Pathology Flashcards Preview

► Med 11 - USMLE 1 > Pathology > Flashcards

Flashcards in Pathology Deck (141):
1

Apoptosis
What is it?
What is required?
Phys
Inflammation
Histo
Clean up?

Programmed cell death
ATP required
Cytosolic caspases mediate cellular breakdown
No inflammation
Shrinkage, Pyknosis (nuc shrinkage), Basophilia, Blebbing, Nuclear Fragmentation (karyorrhexis), Apoptotic bodies
Phagocytosis

2

Intrinsic Apoptosis Pathway
What process is it involved with?
Mechanism
Mito involvement

Tissue remodeling in embryogenesis and after exposure to injurious stimuli
Growth factor withdrawn from proliferating cells
Changes in proportions of anti and pro apoptotic factors lead to ↑ mito permeability and ctyochrome c release

3

Extrinsic Apoptosis Pathways

Fas ligand binding to Fas Receptor (CD95)
Tc cells release Perforin and Granzyme B

4

Necrosis
What causes it?
Process?
Inflammation?

Exogenous injury
Enzymatic degradation and protein denaturation --> Intracellular components extravasate
Inflammation

5

Coagulative Necrosis

Heart, Liver, Kidney

6

Liquefactive Necrosis

Brain, Bacterial Abscess, Pleural Effusion

7

Caseous Necrosis

TB, Systemic Fungi

8

Fatty Necrosis

Peripancreatic fat (saponification via lipase)

9

Fibrinoid Necrosis

Blood vessels

10

Gangrenous Necrosis
Dry
Wet
Where?

Dry: Ischemic Coagulative
Wet: Bacteria
Limbs and GI tract

11

Reversible Cell Injury
What is required?
PathoPhys
Histo

Oxygen
↓ ATP synthesis, ↓ Glycogen
Swelling (impaired Na/K pump), Chromatic clumping, Fatty Change, Ribosomal detachment

12

Pro-apoptotic Mito protein

Bax

13

Anti-apoptotic Mito Protein

Bcl-2

14

Irreversible Cell Injury
Pathway
What happens to the cell?
Histo

Ca influx --> caspase activation
Plasma membrane damage, Lysosomal Rupture, Mito Permeability
Pyknosis, Karyolysis, Karyorrhexis

15

Location of Brain susceptible to ischemic injury

ACA/MCA/PCA boundary area

16

Location of Heart susceptible to ischemic injury

Subendocardium of LV

17

Location of Kidney susceptible to ischemic injury

Straight segment of PT in medulla
Thick Ascending Limb in medulla

18

Location of Liver susceptible to ischemic injury

Central Vein (zone III)

19

Location of Colon susceptible to ischemic injury

Splenic Flexure and Rectum

20

Red Infarcts
What kind of infarct?
What kind of tissue?
Organs?
When?

"Red = Reperfusion"
Hemorrhagic
Tissue with collaterals
Liver, Lungs, Intestines
Following reperfusion

21

Hypoxic Ischemic Encephalopathy affects what kind of cells?

Pyramidal Cells of Hippocampus and Purkinje cells

22

Pale Infarcts
What kind of tissue?
Organs?

Solid tissues with a single blood supply
Heart, Kidney, Spleen

23

Reperfusion injury is due to...

Free Radicals

24

Hypovolemic Shock
Output
TPR
Presentation

Low output
↑ TPR
Cold and Clammy

25

Cardiogenic Shock
Output
TPR
Presentation

Low output
↑ TPR
Cold and Clammy

26

Septic Shock
Output
TPR
Vasculature
Presentation

High output
↓ TPR
Dilated arterioles, High venous return
Hot

27

Atrophy
What is it?
Possible causes?

