Pathology + Hem/Onc Flashcards
(135 cards)
1
Q
what is the exception where metaplasia of this does not lead to increased risk of cancer?
A
apocrine metaplasia of breast
2
Q
vitamin ____ deficiency can lead to metaplasia
specifical example: ______
A
vit A
keratomalacia. in eye, thin squamous of conjunctivia -> stratified keratinizing squamous epithelium = keratomalacia
3
Q
cyanosis with chocolate covered blood
dx and tx?
A
methemoglobinemia. too much Fe3+ compared to Fe2+
tx: methylene blue + vit C
4
Q
coagulative necrosis happens from what type of injury?
A
ischemic infarction
5
Q
liquefactive necrosis happens in 3 organs/scenarios
A
- brain infarction
- abscess (proteolytic enzymes from neutrophils)
- pancreatitis. parenchyma is liquefactive (vs peripancreatic fat which is saponification)
6
Q
ischemia of lower limb and GI tract results in this type of necrosis
A
gangrenous necrosis (it’s a type of coagulative necrosis)
7
Q
Saponification vs metastatic calcification
A
saponification: necrotic tissue acts as nidus for calcification when serum calcium is NORMAL
metastatic calcification: normal tissue, HIGH serum calcium or phosphate levels (happens in hyper PTH)
8
Q
Fibrinoid necrosis happens where?
A
blood vessel wall. happens in malignant hypertension (onion skinning) or vasculitis
9
Q
Endonucleases break down ______
A
DNA
10
Q
Intrinsic mitochondrial apoptotic pathway: inactivation of ____ allows cytochrome c to leak from ______ of mitochondria -> activate caspases
A
- Bcl2
2. inner mitochdonrial matrix
11
Q
extrinsic receptor-ligand apoptotic pathway:
FAS ligand binds FAS receptor (CD____) -> activated caspases
or
____ binds to its receptor -> activated caspases
A
CD95 = fas receptor
or TNF
12
Q
____ from CD8+ t cells can trigger apoptosis
A
perforins create pores in cell
granzyme enters said pores and activates caspases
13
Q
elimiation of free radicals. for each enzyme, name the rxn it does and location in cell:
- superoxide dismutase
- glutathione peroxidase
- catalase
A
- superoxide dismutase. mitochondria. superoxide O2 -> H2O2
- glutathione peroxidase. mitochondria. hydroxy free radical OH- -> Gs-SG and H2O
- catalase. peroxisomes. H2O2 -> O2 and H2O
14
Q
CCl4 is converted to CCl3 free radical by ________, resulting in cell injury.
decreased ______ leads to fatty change in liver**
A
P450 system. hepatocytes.
apolipoproteins (bc dec protein synthesis bc cell injury)
15
Q
2ndry structure of amyloid
A
beta pleated sheet
16
Q
primary amyloidosis is systemic deposition of ____, derived from _____
A
AL amyloid, derived from immunoglobulin LIGHT chain
17
Q
2ndry amyloidosis is systemic deposition of ____, derived from _____
A
AA amyloid, derived from serum amyloid associated protein (SAA) which is an acute phase reactant
18
Q
Mediterranean man presents with episodes of fever and acute serosal inflammation (seems like appendicitis, arthritis, or MI, but it’s not). what is he at increased risk for?
A
amyloidosis, bc this condition (FMF) has high SAA -> 2ndry amyloidosis
19
Q
what kind of cardiomyopathy does amyloidosis most commonly cause
A
restrictive.
note that it can also cause arrhythmias.
20
Q
T or F, tongue enlargement, malabsorption, and hepatosplenomegaly are features of systemic amyloidosis
A
True
21
Q
in senile cardiac amyloidosis, what exactly gets deposited? presentation?
A
non-mutated serum transthyretin
if does present, its >80 yrs of age usually
22
Q
in familial amyloid cardiomyopathy what exactly gets deposited?
A
mutated serum transthyretin -> restrictive cardiomyopathy
23
Q
how can DM type II cause amyloidosis
A
amylin is derived from insulin. deposits in pancreatic islets
24
Q
dialysis associated amyloidosis bc dialysis is not good at getting rid of what protein?
