Pathology - First Aid Flashcards Preview

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Flashcards in Pathology - First Aid Deck (206):
1

Apoptosis requires...

ATP.

2

Both the intrinsic and extrinsic pathways for apoptosis activate...

cytosolic caspases that mediate cellular breakdown.

3

Unlike necrosis, apoptosis does not have...

significant inflammation.

4

Apoptosis is charachterized by..

deeply eosinophilic cytoplasm, cell shrinkage, nuclear shrinkage (pyknosis) and basophilia, membrane blebbing nuclear fragmentation (karyorrhexis), and formation of apoptotic bodies, which are then phagocytosed.

5

DNA laddering is a...

sensitive indicator of apoptosis.

6

Durrying karyorrheix, endonucleases will...

cleave at internucleosomal regions, yielding 180-bp fragments.

7

Radiation therapy causes...

apoptosis of tumors and surrounding tissue via free radical formation and dsDNA breakage.

8

Intrinsic apoptosis pathway is invovled in..

tissue remodeling in embryogenesis.

9

Intrinsic pathway occurs when...

a regulating factor is withdrawn from a proliferating cell population (ex. decreased IL-2 after a completeed immunological rxn leads to apoptosis of proliferating effector cells).

10

Intrinsic pathway also occurs after exposure to...

injurious stimuli (radiation, toxins, hypoxia).

11

During the intrinsic pathway, changes in proportions of...

anti- and pro- apoptotic factors lead to increased mitochondrial permeability and cytochrome c release.

12

BAX and BAK are...

pro-apoptotic proteins.

13

Bcl-2 is...

anti-apoptotic.

14

Bcl-2 prevents...

cytochrome c release by binding to and inhibiting Apaf-1.

15

Apaf-1 normally...

induces the activation of caspases.

16

If Bcl-2 is overexpressed, then...

Apaf-1 is overly inhibitedd, leading to decreased caspase activation and tumorigenesis.

17

2 pathways of the extrinsic apoptosis pathway

1. ligand receptor interactions (FasL binding to Fas)
2. immune cell (cytotoxic T-cell release of perforin and granzyme B)

18

Fas-FasL interaction is necessary in...

thymic medullary negative selection.

19

Mutations in Fas incnresae...

numbers of circulating self-reacting lymphocytes due to failure of clonal deletion.

20

After Fas crosslinks with FasL...

multiple Fas molecules coalesce forming a binding site for a death domain-containing adapter protein, FADD.

21

FADD binds...

inactive caspases, activating them.

22

Defective Fas-FasL interaction is the basis for...

autoimmune disorders.

23

Coagulative Necrosis

-heart, liver, kidney
-occurs in tissues supplied by end-arteries
-increased cytoplasmic binding of acidophilic dye
-proteins denature first, followed by enzymatic degradation

24

Liquefactive Necrosis

-brain, bacterial abscess
-occurs in CNS due to high fat content
-enzymatic degradation is due to the release of lysosomal enzymes

25

Caseous necrosis

-TB, systemic fungi, nocardia

26

Fatty necrosis

-enzymatic (pancreatitis (saponification)) and nonenzymatic (breast trauma); calcium deposits appear dark blue on staining

27

Fibrinoid necrosis

-vasculitides (Henoch-Schonlein purpura)
-Churg-Strauss
-malignant HTN
-amorphous and pink

28

Gangrenous necrosis

-dry (ischemi coagulative) and wet (infxn)
-common in limbs and GI tract

29

Reversible cell injury (w/ O2)

1. ATP depletion
2. cellular/mitochondrial swelling
3. nuclear chromatin clumping
4. decreased glycogen
5. fatty change
6. ribosomal/polysomal detachment
7. membrane blebbing

30

Irreversible cell injury

1. nuclear pyknosis, karyorrhexis, karyolysis
2. plasma membrane damage
3. lysosomal rupture
4. mitochondrial permeability/vacuolization

31

Heart areas susceptible to ischemia/hypoxia

subendocardium (LV)

32

Kidney areas susceptible to hypoxia/ischemia

straight segment of proximal tubule (medulla)
thick ascending limb (medulla)

33

Liver area susceptible to hypoxia/ischemia

area around central vein (zone III)

34

Colon areas susceptible to hypoxia/ischemia

splenic flexure, rectum

35

Reperfusion injury is due to...

damage by free radicals.