Reduction in size or # of cells
↓ hormones, innervation, blood flow nutrients
↑ pressure
Occlusion of secretory ducts

28

Characteristics of Inflammation

Redness, Heat, Swelling, Loss of Function

29

Vascular component of inflammation

↑ vascular permeability, vasodilation, endothelial injury

30

Cellular component of inflammation

Neutrophil mediated

31

Acute component of inflammation
Mediators
Onset
Duration
Possible outcomes

Neutrophils, Eosinophils, Abs
Seconds to minutes
Minute to days
Resolution, Abscess, Chronic inflammation

32

Chronic component of inflammation
Mediators
Characteristic
Associated with...
Outcomes

Mononuclear cells
Persistent destruction and repair
Blood vessel proliferation. Fibrosis
Scarring, Amyloidosis

33

Granuloma
Histo
Pathway

Nodular collection of Epithelioid Macrophages and Giant Cells
Th1 secretes IFNγ which activates Macs which secrete TNFα

34

Leukocyte Extravasation
Steps w/ mediators

1.Rolling:
Vasculature: E and P selectins. Leukocyte: Sialyl-Lewis
2. Tight Binding
V: ICAM. L: LFA1 (integrin)
3. Diapedesis (between endothelial cells)
V: PECAM. L: PECAM
4. Migration

35

Leukocyte (neutrophil) chemotactic factors

"CLIK"
C5a, LTB4, IL8, Kallikrein

36

How do free radicals damage cells?

Membrane lipid peroxidation
Protein modifications
DNA breakage

37

Free Radicals
What causes them?
How are they eliminated?

Radiation, Metabolism of drugs, Redox rxns, Nitric Oxide (NO), Transition metals, Leukocyte oxidative burst
Enzymes (Catalase, SOD, Glutathione Peroxidase), Decay, Antioxidants (A, C, E)

38

Free Radical Diseases

ROP, Bronchopulmonary Dysplasia, CCl4 --> liver necrosis (fatty change), Acetominophen OD, Hemochromatosis, Reperfusion

39

Would Healing Phases

Inflammatory, Proliferative, Remodeling

40

Would Healing Inflammatory Phase
When?
Mediators
What happens?

Immediate
Platelets, Neutrophils, Macrophages
Clot formation and ↑ permeability

41

Would Healing Proliferative Phase
When?
Mediators
What happens?

2-3 days after injury
Fibroblasts, Myofibroblasts, Endothelial cells, Keratinocytes, Macrophages
Deposition of granulation tissue and collagen. Angiogenesis, Epithelial cell proliferation, Dissolution of clot, Wound contraction (via myofibroblasts)

42

Would Healing Remodeling Phase
When?
Mediators
What happens?

1 week
Fibroblasts
Collagen III replaces Collagen I --> ↑ tensile strength of tissue

43

Granulomatous Diseases

TB
Fungal Infections (Histoplasmosis, Coccidioidomycosis)
Treponema Pallidum (Syphilis)
M Leprae (Leprosy)
Bartonella Henselae (cat scratch disease)
Sarcoidosis, Crohn's Disease, Wegener's, Churg Strauss
Berylliosis, Silicosis

44

Transudate
Cellularity?
Protein?
Specific gravity
Causes

Hypocellular
Low protein
Less than 1.012
↑ hydrostatic pressure, ↓ oncotic pressure, Na retention

45

Exudate
Cellularity?
Protein?
Specific gravity
Causes

Cellular
Protein rich
Greater than 1.02
Lymphatic obstruction or Inflammation

46

Iron Poisoning
MoA
Acute
Chronic

Peroxidation of membrane lipids
Acute gastric bleeding
Chronic: Metabolic acidosis, Scarring --> GI obstruction

47

Amyloidosis
What is it?
What does it cause?
Appearance of tissue?

Abnormal aggregation of proteins into β-pleated sheets
Cell damage and apoptosis
Waxy appearance

48

AL Amyloidosis
What kind of protein?
What disorders present with it?
Organ systems affected

Ig Light chains
Plasma cell disorder or Multiple Myeloma
Renal (nephrotic), Cardiac (failure, arrhythmia), Hematologic (easy bruising), Hepatomegaly, Neuropathy

49

AA Amyloidosis
What kind of protein?
What diseases?
Systems involved?