A
B2-microglobulin
25
"tumor cells in an amyloid background" is what kind of cancer? what is deposited within the tumor (the amyloid background)?
medullary thyroid carcinoma
| calcitonin, made by tumor cells, deposits in tumor
calcitonin will also be elevated in the serum
26
which neurons are most susceptible to hypoxic injury? (3)
Purkinje cells of cerebellum
pyramidal cells of hippocampus
pyramidal cells of neocortex
27
wound repair initial step?
granulation tissue formation. fibroblasts deposit ype III collagen
28
collagenase removes type ___ collagen in wound healing to be replaced by type ____. and requires ____ as cofactor
remove III to be replaced by I
| zinc cofactor
29
which growth factors are important for angiogenesis
FGF and VEGF (and TGF-B)
30
vit C is needed for hydroxylation of ____ and _____ procollagen residues
proline, lysine
31
copper is a cofactor for _______ which cross links lysine and hydroxylysine to form stable collagen
lysyl oxidase
32
hypertrophic scars have type ____ collagen
| vs keloid scars have type ________ and ____ collagen
hypertrophic III
| keloid I and III
33
what conditions do you have decreased ESR? (5)
sickle cell anemia (other anemias are increased ESR)
polycythemia (apparent decrease b/c RBCs dilute)
HF
microcytosis
hypofibrinogenemia
34
arsenic exposure increases risk of what cancers? (3)
squamous cell of skin
lung cancer
angiosarcoma of liver
35
naphthylamine is found in what? increases risk for which cancer?
cigarette smoke
| urothelial carcinoma of bladder
36
vinyl chloride is found in what? increases risk for which cancer?
PVC pipes
| angiosarcoma of liver
37
ionizing radiation (nuclear and radiotherapy) increases risk for which cancers? (3) how?
by generating hydroxyl free radicals
1. AML
2. CML
3. papillary carcinoma of thyroid
38
nonionizing radiation (sunlight, UVB) causes cancer how? what enzyme usually works against this?
forms pyrimidine dimers in DNA
normally excised by restriction endonuclease but is overwhelmed w/ too much radiation exposure
39
mutated Ras keeps itself activated by inhibiting _________
GTPase activating protein
Ras normally cleaves GTP to GDP to inactivate itself, this is augmented by GTPase activating protein
40
_________ complex phosphorylates Rb, which promotes progression through G1/S checkpoint by _______
cyclinD/CDK4 complex phosphorylates Rb -> phosphorylated Rb releases E2F transcription factor -> free E2F allows progression of cell cycle G1 -> S
41
germline mutation of Rb results in which 2 cancers?
retinoblastoma
| osteosarcoma
42
what does P53 normally do in response to DNA damage (not repairable)?
p53 upregulates BAX -> disrupts Bcl2 -> mitochondrial membrane unstable -> cytochrome c leaks out
also induces p21 which inhibits CDKs (which normally phosphorylate Rb) ->
43
what chromsomes are Bcl2 and Ig heavy chain locus genes on?
Bcl2 on ch 18
Ig heavy chain ch 14
so in follicular lymphoma where t(14;18), the Bcl2 (18) gets translocated to Ig heavy chain locus (14) -> overexpressed -> decreased apoptosis -> lymphoma
44
what are the 4 carcinomas that spread hematogenously? (most carcinomas spread by lymph)
1. renal cell carcioma (renal vein)
2. HCC (hepatic vein)
3. follicular carcinoma of thyroid
4. choriocarcinoma (trophoblasts. it's their job lol)
45
granulomas release what enzyme that causes hyper vitD - > hypercalcemia? like in sarcoidosis
1-alpha hydroxylase
46
marker -> tissue type:
vimentin -> ______
desmin -> _____
_____->neuroglia
_____->neurons
chromogranin and ____-> neuroendocrine cells
S-100 -> ____________(3)
vimentin -> mesenchyme
desmin -> muscle
GFAP -> neuroglia
neurofilament -> neurons
chromogranin and synaptophysin-> neuroendocrine cells
S-100 -> melanoma, Schwannoma, Langerhans cell histiocytosis
47
radon accumulates in ______
| exposure increases risk of ____ cancer
closed spaces, like basements
lung cancer (2nd leading cause after smoking!)
48
5 cancers that have psammoma bodies (concentric dystrophic calcification)
```
Papillary carcinoma of thyroid
Serous papillary cystadenocarcinoma of ovary
Meningioma
Malignant Mesothelioma
endometrial carcinoma
```
49
common primary sites that metastasize to brain (5)
lung > breast > kidney, colon, melanoma
50
common primary sites that metastasize to bone (lead kettle = Pb KTL)
Prostate, Breast > Kidney, Thyroid, Lung.
