

6

Cell injury that's irreversible

-Nuclear pyknosis, karyolysis, karyhorrhexis (all processes involved in apoptosis)
-Calcium influx--> caspase activation
-plasma membrane damage
-lysosomal rupture
-mitochondiral permeability (ie with intrinsic pathway of apoptosis)

7

Areas that are susceptible to hypoxia:

*Watershed areas --> Splenic flexure and ACA/MCA
*Subendocardial tissue of heart
*Proximal Tubule in cortex of Kidney
*Thick Ascending limb in medulla of kidney
*Neurons
*Area around central vein of liver

8

Red vs Pale Infarcts

Red = hemorrhagic; happens in tissues with loose collaterals, like liver, lungs, intestine; or, after reperfusion of an area

Pale happen in solid tissues with old one blood supply (like heart, kidney, spleen)

9

What causes reperfusion injury?

Damage by free radicals

10

Hypovolemic/Cardiogenic Shock vs Septic Shock findings:

Hypovolemic/Cardiogenic:
-LOW-output failure
-increased TPR
-Low cardiac output
-Cold, Clammy pt

Septic Shock:
-HIGH-output failure
-decreased TPR
-dilated arterioles, high venous return
-Hot patient

11

Mediators of fluid exudation in inflammation:

-Histamine
-Serotonin
-Bradykinin

12

Acute phase cytokines associated with inflammation?

IL-1
IL-6
TNF-alpha

13

Metalloproteinases:

Enzymes involved in remodeling of ECM following injury
--> require ZINC! this is why Zinc deficiencies result in delayed wound healing!

14

Why is vitamin C important for wound healing?

-->fibrosis, need collagen for deposition of ECM; need vitamin C for collagen!

15

Two supplements given to pts who are healing:

-Vitamin C (for collagen)
-Zinc (for metalloproteinases)

16

5 steps of Leukocyte Extravasion:

1) Rolling (E- and P-Selectins and Sialyl Lewis leukocyte)
2) Tight binding (ICAM and Integrin)
3) Diapedesis (PECAM)
4) Migration (Bacterial products and chemotactic signals = C5a, IL-8, LTB4, Kallikrein)
5) Phagocytosis

17

signals for neutrophil chemotaxis?

C5a
IL-8
Leukotriene B4
Kallikrein

18

Delayed separation of umbilicus, and abnormal integrin:

Leukocyte Adhesion Deficiency

19

Which vitamins are anti-oxidants (can eliminate free radicals)?

A, C, E

20

3 phases of wound healing: When does each phase occur? which cells are the mediators? characteristics?
1) Inflammatory
2) Proliferative
3) Remodeling

1) Inflammatory:
-->occurs immediately
-->Mediators: platelets, neutrophils, macrophages
-->form clot, neutrophils go into tissue, macrophages clean up

2) Proliferative:
-->2-3 days after wound
-->Mediators: fibroblasts, myofibroblasts, endothelial cells, keratinocytes
-->granulation tissue, collagen, angiogenesis, epithelial cell proliferation, dissolve clot, wound contraction

3) Remodeling:
-->1 week after wound
--> Mediators: Fibroblasts
--> Type I collagen replaces type III collagen (type I is for late wound repair; type III is for granulation/early wound repair)

21

Type of collagen involved in early wound healing? late wound healing?

-Early wound healing --> granulation tissue --> Collagen Type III
Late wound repair --> Scar tissue --> Type I collagen (stronger)

22

Pathogenesis of granuloma formation:

Th1 cells secrete IFN-gamma --> activate macrophages --> macrophages secrete TNF-alpha --> induces and maintains granuloma formation

***If give pt with a granuloma an anti-TNF drug --> drug can break down granulomas, leading to disseminated disease

23

Transudate vs Exudate:

*Transudate:
-Hypocellular
-Protein poor

24

What is the ESR?