Amyloid A fibrils
RA, IBD, Spondyloarthropathy, Chronic Infections
Multiple systems like in AL

50

Dialysis Related Amyloidosis
What kind of protein?
What kind of pt?
Presentation

β2 microglobulin
ESRD on long term dialysis
Carpal tunnel syndrome and other joint issues

51

Heritable Amyloidosis
Genetics
Disease

Transthyretin (TTR or prealbumin) gene mutation
ATTR neurologic/cardiac amyloidosis

52

Age-Related (Senile) Amyloidosis
What kind of protein?
Organs affected
Progression

wt TTR
Systemic: deposited in myocardium and other sites
Slower progression of cardiac dysfunction vs AL

53

Organ Specific Amyloidosis
What is affected?
Example with protein

A single organ
Alzheimer's Disease due to deposition of amyloid-β protein from APP

54

Anaplasia

Abnormal cells lacking differentiation

55

Desmoplasia

Fibrous tissue formation in response to neoplasm

56

Tumor Grade

Degree of cellular differentiation

57

Tumor Stage
TNM

Degree of localization/spread based on site and size
Tumor Size
Node Involvement
Metastases

58

Tumor stage vs grade re prognostic value

Stage has more prognostic value

59

Epithelium tumor names
Benign
Malignant

Adenoma, Papilloma
Adenocarcinoma, Papillary carcinoma

60

Tumor of Blood Vessels
Benign
Malignant

Hemangioma
Angiosarcoma

61

Tumor of Smooth Muscle
Benign
Malignant

Leiomyoma
Leiomyosarcoma

62

Tumor of Striated Muscle
Benign
Malignant

Rhabdomyoma
Rhabdomyosarcoma

63

Tumor of Connective Tissue
Benign
Malignant

Fibroma
Fibrosarcoma

64

Tumor of Bone
Benign
Malignant

Osteoma
Osteosarcoma

65

Tumor of Fat
Benign
Malignant

Lipoma
Liposarcoma

66

Cachexia
Presentation
Disease with it?
Mediated by

Wt loss, Muscle atrophy, Fatigue
Cancer, AIDS, Heart Failure, TB
TNFα, IFNγ, IL6

67

Neoplasm of Down Syndrome

ALL, AML

68

Neoplasm of Xeroderma Pigmentosum or Albinism

Melanoma, Basal Cell Carcinoma, Squamous Cell Carcinoma of the Skin

69

Neoplasm of Chronic Gastritis, Pernicious Anemia, Postsurgical Gastric Remnant

Gastric Adenocarcinoma

70

Neoplasm of Tuberous Sclerosis

Giant Cell Astrocytoma, Renal Angiomyolipoma, Cardiac Rhabdomyoma

71

Neoplasm of Actinic Keratosis

Squamous cell carcinoma of the skin

72

Neoplasm of Barrett's Esophagus

Esophageal adenocarcinoma

73

Neoplasm of PVS

Squamous cell carcinoma of the esophagus

74

Neoplasm of Paget's Disease of Bone

Osteosarcoma, Fibrosarcoma

75

Neoplasm of Immunodeficiency States

Malignant Lymphomas

76

Neoplasm of AIDS

Malignant Lymphomas and Kaposi Sarcoma

77

Neoplasm of autoimmune disease

Lymphoma

78

Neoplasm of Acanthosis Nigricans

Visceral Malignancy (Stomach, Lung, Uterus)