51
3 organs where problems can lead to increased alkaline phosphatase
liver- obstruction or metastasis
bone - dz or metastasis
Seminoma - placental ALP
52
4 cancer/tumors that have elevated alpha-fetoprotein
HCC
hepatoblastoma
yolk sac (endodermal sinus) tumor
mixed germ cell tumor
53
4 cancer/tumors that have elevated B-hCG
hydatidiform moles
choriocarciomas (getational trophpoblastic dz)
testicular cancer
mixed germ cell tumor
54
serum marker for pancreatic adenocarcinoma
CA 19-9
55
serum marker for ovarian cancer
CA 125
56
CA 15-3/CA 27-29 is serum marker for what?
breast cancer
57
P-glycoprotein is marker for what?
it's a multidrug resistance protein. pumps out the drugs out of the cell
58
Cachexia is mediated by what 4 cytokines?
TNF
IFN-y
IL-1
IL-6
59
Hb electrophoresis in order fromr least to farthest traveling Hb
C S F A
60
genetic mutation of HbS? HbC?
HbS = glutamic acid replaced with valine (neutral charge)
HbC: glutamic acid replaced with lysine (+ charge)
61
the 2 principal targets of antithrombin (and thus heparin)
thrombin
| factor Xa
62
2 sources of vWF
Weibel Palade bodies of endothelial cells
| alpha-granules of platelets
63
hemostasis: platelets bind to vWF via _____ receptor
GpIb
64
what does alpha-granules put out? (3)
vWF
fibrinogen
fibronectin
65
what do you give to prevent mast cell degranulation. used for asthma prophylaxis
cromolyn sodium
66
ADP binds to ____ receptor to induce GPIIb/IIIa expression on platelets
P2Y12
67
what is Ristocetin test? postive test in what? (2)
Ristocetin activates vWF to bind GpIb on platelets.
failure (positive test) occurs in von Willebrand dz and Bernard Soulier syndrome (missing Gp1b receptor)
68
when do you see spur cells
liver dz
| abetalipoproteinemia, or any other state of cholesterol dysregulation (increased cholesterol in RBCs)
69
when do you see echinocytes (burr cells)? (3)
end stage renal dz
liver dz
pyruvate kinase deficiency
70
ringed sideroblasts is from excess ____ in ___(organelle)
iron in mitochondria
71
when do you see target cells (HALT the hunter said to his target)
```
caused from decreased cytoplasm volume of increased membrane so
HbC dz,
Asplenia,
Liver dz,
Thalassemia
```
72
how do Heinz bodies form?
oxidation of Hb-SH groups to -S--S -> Hb precipitates as Heinz bodies
73
___ and ___ are released from platelet dense granules
Ca2+ and ADP
74
```
mucosal bleeding:
epistaxis
hemoptysis
GI bleeding
hematuria
menorrhagia
intracranial bleeding
```
is this primary or 2ndry hemostasis disorder?
primary
also have skin bleeding: purpura, bruising, ecchymoses
75
Immune thrombocytopenic purpura, pt has Ig__ against platelet antigens, produced by_______
IgG (which means it can cross placenta if woman is pregnant)
| plasma cells in spleen
76
decreased ADAMTS13 enzyme results in what dz? what is its normal function?
thrombotic thrombocytopenic purpura (TTP)
enzyme fx is to cleave vWF into monomers for degredgation
77
E. coli O157:H7 releases _____ which damages endothelial cells resulting in platelet microthrombi
verotoxin
78
mild thrombocytopenia an enlarged platelets, abnormal Ristocetin test. dx and pathogenesis?
Bernard Soulier sydrome
GP1b deficiency
there is thrombocytopenia bc the platelets die faster
79
extrinsic coagulation pathway is activated by? measure by (PT or PTT)?
activated by tissue thromboplastin (activates factor VII)
measure by PT
80
obstetric complications can cause DIC b/c of what enzyme in the amniotic fluid?
tissue thromboplastin
81
if pt has hemophilia like symptoms (deep bleeding) and mixing study normalizes PTT, pt has ________
if mixing study does not correct patient's PTT, pt has __________
PTT normalizes: hemophilia. deficiency.
does not normalize: coagulation factor inhibitor. most commonly anti-FVIII antibody.
82
tx for von willebrand dz is ____, which increases vWF release from _______
desmopressin (ADH analog)
| from Weibel-Palade bodies
83
what events can cause DIC, besides the obvious? (trauma, obstetric, gram neg sepsis)
```
Pancreatitis,
Malignancy (Adenocarcioma the mucin activates coagulation, and APL the primary granules activate coagulation),
Nephrotic syndrome,
Transfusion
Rattlesnake bite
```
84
radical prostatectomy releases urokinase which activates ______, leading to ______
urokinase activates plasmin -> to much fibrinolysis. bleeding.