36

Red infarcts occur in...

loose tissues with multiple blood supplies such as liver, lungs and intestine.

37

Pale infarcts occur in...

solid tissues with a single blood supply such as heart, kidney and spleen.

38

First sign of shock is...

tachycardia.

39

Shock in the setting of DIC secondary to trauma is likely due to...

sepsis.

40

Distributive shock includes...

septic, neurogenic, and anaphylactic shock.

41

Features of Distributive shock

1. high-output failure (decreased TPR, increased CO, increased venous return)
2. decreased PCWP
3. vasodilation (warm, dry skin)
4. failure to increase blood pressure with IV fluids

42

Features of hypovolemic/cardiogenic shock

1. low-output failure (increased TPR, decreased CO, decreased venous return)
2. PCWP increased in cardiogenic; decreased in hypovolemic
3. vasoconstriction
4. blood pressure restored with IV fluids

43

Inflammation is characterized by...

redness, pain, heat, swelling and loss of function.

44

Vascular component of inflammation

increased vascular permeability, vasodilation, endothelial injury

45

Cellular component of inflammation

neutrophils extravasate from circulation to injured tissue to participate in inflammation through phagocytosis, degranulation and inflammatory mediator release

46

Acute inflammation is mediated by...

neutrophils, eosinophils, and antibodies. There i rapid onset and it lasts minutes to days.

47

Outcomes of acute inflammation include...

complete resolution, abscess formation, and progression to chronic inflammation.

48

Chronic inflammation is mediated by...

mononuclear cell and fibroblasts. Characterized by persistent destruction and repair.

49

Chronic inflammation is associated with...

blood vessel proliferation and fibrosis.

50

A granuloma is a...

nodular collection of epithelioid macrophages and giant cells.

51

Outcomes of chronic inflammation include...

scarring and amyloidosis.

52

Chromatolysis is a process involving...

the cell body following axonal injury. Changes reflect increased protein synthesis in an effort to repair the damaged axon.

53

Chromatolysis is characterized by (3):

1. round cellular swelling
2. displacement of the nucleus to the periphery
3. dispersion of Nissl substance throughout the cytoplas

54

Dystrophic calcification is...

calcium deposition in tissues secondary to necrosis.

55

Dystrophic calcification tends to be...

localized (ex. on heart valves).

56

Dystrophic calcification is seen in...

TB (lungs and pericardium), liquefactive necrosis of chronic abscesses, fat necrosis, infarcts, throbmi, schistosomiasis, Monckeberg arteriolosclerossi, congenital CMV + toxoplasmosis and psammoma bodies.

57

Dystrophic calcification is not directly associated with...

hypercalcemia. Patients are usually normocalcemic.

58

Metastatic calcification is..

widespread deposition of calcium in normal tissue secondary to hypercalcemia or high calcium-phosphate product. Pts are not normocalcemic.

59

In metastatic calcification, calcium deposits predominantly are in...

interstitial tissues of kidney, lungs and gastric mucosa (bc these tissues lose acid quickly; increased pH favors deposition).

60

Causes of hypercalcemia leading to metastatic calcification include...

primary hyperparathyroidism, sarcoidosis, hypervitaminosis D.

61

Causes of high calcium-phoshpate product leading to metastatic calcification include...

chronic renal failure + secondary hyperparathyroidism, long-term dialysis, calciphylaxis and warfarin.

