CLINICAL/DISEASE RELATED QUESTIONS Flashcards
In what circumstance would 30 year old woman present with fibrinoid necrosis?
pre-eclampsia (3rd trimester) elevated bp (protinuria)
fibrinoid necrosis of placenta (of placental blood vessels)
If someone was exposed to dry cleaning industry presents with fatty liver change, describe the mechanism of what has occurred.
CCl4 (carbon tetrachloride) gets into blood and converted into CCl3 in p450 system of liver, once converted to CCl3 its a free radical and damages hepatocytes
key sign of reversible damage is cellular swelling (RER will swell and ribosomes pop off and protein synthesis is reduced
-key function of liver is to repackage fat and send it back out, repackaging of fat occurs by binding up molecules of chol. and lipids via apolipoproteins, lack of apo proteins, so fat gets into liver but can’t get out …so classical finding is FATTY CHANGE OF LIVER.
Patient with MI, cardiac enzymes going up, taken to cardiac cath lab, artery opened, then cardiac enzymes continue to rise. Why?
free radical injury
reperfusion injury
when cut blood supply to an organ, coronary artery occluded, MI, tissue begins to die, once tissue dies, cell membrane damaged (hallmark of irreversible damage) enzymes leak into blood, troponins will leak out, as they leak they indicate that there has been irreversible injury to cell, if blood returned to the organ, artery opened and blood back to organ, now oxygen also returned to organ with inflammatory cells…combo of inflammatory cells with dead tissue and oxygen can generate free radicals and can further damage cardiac myocytes
enzymes continue to rise bc blood returned and contains oxygen and inflammatory cells, free radicals produced, continued injury to myocardium.
A patient presents w fever and acute serosal inflammation (serosal surface of heart = pericardium ..would present as mimicking MI, serosal surface of abdomen= mimick acute appendicitis).
Describe the disease and mechanism.
Familial Mediterranean fever. ex: secondary amyloidosis
Dysfunction of neutrophils (AR); persons of Med. origin (neutrophils activated and create attack of acute inflammation that is not drive by infection but driven by misfunction of neutrophils)
presents w fever and acute serosal inflammation (serosal surface of heart = pericardium ..would present as mimicking MI, serosal surface of abdomen= mimick acute appendicitis)
during attack acute phase reactants prod; high SAA during attacks deposits as AA amyloid
Patient has thyroid mass, fine needle aspiration is performed (needle in thyroid, cells pulled away to biospsy), pathologist sees tumor cells in amyloid background.
What disease? Describe mechanism.
medullary carcinoma of thyroid- tumor of thryroid and that is derived from C cells
C cells - neuroendocrine derived cells present in thyroid that produce protein called calcitonin
if tumor of C cells there is overproduction of calcitonin which can deposit in tumor which can create amyloid in association with medullary carcinoma of thyroid
After an MI a patient may have an increase in white count. What type of cell has increased?
neutrophils bc they are generated and pushed up into dead tissue
Patient has mast cells which activate the acute inflammatory response and several hours later the acute inflammatory response continues, what is major mechanism by which mast cells will allow for progression of acute inflammatory response?
production of arachidonic acid metabolites, particularly leukotrienes
What might delayed separation of umbilical cord indicate? Describe disease and mechanism.
Leukocyte Adhesion Deficiency
Delayed separation of umbilical cord (when baby born, umbilical cord which had blood flowing through it is sealed when no longer connected to placenta, so undergoes necrosis, then acute inflammation so tissue can be destoryed so it can be healed, when blood supply of umbilical cord is cut off, tissue will tie, and cord will fall off…neutrophils coming in to destroy tissue help it fall off
if neutrophils cannot come in, that separation of umbilical cord from baby skin will be delayed
What do increased circulating neutrophils indicate?
Describe.
Leukocyte Adhesion deficiency
Normally:
neutrophils circulating in the blood (50 percent)
neutrophils hanging out in blood vessels of lung (50 percent) =marginated pool (adhesion necessary)
if adhesion defected marginal pool can’t hang out, those neutrophils will be released into blood so patients have increased circulating neutrophils
What do recurrent bacterial infections that lack pus formation indicate?
Leukocyte Adhesion deficiency
What might giant granules in leukocytes indicate?
Chediak-Higashi Syndrome
Giant granules in leukocytes (granules produced in golgi go along railroad system to get distributed across neutrophils, if defect in trafficking and granules cannot be sent to periphery and distribute to cell, they pile up around golgi and appear as giant granules around leukocyte)
What might neutropenia indicate?
Chediak-Higashi Syndrome
(neutrophils in bone marrow when dividing ..moving DNA and cellular components, but if cannot move things around properly, cannot divide properly, so defect in generation of neutorphils)
If a patient presents with albinism and peripheral neuropathy, what genetic disorder may be present? Explain.
Chediak-Higashi Syndrome
Albinism (pigment of skin occurs via melanocytes… multiple keratinocytes make up skin, 1 melanocyte prod. pigment for 25 keratinocytes, prod pigment then hands off to keratinocytes, melanocytes can prod. pigment but cannot pass along rail system to keratinocytes so can’t get proper pigment of skin)
Peripheral neuropathy (if we have nerve at periphery… cell body for nerve of toe is near spinal cord, so the actual nerve can be up to 2 feet or longer, nucleus and key proteins prod by cord, need railroad system to keep the bottom of nerve or distal nerve healthy and alive, if patients have protein trafficking defect they can’t keep alive peripheral nerves)
Process has been going on for 8 weeks but patient is still coughing up pus, what is actually happening?
it is still ex of acute inflammation bc of the fact still have neutrophilic response
(neutrophils define acute inflammation)
Patient has history of breast cancer and breast is removed, she gets implants, she feels lymph nodes in axilla. What is the differential diagnosis?
reaction of foreign material: implants leak and release foreign material in lymphatics and go into axillary lymph node and produce enlarged lymph nodes within axilla (which then is creating granulomas)
or recurrence of breast cancer or spread and now involves axilla
so biopsy could show noncaseating granuloma or cancer