85
how do labs differ for DIC vs fibrinolysis disorder/dysfunction (like from overactive plasmin)?
fibrinolysis dysfunction has normal platelet count and does not have elevated D-dimer
DIC has decreased platelet count and elevated D-dimer
both have increased PT PTT and bleeding time
86
liver cirrhosis causes fibrinolysis disorder how?
reduced production of alpha2-antiplasmin -> overactive plasmin
87
what does aminocaproic acid do?
blocks activation of plasminogen. give to patients with fibrinolysis dysfunction
88
what do endothelial cells produce/secrete to prevent thrombosis? (5)
```
PGI2
NO
heparin like molecules -> augment ATIII
tPA
thrombomodulin - redirects thrombin to activate protein C -> protein C inactivates factors V and VIII
```
89
person has vessel thrombosis, mental retardation, lens dislocation, and long slender fingers. they have high homocysteine levels. what enzyme is deficient?
cystathionin . beta synthase (CBS) deficiency. normally turns homocysteine to cystathionine. deficiency leads to homocysteine buildup and the following sx
90
what conditions have high levels of D-dimer? (3)
DIC
DVT
PE
91
which section of small bowel is iron, folate, and B12 absorbed in?
iron - duodenum
folate B9 - jejunum
B12 - ileum
it's in order of increasing #. (think of Fe as 0. or even 2-3)
92
which enzyme is deficient in porphyria cutanea tarda? presentation?
uroporphyrinogen decarboxlyase
neuro stuff. photosensitivity -> skin blistering
exacerbated by alcohol
93
which enzyme is deficient in acute intermittent porphyria? presentation? (the 5 P's)
PBG deaminase
sx are the 5 P's: Painful abdomen, Port wine-colored urine, Polyneuropathy, Psychological disturbances, Precipitated by drugs, alcohol, starvation
94
tx for acute intermittent porphyria?
glucose and heme, bc they inhibit ALA synthase
95
basophilic stippling in cells is from _______
residual ribosomes
96
how does preganancy and oral contraceptives affect TIBC and % saturation iron in blood?
increase TIBC
decrease % saturation
97
4 common protein deficiencies in hereditary spherocytosis
akyrin
spectrin
band 3.1
protein 4.2
98
what blood thing has increased mean corpuscular Hb concentration (MCHC)?
confirm dx with?
hereditary spherocytosis. b/c cells are smaller bc less membrane, but normal amt of cytoplasm -> increased Hb concentration relatively
confirm dx with osmotic fragility test
99
treat sickle cell anemia with ____ b/c it increases levels of HbF
Hydroxyurea
100
which cancer is a complication of PNH?
AML. makes sense, they're both RBC stuff
101
mix and match:
IgM or IgG causes intravascular or extravascular hemolysis?
IgG = extravascular hemolysis
IgM = intravascular hemolysis
102
3 common causes of immune hemolytic anemia extravascular hemolysis
SLE
CLL
drugs - penicillin and cephalosporins
103
which plasmodium is every day fever?
P. falciparum
104
infectious mononucleosis is not actually reacting monocytes, it's _____ cells
virus can become dormant in _____ cells
reacting CD8+ T cells
virus can become dormant in B cells -> recurrence and/or B cell lymphoma
105
lymphoblasts have positive nuclear staining for ____ a DNA polymerase
TdT
106
if cells are TdT positive, you know it's ____ leukemia
ALL
TdT is only present in lymphoblasts
107
which leukemia arises in children before and after 5 yrs old
>5 yrs old = ALL
< 5 yrs old = AML, specifically acute megakaryoblastic leukemia
108
which 2 places does ALL like to metastasize to?
scrotum
| CNS (meninges, CSF)
109
which translocations have poor and good prognoses for ALL?
good prognosis: t(12;21)
bad prognosis: t(9;22) Philadelphia + BCR-ABL fusion. remember this is seen a lot in CML! in which case it's doesn't mean bad prognosis
110
which cancer usually presents in teenagers as a mediastinal (thymic) mass?
T-cell ALL (forms mass so called lymphoma even tho ALL is a leukemia)
the 3 T's. T-cell, Teenager, Thymic mass
mediastinal mass can result in SVC like syndrome
111
if you see Auer rods in cancer cells, those are made of _____ and means it's a ____ leukemia
myeloperoxidase
AML (not seen in CML i guess). more specifically APL type.
112
APL of AML has what translocation?
t(15;17) = retinoic acid RAR disruption. all trans retinoic acid (ATRA) is effective tx
113
t(1;22) is for what leukemia? who is at risk of getting this?
acute megakaryoblastic leukemia of AML.