62

4 Steps of Leukocyte Extravasation

1. Margination and rolling
2. Tight-binding
3. Diapedesis (leukocyte travels between endothelial cells and exits the blood vessels)
4. Migration (leukocyte travels through interstitium to site of injury or infection guided by chemotactic signals)

63

Step 1 Mediators

Vasculature: E-selectin, P-selectin, glyCAM-1, CD34
Leukocyte: Sialyl-Lewis, L-selectin

64

Step 2 mediators

Vasculature: ICAM-1, VCAM-1
Leukocyte: CD11/18, VLA-4 integrin

65

Step 3 mediators

Vasculature: PECAM-1
Leukocyte: PECAM-1

66

Step 4 mediators

Vasculature: C5a, IL-8, LTB4, kallikrein, PAF (chemotactic products released in response to bacteria)

67

Free radicals damage cells via...

membrane lipid peroxidation, protein modification and DNA breakage.

68

Free radical injury is initiated via...

radiation exposure, drug metabolism, redox rxns, NO, transition metals, and leukocyte oxidative burst.

69

Free radicals can be elimitated by...

enzymes (catalase, SOD, glutathione, and peroxidase)
spontaneous decay
antioxidants (Vit A, C, E)

70

Pathologies of Free Radicals include:

-retinopathy of prematurity
-bronchopumonary dysplasia
-carbon tetrachloride (leading to liver necrosis)
-acetaminophen overdose
-iron overload
-reperfusion injury

71

Inhalation injury is the most common...

pulmonary complication after exposure to fire. INhalation of the products of combustion (carbon, toxic fumes) leads to chemical tracheobronchitis, edema and pneumonia.

72

Hypertrophic scars features

-increased collagen synthesis
-parallel collagen
-confined to borders of original wounds
-infrequently recur following resection

73

Keloid scars features

-extremely increased collagen
-disorganized collagen
-extneds beyond borders of original wound
-frequently recurs following resection

74

PDGF is secreted by...

activated platelets and macrophages. It induces vascular remodeling and smooth muscle cell migration. It stimulates fibroblast growth for collagen synthesis.

75

FGF stimulates...

all aspects of angiogenesis.

76

EGF stimulates...

cell growth via tyrosine kinases

77

TGF-beta has a role in...

angiogenesis, fibrosis, cell cycle arrest.

78

Metalloproteinases have a role in...

tissue remodeling.

79

Inflammatory stage of wound healing mediators

platelets, neutrophils, macrophages

80

Characteristics of the inflammatory stage of wound healing

-clot formation
-increased vessel permeability
-neutrophil migration
-maacrophages clear debris 2 days later

81

Proliferative stage of wound healing (2-3 days later) mediators

fibroblasts, myofibroblasts, endothelial cells, keratinocytes, macrophages

82

Characteristics of the proliferative stage of wound healing

-deposition of granulation tissue and collagen
-angiogenesis
-epithelial cell proliferation
-dissolution of clot
-wound contraction (mediated by myofibroblasts)

83

Remodeling (1 wk later) stage of wound healing mediators

fibroblasts

84

Remodeling stage characteristics

type III collagen replaced by type I collagen; increased tensile strength of tissue

85

Granulomatous diseases

1. Bartonella henselae (cat scratch dz)
2. berylliosis
3. Churg-Strauss
4. Crohn's
5. Francisella tularensis
6. Fungal infxns
7. Granulomatosis with polyangiitis
8. Listeria
9. M. leprae
10. M. tuberculosis
11. Treponema pallidum
12. Sarcoidosis
13. Schistosomiasis

86

Granuloma formation is mediated when Th1 cells secrete...

gamma-interferon which activates macrophages. TNF-alpha from macrophages induces and maintains granuloma formation.

87

Anti-TNF drugs can cause sequestering granulomas to...

breakdown leading to disseminated disease. So you should always test for latent TB before starting anit-TNF therapy.