79

Neoplasm of Dysplastic Nevus

Malignant Melanoma

80

Neoplasm of Radiation Exposure

Leukemia, Sarcoma, Papillary Thyroid Cancer, Breast Cancer

81

abl
What kind of protein?
Tumor
Product

Oncogene
CML
Tyrosine Kinase

82

c-myc
What kind of protein?
Tumor
Product

Oncogene
Burkitt's Lymphoma
Transcription factor

83

bcl2
What kind of protein?
Tumor
Product

Oncogene
Follicular and undifferentiated lymphoma
Anti-apoptotic molecule

84

HER2/neu (c-erbB2)
What kind of protein?
Tumor
Product

Oncogene
Breast, Ovarian, Gastric Carcinoma
Tyrosine Kinase

85

ras
What kind of protein?
Tumor
Product

Oncogene
Colon Carcinoma
GTPase

86

L-myc
What kind of protein?
Tumor
Product

Oncogene
Lung Tumor
Transcription Factor

87

N-myc
What kind of protein?
Tumor
Product

Oncogene
Neuroblastoma
Transcription Factor

88

ret
What kind of protein?
Tumor
Product

Oncogene
MEN 2A and 2B
Tyrosine Kinase

89

c-kit
What kind of protein?
Tumor
Product

Oncogene
GI stromal tumor
Cytokine Receptor

90

Rb
What kind of protein?
Tumor
Product

Tummor Suppressor
Retinoblastoma, Osteosarcoma
Normally inhibits E2F thus blocking G1 --> S transition

91

p53
What kind of protein?
Tumor
Product

Tummor Suppressor
Most human cancers, Li-Fraumeni Syndrome
Transcription factor for p21. Normally blocks G1 --> S transition

92

BRCA1 and BRCA2
What kind of protein?
Tumor
Product

Tummor Suppressor
Breast and Ovarian Cancer
DNA repair protein

93

p16
What kind of protein?
Cancer

Tummor Suppressor
Melanoma

94

BRAF
What kind of protein?
Tumor
Product

Tummor Suppressor
Melanoma
B-raf

95

APC
What kind of protein?
Cancer?

Tummor Suppressor
Colorectal cancer

96

WT1
What kind of protein?
Tumor

Tummor Suppressor
Wilm's Tumor (Neuroblastoma)

97

NF1
What kind of protein?
Tumor
Product

Tummor Suppressor
Neurofibromatosis type 1
RAS GTPase activating protein (RAS GAP)

98

NF2
What kind of protein?
Tumor
Product

Tummor Suppressor
Neurofibromatosis type 2
Merlin (Schwannomin) protein

99

DPC4
What kind of protein?
Tumor
Product

Tummor Suppressor
Pancreatic Cancer
"Deleted in Pancreatic Cancer"

100

DCC
What kind of protein?
Tumor
Product

Tummor Suppressor
Colon Cancer
"Deleted in Colon Cancer"

101

PSA
Function
When is it elevated?
Screen utility?

Follow prostate carcinoma
Prostate carcinoma, BPH, Prostatitis
Questionable

102

Prostatic Acid Phosphatase maker for...

Prostate carcinoma

103

CEA marker
Name
Cancers associated with it?

CarcinoEmbryonic Antigen
Colorectal and Pancreatic Cancer
Gastric, Breast, and Medullary Thyroid Carcinoma

104

α-FetoProtein
Normally made by
Marker for what kind of cancers?

Normally made by fetus
Hepatocellular carcinoma, NonSeminomatuous germ cell tumor (ovary, testis)

105

βhCG: Marker for what kind of tumors?

Hydatidiform moles and Choriocarcinomas (Gestational trophoblastic disease)

106

CA-125 marker for

Ovarian Cancer

107

S-100 marker for

Melanoma, Neural tumors, Schwannomas

108

ALP marker for

Metastases to bone, Liver, Paget's Disease of bone

109

Bombesin marker for...

Neuroblastoma, Lung, and Gastric Cancers

110

TRAP
Name
Marker for...

"Trap the Hair Animal"
Tartrate Resistant Acid Phosphatase
Hairy Cell Leukemia (B cell neoplasm)

111

CA-19-9 marker for

Pancreatic Adenocarcinoma

112

Calcitonin marker for

Medullary Thyroid Carcinoma

113

HTLV-1 leads to what cancer?

Adult T cell leukemia/lymphoma

114

HBV and HCV lead to what cancer?

