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Chapter 1 Flashcards

1
Q

Which permanent tissue only undergo hypertrophy and not hyperplasia

A

Cardiac muscle, skeletal muscle, and nerve

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2
Q

How does hyperplasia lead to cancer

A

When hyperplasia occurs secondary to pathologic process

Pathologic hyperplasia (ex Endometrial hyperplasia ) can progress to dysplasia and eventually cancer

Exception : BPH no increase risk for prostate cancer

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3
Q

Name of process that results in decrease cell no.

A

apoptosis

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4
Q

Name of processes that results in decrease cell size

A

Ubiquitin-proteosome degradation of the cytoskeleton and autophagy of cellular components

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5
Q

What is metaplasia

A

A change in stress on an organ leads to a change in cell type

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6
Q

Barrett Oesophagus is a classic example of which type of growth adaptation?

A

Metaplasia

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7
Q

What type of tissue changes occur most commonly in metaplasia

A

Changes of one type of surface epithelium( squamous,columnar,urothelial) to another

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8
Q

What type of metaplasia do you see with Barrett’s Oesophagus

A

non-keratinized squamous epithelium to mucin producing columnar cells

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9
Q

Metaplasia is reversible or irreversible

A

reversible - with removal of stressor

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10
Q

Can metplasia progress to cancer

A

Yes, under persistent stress
meatplasia—>dysplasia—>cancer
ex Barrett’s oesophagus—> adenocarcinoma of the Oesophagus
Exception: BPH

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11
Q

What vitamin deficiency can lead to metaplasia

A

Vitamin A
is necessary for differentiation of specialized epithelial surfaces such as the conjuctiva covering the eye

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12
Q

How will a vitamin A deficiency manifest

A

Keratomalacia = thin squamous lining of the conjunctiva undergo metaplasia into stratified keratinizing squamous epithelium.
Night blindness

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13
Q

MYOSITIS OSSIFICANS is an example of what

A

Mesenchymal (connective) tissue undergoing metaplasia

muscle tissue changes to bone during healing after trauma (inflammation)

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14
Q

Define dysplasia in 3 words

A

dissordered cellular growth

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15
Q

Cervical intraepithelial neoplasia( CIN) is an example of what growth adaptation

A

Dysplasia

refers to a proliferation of precancerous cellls

is a precursor of cervical cancer

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16
Q

How does dysplasia arise?

A

often from longstanding pathologic hyperplasia (endometrial hyperplasia) or metaplasia (Barrett)

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17
Q

Is Dysplasia Reversible

A

Yes in theory, with alleviation of inciting stress

if stress persists and it progresses to carcinoma—> that is irreversible

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18
Q

Define aplasia

A

Failure of cell production during embryogenesis

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19
Q

Define hypoplasia

A

Decrease in cell production during embryogenesis resulting in relatively small organ (streak ovaries– turner’s syndrome)

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20
Q

What type of cells are highly succeptible to ischemic injury ?

A

Neurons (occurs after 3-5mins)

21
Q

What does slowly progressing ischemia result in

A

results in atrophy

in contrast to acute ischemia which results in cell injury

22
Q

Define Hypoxia

A

Low oxygen delivery to tissues

23
Q

what are three causes of hypoxia

A

Ischemia (decreased blood flow through an organ)
Hypoxemia (low partial pressure of oxygen in the blood)
Decreased O2 carrying capacity

24
Q

What are three causes of ischemia ?

A

Decreased arterial perfusion
decreased venous drainage (Budd Chiari Syndrome- from polycythemia vera or Lupus causing a thrombosis in hepatic vein)
Shock

