Pathology

Question 1

Where would edema be found in right and left sided heart failure?

Answer 1

Right - liver and lower extremities

Left - lungs

Question 2

What is the function of endothelin?

Answer 2

Vasoconstriction after injury

Question 3

What is the function of thrombin?

Answer 3

Fibrinogen to fibrin

Secondary hemostasis

Question 4

What is the function of prostacyclin? Where is it produced?

Answer 4

Produced by endothelium

Vasodilation and inhibition of plt aggregation

Question 5

What are the anti-thombotic factors produced by endothelium?

Answer 5

Prostacyclin
NO
ADPase

Question 6

What is the function of NO in hemostasis? Where is it produced?

Answer 6

Endothelium

Inhibits plt aggregation

Question 7

What is the function of ADPase? Where is it produced?

Answer 7

Expressed on endothelial cells

Degrades ADP, inhibits plt aggregation

Question 8

What is the function of heparin-like molecules? Where is it produced?

Answer 8

Endothelium

Cofactors of antithombin III

Question 9

What is the function of thrombomodulin? Where is it produced?

Answer 9

Endothelium

Activated by binding thombin - activates protein C, which works with protein S to cleave factors five and eight a

Question 10

What is the function of tissue factor inhibitor? Where is it produced?

Answer 10

Endothelium

Inhibits activated tissue factor which stimulates secondary hemostasis

Question 11

What are the anti-coagulant factors produced by endothelium?

Answer 11

Heparin-like molecules
Thrombomodulin
Tissue Factor Inhibitor

Question 12

What is a prothombotic factor produced by endothelium?

Answer 12

Von Willibrand Factor

Question 13

What is a procoagulant factor produced by endothelium? What does it do?

Answer 13

Tissue Factor

Initiates secondary hemostasis (extrinsic pathway)

Question 14

What is an anti-fibrinolytic factor produced by endothelium? What does this do?

Answer 14

Plasminogen inhibitors

Inhibits the breakdown of clot - promotes clot

Question 15

What is a fibrinolytic factor produced by endothelium? What does it do?

Answer 15

tPA - tissue plasminogen factor

Question 16

What factor do the intrinsic and extrinsic pathways converge on?

Answer 16

X

Question 17

Describe the intrinsic coag cascade

Answer 17

Negative surface - Factor 7 to 7a - Factor 11 to 11a - Factor 9 to 9a (factor 8a) - factor X - Xa - prothrombin to thrombin - fibrinogen to fibrin

Question 18

Describe the extrinsic coag cascade

Answer 18

Tissue factor - Factor 7 to 7a - factor X - Xa - prothrombin to thrombin - fibrinogen to fibrin

Question 19

Describe the clotting system in vivo

Answer 19

Tissue Factor - Factor 7 to 7a OR 11 to 11a - Factor 9 to 9a - factor X - Xa - prothrombin to thrombin - fibrinogen to fibrin

Question 20

What are alpha granules and what do they contain?

Answer 20

Plt granules containing fibrinogen, fibronectin, factor 5 and vWF

Question 21

What are dense bodies and what do they contain?

Answer 21

Plt granules containing ATP, ADP, calcium, histamine, serotinin, epi

Question 22

How are M1 macrophages activated and what is their role?

Answer 22

Activated by IFN-gamma and microbial products
Enhances removal of organism – ROS, NO, lysosomal enzymes
Inflammation – IL-1, 12, and 23, chemokines

Question 23

How are M2 macrophages activated and what is their role?

Answer 23

Cytokine activated (IL-4 and 13)
Tissue Repair - Growth factor, TGF-beta
Anti-inflammatory – IL-10, TGF-beta

Question 24

Where are plasma cells produced and what is their role?

Answer 24

Produced by B cells - antigen presenting

Question 25

What factors produce the physical symptoms of chronic inflammation and where do they come from?

Answer 25

IL-1, IL-6, TNF-alpha – macrophage derived

Question 26

What are 3 acute phase proteins of inflammation?

Answer 26

Fibrinogen, CRP, serum amyloid A protein

Question 27

Explain the cycle of lymphocyte and macrophage activation in chronic inflammation including specific cytokines and chemical mediators.