Down's kids . <5 yrs old
114
AML risk increases with prior exposure to what 3 substances/things
alkylating agents
radiotherapy
benzene
115
smudge cells. which leukemia? which 2 CDs coexpressed?
CLL
CD5 and CD20 ( can have others also, it's B cell)
CD5 is normally on T cells! so this is unique.
116
guy has leukemia. he also has hypogammaglobulinemia and autoimmune hemolytic anemia. which leukemia does he have?
CLL. coexpresses CD5 and CD20, btw
117
adult T cell leuk/lymph is proliferation of which T cells?
presentation?
mature CD4+ T cells
skin lesions, lytic bone lesions w/ hypercalcemia (kinda looks like MM) + lymphadenopathy, hepatosplenomegaly
118
blood smear shows lymphocytes with cerebriform nuclei (nuclei has brain like looking folds/contour)
which cancer? which cells are proliferation?
mycosis fungoides disseminated into Sezary syndrome.
CD4+ T cells
119
what is unique about the splenomegaly that happens in hairy cell leukemia? what other unique manifestation do you get?
due to accumulation of hairy cells in red pulp. b/c usually leukemias are in white pulp.
also dry tap on bone marrow aspiration due to marrow fibrosis.
AND lymphadenopathy is usually absent!
120
differences between CML and acute leukemoid reaction?
CML is negative for leukocyte alkaline phsophatase (LAP) stain, and CML has increased basophils. and the translocation, obvis
leukemoid rxn is opposite of those
121
what is the mediator of marrow fibrosis in myelofibrosis?
excess PDGF derived from megakaryocytes
122
gene translocation in follicular lymphoma?
t(14;18)
Bcl2 on 18 translocates to Ig heavy chain locus on 14
123
important difference histologically between folicular lymphoma and follicular hyperplasia
follicular hyperplasia has tingible body macrophages present in germinal centers
124
gene translocation in mantle cell lymphoma?
t(11;14)
cyclin D1 on 11 translocates to Ig heavy chain locus on 14 (remember cyclin D1 poromotes G1/S transition)
125
gene translocation in Burkitt's lymphoma?
t(8;14)
| c-myc on 8 to heavy chain 14
126
which interleukin can be high in multiple myeloma?
IL-6. it stimulates plasma cell growth and Ig production
127
what are the lymphoma cells in waldenstrom macroglobulinemia?
B cell lymphoma with monoclonal IgM production (IgM is big hence macroglobulinemia in name)
128
M spike in waldenstrom macroglobulinemia is from Ig____ whereas M spike in multiple myeloma is Ig___ and Ig___
WM: IgM
MM: IgG and IgA
129
Langerhans cells have Birbeck granules (tennis racket) and are ___ and ____ positive by immunohistochemistry.
derived from what cell?
CD1a and S100 positive
derived from bone marrow monocytes, they are dendritic cells mostly in skin
130
classic presentation of Hand-Schuller-Christian dz:
remember, it has names in it so it's malignant. and malignant ones have rash. also it has 3 names so affects children > 3 yrs old
```
scalp rash
lytic skull
diabetes insipidus
exophthalmos
recurrent otitis media
```
131
child presents w/ failure to thrive, developmental delay, and megaloblastic anemia. treat them w/ folate and B12 but doesn't get better. what is it? tx?
orotic aciduria. defect in UMP synthase (orotic acid -> UMP in de novo pyrimidine synthesis pathway)
will have orotic acid in urine, but NO hyperammonemia, as opposed to OTC deficiency that has increased orotic acid and hyperammonemia
tx: give uridine triacetate to bypass mutated enzyme
132
<1 yr old baby has macrocytic anemia (not megaloblastic). craniofacial abnormalities, TRIPHALANGEAL THUMBS and other upper extremity malformations. what do they have? pathogenesis?
Diamond Blackfan anemia
intrinsic defect in erythroid progenitor cells
increased %HbF but decreased total Hb
133
kid has normocytic anemia. short stature. cafe au lait spots, hypoplastic thumbs. what do they have? pathogenesis?
Fanconi anemia
due to DNA repair defect -> bone marrow failure. can see macrocytosis though. so it's similar to diamond blackfan anemia in presentation. this is a type of aplastic anemia.
134
how does pyruvate kinase deficiency cause hemolytic anemia? presentation?
rxn is PEP -> pyruvate
dec enzyme -> decreased ATP -> rigid RBCs -> extravascular hemolysis
(also, increases 2,3-BPG levels -> right shift)
hemolytic anemia in a newborn
135
which cancers is RET oncogene mutation associated w/? (2)
medullary thyroid cancer
| pheo