--> Erythrocyte sedimentation rate
--> inflammatory products, like fibrinogen, coat RBCs, causing them to aggregate. So, when put in test tube, aggregated RBCs fall at a faster rate....

25

3 conditions with DECREASED ESR?

-Sickle Cell (weird RBC shape!)
-Polycythemia (too many RBCs!)
-CHF (not sure why...)

26

5 states in which have increased ESR?

-inflammation
-infection
-cancer
-pregnancy
-SLE

27

Bence Jones

=amyloid seen in multiple myeloma; derived from Ig light chains

28

Beta-amyloid

amyloid protein in Alzheimer's deases

29

Beta-2-microglobulin

protein seen in dialysis-associated amyloidosis

*note: have B2-microglobulin on MHC I; this amyloid is derived from MHC-I proteins

30

Transthyretin

protein seen in senile cardiac amyloidosis

31

A-CAL protein

protein seen in Medullary Carcinoma of the thyroid
-->derived from Calcitonin

32

Carcinoma in situ =

Pre-invasive
-->cells have not yet invaded basement membrane, but neoplastic cells encompass entire thickness
-->have high nuclear/cytoplasmic ratio and clumped chromatin

33

What enzymes do neoplastic cells use to invade the basement membrane?

Collagenases and Hydrolases (metalloproteinases)

34

Hamartoma =

mass of MATURE tissue ENDOGENOUS to site from where it originates (similar to hyperplasia...)

35

Hyperplasia =
Metaplasia =
Dysplasia =
Anaplasia =
Neoplasia =
Desmoplasia =

Which of these processes are reversible? irreversible?

Hyperplasia--> increased # of cells

Metaplasia--> one adult type replaced by another

Dysplasia--> abnormal growth, loss of cellular orientation, shape, size; commonly pre-neoplastic

Anaplasia-->abnormal cells, lack differentiation; very primitive; little/no resemblance to tissue of origin

Neoplasia--> uncontrolled, excessive, clonal proliferation of cells

Desmoplasia--> fibrous tissue formation in response to neoplasm

36

Features of Anaplastic cells:

-high nucleus:cytoplasm ratio
-prominent nucleoli
-nuclear chromatin clumpin
-lots of mitotic figures

37

Are mature teratomas benign or malignant?

in women--> benign
in men--> malignant

38

Hemangioma

benign tumor of blood vessels; usually affect infants, then disappear spontaneously in the months following birth

39

Angiosarcoma

malignant tumor of blood vessels; chronic lymphedema is a predisposing factor (ie following a radical mastectomy with axillary lymph node dissection to treat breast cancer)

40

Rhabdomyoma and Rhabdoymyosarcoma

benign and malignant tumors of skeletal muscle

41

Fibroma

benign tumor of connective tissue

42

Cachexia

loss of weight, muscle atrophy, fatigue --> occurs in chronic disease
-mediated by: TNF-alpha, IFN-gamma, IL-6

43

Neoplasms associated with Down Syndrome?

-ALL
-AML

44

Neoplasms associated with Tuberus Sclerosis (facial angiofibroma, seziures, MR, ash leaf spots)?

-Cardiac rhabdomyoma (about 2/3rds of TS pts)
-Astrocytoma
-Angiomyolipoma

45

Neoplasm associated with Barrett's esophagus?

-Esophageal adenocarcinoma

46

Neoplasm associated with Plummer-Vinson syndrome (atrophic glossitis, esophageal webs, anemia; all d/t iron deficiency)?

-Squamous cell carcinoma of esophagus

47

Neoplasm associated with Ulcerative Colitis?

Colonic adenocarcinoma

48

Neoplasm associated with autoimmune diseases (ie Hashimoto's, Myasthenia gravis)?

Lymphoma

49

Neoplasmas associated with radiation exposure?

-Sarcoma
-Papillary thyroid cancer

50

Neoplasm associated with Sjogren's?