88

Exudate features

-cellular
-protein rich
-specific gravity > 1.02
-due to lymphatic obstruction, inflammation, infxn, malignancy

89

Transudate features

-hypocellular
-protein poor
-specific gravity

90

Products of inflammation (fibrinogen) coat...

RBCs and cause aggregation. When aggregated, RBCs fall at a faster rate within the test tube (measure of erythrocyte sedimentation rate).

91

Conditions with increased ESR

-most anemias
-infxns
-inflammation
-cancer
-pregnancy
-autoimmune disorders

92

Conditions with decreased ESR

-sickle cell (due to altered shape)
-polycythemia (increased RBCs "dilute" aggregation factors)
-CHF

93

Mechanism of iron poisoning

cell death due to peroxidation of membrane lipids

94

Symptoms of acute iron poisoning

nausea, vomiting, gastric bleeding, lethargy

95

Symptoms of chronic iron poisoning

metabolic acidosis, scarring leading to GI obstruction

96

Treatment for iron poisoning

Chelation (IV deferoxamine, oral deferasirox) and dialysis

97

Amyloidosis is...

abnromal aggregation of proteins into beta-pleated sheet structures leading to damage and apoptosis.

98

AL amyloidosis (primary) is due to...

deposition of proteins from Ig Light chains. It can occur as a plasma cell disorder or associated with multiple myeloma.

99

AL amyloidosis often affects...

multiple organ systems including:
-renal (nephrotic sydnrome)
-cardiac (restrictive cardiomyopathy, arrhythmia)
-hematologic (easy bruising)
-GI (hepatomegaly)
-neurologic (neuropathy)

100

AA amyloidosis (secondary) is seen with...

chronic conditions such as RA, IBD, spondyloarthropathy, and protracted infxn.

101

AA amyloidosis is due to...

fibrils composed of serum Amyloid A and is often multisystem.

102

Dialysis-related amyloidosis is due to...

fibrils composed of beta2-microglobulin in pts with ESRD or on long-term dialysis. May present as carpal tunnel.

103

Heritable amyloidosis is a...

heterogenous group of disorders. Example is ATTR neurologic/cardiac amyloidosis due to transthyretin gene mutation.

104

Age-related systemic amyloidosis is due to...

deposition of normal TTR in myocardium, etc. Slower progression of cardiac dysfunction relative to AL amyloidosis.

105

Organ-specific amyloidosis is most important in...

Alzheimer disease due to deposition of amyloid-beta protein cleaved from APP.

106

Islet amyloid polypeptide (IAPP) is commonly seen in...

T2DM and is caused by deposition of amylin in pancreatic islets.

107

Lipofuscin is a...

yellow-brown "wear and tear" pigment associated with normal aging.

108

Lipofuscin is formed by...

oxidation and polymerization of autophagocytosed organellar membranes.

109

Autopsy of elderly person will reveal deposits of...

lipfuscin in the heart, liver, kidney, eye, etc.

110

Hyperplasia features

-increased number of cells

111

Dysplasia is an...

abnormal proliferation of cells with loss of size, shape and orientation.

112

Carcinoma in situ features

-neoplastic cells have not invaded basement membrane
-high N/C ratio and clumped chromatin
-neoplastic cells encompass the entire thickness

113

Invasive carcinoma features

-cells have invaded basement membrane using collagenases and hydrolases (metalloproteinases)
-can metastasize if they reach a blood or lymph vessel

114

P-glycoprotein is also known as...

multidrug resistance protein 1 (MDR1).

115

P-glycoprotein is expressed by some cancer cells (colon, liver) to...

pump out toxins, including chemo agents.

116

Anaplasia is...

loss of structural differentiation and function of cells, resembling primitive cells of the same tissue. Often equated with undifferentiated malignant neoplasms.

117

Desmoplasia is...

fibrous tissue formation in response to neoplasm.

(ex. linitis plastica in diffuse stomach cancer)

118

Grade is determined by...

the degree of cellular differenitation and mitotic activity.