Hepatocellular Carcinoma

115

EBV leads to what cancer?

Burkitt's Lymphoma, Hodgkin's Lymphoma, Nasopharyngeal Carcinoma, CNS lymphoma (in immunosuppressed pts)

116

HPV leads to what cancer?

Cervical carcinoma (16, 18)
Penile/anal carcinoma
Upper Respiratory SCC

117

HHV8 leads to what cancer?

Kaposi sarcoma, Body Cavity Fluid B cell lymphoma

118

H. pylori leads to what cancer?

Gastric Adenocarcinoma and Lymphoma

119

Liver Fluke (Clonorchis sinensis) leads to what cancer?

Cholangiocarcinoma

120

Aflatoxin
Made by what organism?
Organ affected?
Impact?

Aspergillus
Liver
Hepatocellular carcinoma

121

Vinyl Chloride
Organ affected?
Impact?

Liver
Angiosarcoma

122

CCl4
Organ affected?
Impact?

Liver
Centriolobular Necrosis and Fatty Change

123

Nitrosamines
Where are they from?
Organ affected?
Impact?

Smoked foods
Stomach
Gastric Cancer

124

Cigarette smoke
Organ affected?
Impact?

Larynx: Squamous Cell Carcinoma
Lung: Squamous and Small cell carcinoma
Kidney: Renal cell carcinoma
Bladder: Transitional cell carcinoma
Pancreas: Pancreatic adenocarcinoma

125

Asbestos
Organ affected?
Impact?

Lung
Bronchogenic carcinoma > Mesothelioma

126

Arsenic
Organ affected?
Impact?

Skin: Squamous Cell Carcinoma
Liver: Angiosarcoma

127

Naphthalene (aniline)
Organ affected?
Impact?

Bladder
Transitional Cell Carcinoma

128

Alkylating Agents
Organ affected?
Impact?

Blood
Leukemia

129

Paraneoplastic ACTH
Made from...
Effect

Small cell carcinoma of the lung
Cushing's syndrome

130

Paraneoplastic ADH
Made from...
Effect

Small cell carcinoma of the lung and intracranial neoplasms
SIADH

131

Paraneoplastic PTHrP
Made from...
Effect

Small cell carcinoma of the lung, Renal cell carcinoma, Breast cancer
HyperCa

132

Paraneoplastic VitD
Made from...
Effect

Hodgkin's Lymphoma and some Non-Hodgkin's Lymphoma
HyperCa

133

Paraneoplastic EPO
Made from...
Effect

Renal Cell Carcinoma, Hemangioblastoma, Hepatocellular carcinoma, Pheochromocytoma
Polycythemia

134

Paraneoplastic Abs against presynaptic Ca channels
Made from...
Effect

Small Cell Carcinoma of the Lung
Lambert Eaton Syndrome

135

Psammoma Bodies
Appearance
Seen in what?

Laminated, Concentric, Calcific Spherules
"PSaMMoma"
Papillary Adenocarcinoma of the Thyroid
Serous Papillary cystadenocarcinoma of the ovary
Meningioma
Malignant Mesothelioma

136

Cancer epidemiology in Men
Incidence
Mortality

Prostate (32%), Lung (16%), Colon/Rectum (12%)
Lung (33%), Prostate (13%)

137

Cancer epidemiology in Women
Incidence
Mortality

Breast (32%), Lung (13%), Colon/Rectum (13%)
Lung (23%), Breast (18%)

138

Cancers that metastasize to Brain

Lung, Breast, GU, Osteosarcoma, Melanoma, GI

139

Cancers that metastasize to Liver

Colon, Stomach, Pancreas

140

Cancers that metastasize to Bone
What bones are more common?

Prostate (blastic), Breast (lytic and blastic), Lung (lytic), Thyroid, Testes
Axial skeleton

141

Metastatic Brain tumors
Frequency
Location
Appearance

50% of brain tumors are metastatic
Gray/White Junction
Multiple well circumscribed tumors