25
What lab values constitute hypoxemia
PaO2< 60 mmhg SaO2<90%
26
4 causes of hypoxemia
high altitude v/q mismatch (right-to-left shunt; atelectasis) Diffusion Defect (Interstitial pulmonary fibrosis) hypoventilation (increased PACO2---> decreased PAO2)
27
How does decreased O2 carrying capacity of the blood occur ?
Arises with hemoglobin (Hb) loss or dysfunction
28
What are 3 examples of decreased O2 carrying capacity
Anemia carbon monoxide posioning Methhemoglobinemia (PaO2 normal; SaO2 decreased)
29
What is the classic physical finding in CO poisoning
Cherry-red appearance of skin Headache = early sign the lead to coma and death
30
Explain Methhemoglobinemia
Iron in heme is oxidized to Fe3+ which cannot bind O2 seen with oxidant stress (sulfa and nitrate drugs) or in newborns (babies suck at reducing Fe3+ to Fe2+)
31
What is a classic finding in methhemoglobinemia
cyanosis with chocolate coloured blood
32
What is the treatment for methhemoglobinemia
Intravenous methylene blue helps reduce Fe3+ to Fe2+ state
33
What is the hallmark of reversible injury
Cellular swelling
34
What is the hallmark of irreversible damage
1. Plasma membrane damage cytosolic enzymes leaking into the serum (eg. cardiac troponin) additional calcium entering the cell 2. Mitochondrial membrane damage Loss of electron transport chain (inner mitochondrial membrane) cytochrome c leaking into cytosol (activates apoptosis) 3. Lysosome membrane damage resultsi in hydrolytic enzymes leaking into the cytosol , which in turn are activated by the high intracellular calcium
35
what is the morphologic hallmark of cell death
loss of the nucleus ( occurs via nuclear condensation- pyknosis, fragmentation - karyorrhexis and dissolution - karyolysis
36
Define coagulative necrosis
Necrotic tissue that remains firm characteristic of ischemic infarction of any organ except the brain .
37
What ir red infarction
if blood re-enters a loosely organized tissue after ischemic infarction (eg. pulmonary or testicular infarction)
38
What is Liquefactive necrosis
Necrotic tissue that becomes liquefied ; enzymatic lysis of cells and protein results in liquefactin
39
Liwuefactive necrosis is characteristic of what type of infarction(s)
Brain infarction: Proteolytic enzymes from microglial cells liquefy the brain Abscess: Proteolytic enzymes from neutrophils liquefy tissue Pancreatitis: Proteolytic enzymes from pancreas liquefy parenchyma
40
what is gangrenous necrosis
Coagulative necrosis that resembles mummified tissue characteristic of ischemia of lower limb and GI tract
41
Caseous necrosis
Soft and friable necrotic tissue with @cottage cheese-like appearance combination of coagulative and liquefactive necrosis characteristic of granulomatous inflammation due to tuberculous or fungal infection
42
What is fat necrosis
Necrotic adipose tissue with chalky-white appearance due to deposition of calcium Characteristic of trauma to fat (eg. breast) and pancreatitis mediated damage of pancreatic fat
43
What is saponification
Saponification is an example of dystrophic calcification in which calcium deposits on dead tissues. In dystrophic calcification, necrotic tissue acts as a nidus for calcification in the setting of normal serum calcium and phosphate
44
what distinguishes dystrophic calcification from metastatic calcification
in metastatic calcification there is an increase in serum calcium or phosphate levels whilst in dystrophic calcification the serum calcium is normal
45
What is Fibrinoid necrosis
Necrotic damage to blood vessel wall leaking of proteins (including fibrin) into vessel wall results in bright pink staining of the wall microscopically characteristic of malignant hypertension and vasculitis
46
What is apoptosis
energy (ATP) dependent, genetically programmed cell death
47
Apoptosis is mediated by what?
caspases that activate proteases and endonucleases 1. Proteases break down the cytoskeleton Endonucleases break down DNA
48
What are the pathways in which caspases are activated
1.Intrinsic mitochondrial pathway cell injury, DNA damage or loss of hormonal stimulation (eg.menses) leads to inactivation of Bcl2 , lack of Bcl2 allows cytochrome c to leave the mitochondrial matrix activating caspases 2.Extrinsic receptor-ligand pathway FAS ligand binds FAS death receptor(CD95) on the target cell activating caspase (eg. negative selection of thymocytes in thymus) Tumor Necrosis Factor(TNF) binds TNF receptor on target cell, activating caspases 3. Cytotoxic CD8+ T-Cell mediated pathway perforins secreted by CD8+ T cells enter pores and activates caspases Granzymes from CD8+ T cell enters through the pores and activates caspases CD8+ T cell killing of virally infected cells is an example

Pathoma (4 decks)

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