119

More prognostic value is determined by...

stage (rather than grade).

120

Stage is the degree of...

localization/spread based on site and size of primary lesion, spread to regional LNs, and metastases.

121

The term carcinoma implies...

epithelial origin.

122

The term sarcoma implies...

mesenchymal origin.

123

Most carinomas spread...

through the lymphatics.

Exceptions:
RCC through renal vein.
HCC through hepatic vein.
Follicular carcinoma of thyroid
Choriocarcinoma

124

Most sarcomas spread...

hematogenously.

125

Cachexia is...

weight loss, muscle atrophy, and fatigue that occurs in chronic disease (cancer, AIDS, heart failure, TB).

126

Cachexia is mediated by...

TNF-alpha, IFN-gamma, and IL-6.

127

Acanthosis nigricans is ass. w/

visceral malignancy (esp. stomach).

128

Actinic keratosis is associated with...

SCC of the skin.

129

AIDS is associated with...

aggressive malignant lymphomas (non-Hodgkin) and Kaposi sarcoma.

130

Autoimmune diseases are associated with...

lymphoma.

131

Chronic atrophic gastritis, pernicious anemia and postsurgical gastric remnants are associated with...

gastric adenocarcinoma.

132

Cirrhosis is associated with...

HCC.

133

Cushing syndrome is associated with...

small cell lung cancer.

134

Dermatomyositis is associated with...

lung cancer.

135

Down Syndrome is associated with...

ALL and AML.

136

Dysplastic nevus is associated with...

malignant melanoma.

137

Hypercalcemia is associated with...

squamous cell lung cancer.

138

Immunodeficiency states are associated with...

malignant lymphomas.

139

Lambert-Eaton myasthenic syndrome is associated with...

small cell lung cancer.

140

Myasthenia gravis and pure RBC aplasia is associated with...

thymoma.

141

Paget disease of bone is associated with...

secondary osteosarcoma and fibrosarcoma.

142

Plummer-Vinson syndrome is associated with...

SCC of esophagus.

143

Polycythemia is associated with...

RCC and HCC.

144

Radiation exposure is associated with...

leukemia, sarcoma, papillary thyroid cancer and breast cancer.

145

SIADH is associated with...

small cell lung cancer.

146

Tuberous sclerosis is associated with...

giant cell astrocytoma, renal angiomyolipoma, and cardiac rhabdomyoma.

147

UC is associated with...

colonic adenocarcinoma.

148

Xeroderma pigmentosum and albinism is associated with...

melanoma, basal cell carcinoma and squamous cell carcinomas of the skin.

149

BCR-ABL

CML, ALL
(tyrosine kinase gene)

150

bcl-2

follicular and undifferentiated lymphomas
(anti-apoptotic molecule gene)

151

BRAF

melanoma
(serine/threonine kinase gene)

152

c-kit

gastrointestinal stromal tumor
(cytokine receptor gene)

153

c-myc

Burkitt lymphoma
(transcription factor)

154

HER2/neu

breast, ovarian, gastric carcinomas
(tyrosine kinase gene)

155

L-myc

lung tumor
(transcription factor)

156

N-myc

neuroblastoma
(transcription factor gene)

157

ras

colon cancer, lung cancer, pancreatic cancer
(GTPase gene)

158

ret

MEN 2A and 2B
(tyrosine kinase gene)

159

APC

colorectal cancer (esp. associated with FAP)

160

BRCA1 and BRCA2

breast and ovarian cancer
(DNA repair protein)

161

CPD4/SMAD4

pancreatic cancer
(DPC)

162

DCC

colon cancer
(DCC)

163

NF1

NF1
(RAS GTPase activating protein (neurofibromin))

164

NF2

NF2
(Merlin (schwannomin) protein)

165

p16

melanoma
(cyclin-dependent kinase inhibitor 2A)