Answer 27

Macrophage is classically activated (microbes and IFN-gamma) Activated macrophage secretes TNF and IL-1 to recruit leukocytes Activated macrophage secretes cytokines IL-12, 6, 23 and presents antigens to T-lymphocyte Activated T lymphocyte presents IL-17 and TNF to additionally recruits leukocytes Activated T cell presents IFN-gamma to further activate macrophages continuing the cycle

Question 28

What are the primary pro and anti-inflammatory cytokines?

Answer 28

Pro-inflammatory: TNF and IL-1 | Anti-inflammatory: IL-10, TGF-beta, lipoxins

Question 29

What is complement C5a?

Answer 29

Chemotaxis

Question 30

What is complement C3a?

Answer 30

Opsonin (antibody)

Question 31

What is complement Anaphylatoxin?

Answer 31

Release histamine – vasodilation and permeability

Question 32

Where is histamine released from?

Answer 32

Mast cells, basophils, platelets

Question 33

What role does histamine play in inflammation?

Answer 33

Vasodilation - arterioles | Vascular permeability of venules – immediate transient response

Question 34

What is the role of the kinin system?

Answer 34

Vasodilation – plasma proteins release bradykinin (vasoactive peptides) Vascular permeability, vasodilation, pain

Question 35

Which chemical mediator is responsible for pain?

Answer 35

Kinin

Question 36

Differentiate between the two arachadonic acid pathways in inflammation

Answer 36

COX pathway – prostaglandins – pro-inflammatory PGI2 – vasodilation, inhibits plt aggregation Thromboxane A2 – vasoconstriction, promotes plt aggregation PGd2/E2 – Vasodilation, vascular permeability Anti-inflammatory pathway – Lipoxygenase – Leukotrienes 5-HETE – chemotaxis C4, D4, E4 – bronchospasm and vascular permeability Lipoxin A4 B4 – inhibition of inflammation

Question 37

Differentiate between parenchyma and stroma in neoplasia.

Answer 37

Parenchyma - basis for nomenclature - cell type | Stroma - environment - responsible for growth and spread

Question 38

What is an example of a common cancer point mutation?

Answer 38

RAS point mutation causing carcinoma - constitutively "on" activating transcription

Question 39

What are two examples of common cancer translocations?

Answer 39

ABL/BCR in CML - creates a new protein that overactivates ABL which is a cytoplasmic tyrosine kinase 8:14 promoter translocation in Burkitt's Lymphoma which switches the myc and Ig promoters such that myc is produced in excessive quantities - too much normal protein

Question 40

What is an example of a common cancer gene amplification?

Answer 40

Her2 receptor overexpression in breast cancer due to gene duplication - causes sensitivity to growth factor

Question 41

What inhibits RAS/RAF?

Answer 41

NF1

Question 42

Describe a common regulation pathway for transcription

Answer 42

B-catenin promotes proliferation and transcription. It is inhibited by APC and E-cadherin - loss of APC or E-cadherin will lead to increased transcription

Question 43

What promotes progression through the cell cycle?

Answer 43

CDK-cyclin complexes

Question 44

What inhibits progression through the cell cycle?

Answer 44

p16 and Rb

Question 45

How does phosphorylation of RB affect transcription?

Answer 45

Phosphorylated - activates transcription | Dephosphorylated - blocks transcription

Question 46

What promotes apoptosis?

Answer 46

p53

Question 47

Describe the intrinsic apoptosis pathway

Answer 47

DNA damage activates p53 - P53 activates BAX and BAK in the mitochondria – activating cytochrome C and APAF-1 which activates caspase 9 to 3 to APOPTOSIS

Question 48

Describe the extrinsic apoptosis pathway

Answer 48

FasL binds Fas (CD 95) on membrane - Death-induced signaling complex – FADD and procaspase 8 – caspase 8- Caspase 3 – APOPTOSIS

Question 49

What inhibits caspase 9 and what is a consequence?

Answer 49

Inhibitor apoptosis protein (IAP) - blocks apoptosis

Question 50

What hormone is affected in Cushing's Syndrome?

Answer 50

ACTH - retains sodium

Question 51

What hormone is affected in paraneoplastic hypercalcemia?

Answer 51

Parathyroid Hormone Related Protein - mobilizes Ca from bone

Question 52

What hormone is affected in SIADH?

Answer 52

ADH - leads to hyponatremia (low sodium)

Question 53

What Ig mediates eosinophil reactions?

Answer 53

IgE

Question 54

What protein is found in eosinophil granules?

Answer 54

Major Basic Protein

Question 55

What chemokine recruits basophils?

Answer 55

Eotaxin