B-cell lymphoma

51

Neoplasm associated with Cirrhosis (alcoholic, hepatitis B/C)

Hepatocellular carcinoma

52

Neoplasms associated with Paget's disease of bone?

-secondary osteosarcoma
-fibrosarcoma

53

Homer-Wright Pseudorosettes:

Neuroblastoma

54

abl gene

CML
-->tyrosine kinase

55

c-myc

Burkitt's lymphoma
-->transcription factor

56

bcl-2

follicular and undifferentiated lymphomas
-->anti-apoptotic molecule

57

erb-B2

Breast, ovarian, gastric carcinomas
-->tyrosine kinase

58

ras

Colon carcinoma
-->GTPase

59

L-myc

Lung tumor
-->transcription factor

60

N-myc

Neuroblastoma (childhood adrenal medulla tumor)
-->transcription factor

61

ret

MEN 2a and 2B
-->tyrosine kinase

62

c-kit

Gastrointestinal Stromal Tumor
-->cytokine receptor

63

Rb

-Retinoblastoma
-Osteosarcoma

64

p53

-Li-Fraumeni syndrome
-various cancers

65

BRCA1 and 2

-->DNA repair protein
-->Breast and ovarian (1), just breast (2)

66

p16

melanoma

67

APC

colorectal cancer (associated with FAP and Gardner's syndrome)

68

WT1

Wilm's tumor

69

NF1

Neurofirbomatosis I

70

NF-2

Neurofibromatosis 2

71

DPC

Pancreatic cancer

72

DCC

Colon Cancer

73

PSA

Prostate-specific antigen
-->used to screen for prostate carcinoma

74

CEA

nonspecific tumor marker for colorectal and pancreatic cancers; also gastric, breast, medullary thyroid carcinomas

75

alpha-fetoprotien = tumor marker for:

-Hepatocellular carcinomas
-also for yolk sac tumors

76

Beta-hCG = tumor marker for:

"HCG"
-Hydatidoform moles
-Choriocarcinomas
-Gestational trophoblastic tumors

77

CA-125 = tumor marker for:

-ovarian tumors

78

S-100 = tumor marker for:

-melanoma
-Scwannomas

(both are derived from neural crest)

79

Alkaline Phosphatase = tumor marker for?

-metastases to bone
-Paget's disease of bone
-obstructive biliary disease

80

TRAP = tumor marker for?

= Tartrate-resistant acid phosphatase
-->marker for Hairy cell leukemia (B-cell neoplasm)
"TRAP the Hairy animal!"

81

CA-19 = tumor marker for?

Pancreatic adenocarcinoma

82

Calcitonin = tumor marker for?

Medullary thryoid carcinoma

83

Cancer associated with HIV (not with HIV-associated conditions; just with HIV)?

Primary CNS lymphoma

84

Cancer associated with H. pylori?

Gastric adenocarcinoma and lymphoma

85

Cancer associated with Aflatoxins (aspergillus)?

Hepatocellular carcinoma

86

cancer associated with vinyl chloride?

Angiosarcoma

87

Cancer associated with Nitrosamines (smoked food)?

Gastric cancer

88

4 cancers associated with smoking?

-Squamous cell carcinoma
-Squamous cell and small cell carcinoma
-Renal cell carcinoma
-Transitional cell carcinoma

89

2 cancers associated with asbestos

-Mesothelioma
-Bronchogenic carcinoma

90

2 cancers associated with Arsenic?

-Squamous cell carcinoma
-Angiosarcoma

91

Cancer associated with Naphthalene/Aniline dyes?

Transitional Cell Carcinoma of bladder

92

Cancer associated with alkylating agents?

Leukemia

93

Cancer associated with radon (coal mines, basements)?

Lung cancer

94

Psammoma bodies: found in?

"PSMM"
-Papillary cancer of thyroid
-Serous cancer of ovary
-Meningioma
-Malignant mesothelioma