166

p53

most cancers; Li-Fraumeni syndrome
(transcription factor fo p21, blocks G1 to S phase)

167

PTEN

breast cancer, prostate cancer, endometrial cancer

168

Rb

retinoblastoma, osteosarcoma
(inhibits EF2; blocks G1 to S phase)

169

TSC1

tuberous sclerosis
(Hamartin protein)

170

TSC2

tuberous sclerosis
(tuberin protein)

171

VHL

von Hippel-Lindau disease
(inhibits hypoxia inducible factor 1a)

172

WT1 and WT2

Wilms tumor (nephroblastoma)

173

Alkaline phosphatase is a tumor marker for...

metastases to bone, liver, Paget disease of bone, serminoma (placental ALP)

174

alpha-fetoprotein is a tumor marker for...

HCC, hepatoblastoma, yolk sac tumor, testicular cancer, mixed germ cell tumor

175

beta-hCG

hydatidiform moles, choriocarcinoma, testicular cancer

176

CA-15-3/CA-27-29

breast cancer

177

CA-19-9

pancreatic adenocarcinoma

178

CA-125

ovarian cancer

179

Calcitonin

medullary thyroid cancer

180

CEA

CarcinoEmbryonic Antigen
(very nonspecific)

181

S-100

neural crest origin (melanomas, neural tumors, schwannomas, Langerhans cell histiocytosis)

182

TRAP

Tartate-Resistant Acid Phosphatase (TRAP)
(hairy cell leukemia)

183

EBV associated cancers

Burkitt
Hodgkin
nasopharyngeal carcinoma
CNS lymphoma

184

HBV, HCV associated cancer

HCC

185

HHV-8 associated cancer

Kaposi sarcoma, body cavity fluid B-cell lymphoma

186

HPV associated cancer

cervical and penile/anal carcinoma, head/neck/throat cancer

187

H.pylori associated cancer

gastic adenocarcinoma and MALToma

188

HTLV-1 associated cancer

adult T-cell leukemia/lymphoma

189

Liver fluke (chlonorchis) associated cancer

cholangiocarcinoma

190

Schistosoma haematobium associated cancer

bladder cancer (squamous cell)

191

Aflatoxins cause...

HCC

192

Alkylating agents cause...

leukemia/lymphoma

193

Aromatic amines cause...

transitional cell carcinoma of the bladder

194

Arsenic causes...

angiosarcoma (liver)
lung cancer
SCC (skin)

195

Asbestos causes...

bronchogenic carcinoma > mesothelioma

196

Cigarette smoke causes...

Transitional cell carcinoma (bladder)
SCC/Adenocarcinoma (esophagus)
RCC
Squamous cell carcinoma (larynx)
Squamous cell and small cell carcinoma (lung)
Pancreatic adenocarcinoma

197

Nitrosamines (smoked food) causes..

gastric cancer.

198

Radon causes...

lung cancer.

199

Vinyl chloride causes...

angiosarcoma of the liver.

200

Hodgkin lymphoma (and some non-Hodgkins) can secrete...

calcitriol causing hypercalcemia.

201

Small cell lung carcinoma secretes...

ACTH causing cushing syndrome. And antibodies against presynaptic calcium channels at NMJ causing Lambert-Eaton myasthenic syndrome.

202

Small cell lung carcinoma and intracranial neoplasms secrete...

ADH leading to SIADH.

203

RCC, thymoma, hemangioblastoma, HCC, leiomyoma and pheochromocytoma can all secrete...

EPO leading to polycythemia.

204

Squamous cell carcinoma of the lung, RCC and breast cancer can all secrete...

PTHrP leading to hypercalcemia.

205

Psammomma bodies are...

laminated, concentric, calcific spherules.

206

Psammoma bodies are seen in (4)..

-papillary carcinoma of the thyroid
-serous papillary cystadenocarcinoma of the ovary
-meningioma
-malignant mesothelioma