CONT. LEC MOD 1 UNIT 2

Question 1

the morphologic hallmark of irreversible injury and necrosis

Answer 1

nuclear changes

Question 2

a nuclear change characterized by chromatin clumping and shrinking with increased basophilia

Answer 2

pyknosis

Question 3

a nuclear change characterized by fragmentation of chromatin

Answer 3

karyorrhexis

Question 4

a nuclear change characterized by fading of chromatin material and disappearance of stainable nuclei

Answer 4

karyolysis

Question 5

necrotic cells are removed by

Answer 5

heterolysis by infiltrating leucocytes

Question 6

A localized area of coagulative necrosis is called an

Answer 6

infarct

Question 7

a pattern of necrosis which results in characteristic digestion, softening, and liquefaction of tissue.

Answer 7

liquefactive necrosis

Question 8

ischemic injury to the CNS results in gangrenous necrosis. T or F

Answer 8

False. Liquefactive necrosis

After the death of CNS cells, liquefaction is caused by AUTOLYSIS

Question 9

The necrotic material in liquefactive necrosis is caramel yellow because of the presence of pus. T or F

Answer 9

False. creamy gurl.

Question 10

It is seen in focal bacterial or occasionally fungal infections that stimulate inflammation and in suppurative infections characterized by the formation of pus (liquefied tissue debris and neutrophils) by heterolytic mechanisms.

Answer 10

liquefactive necrosis

Question 11

a pattern of necrosis which occurs as part of granulomatous inflammation and is a manifestation of partial immunity caused by the interaction of T lymphocytes (CD4+, CD8+, and CD4-CD8-), macrophages, and probably cytokines, such as interferon-γ, derived from these cells

Answer 11

caseous necrosis

Question 12

Caseous necrosis combines features of both fibrinoid necrosis and liquefactive necrosis. T or F

Answer 12

False. coagulative necrosis and liquefactive necrosis

Question 13

why is caseous necrosis named like this?

Answer 13

it has a cheese-like (caseous) consistency, a friable

white appearance on gross examination

Question 14

caseous necrosis has an amorphous eosinophilic appearance on histologic examination. T or F

Answer 14

True

Question 15

pneumonia is the leading cause of caseous necrosis. T or F

Answer 15

False tuberculosis

Question 16

Gangrenous necrosis most often affects the lower extremities or bowel and is secondary to vascular occlusion (blockage of blood vessel). T or F

Answer 16

True

Question 17

Not a specific pattern of cell death but is a commonly used term in clinical practice wherein it is usually applied to a limb, generally the lower leg that has lost is blood supply

Answer 17

gangrenous necrosis

Question 18

When complicated by infective heterolysis and consequent liquefactive necrosis, gangrenous necrosis is called liquid gangrene. T or F

Answer 18

False wet gangrene

Question 19

When characterized primarily by coagulative necrosis without liquefaction, gangrenous necrosis is called coagulated gangrene. T or F

Answer 19

False. dry gangrene

Question 20

When infection is caused by Clostridium perfringens which produces gas and a feeling of crepitus it is called gas gangrene. T or F

Answer 20

True

Question 21

A pattern of necrosis which is often associated with immune-mediated vascular damage.

Answer 21

Fibrinoid necrosis.
Occurs when complexes of antigens and antibodies are deposited in the walls of arteries. There is deposition of fibrin-like proteinaceous material in the arterial walls that appears to be smudgy and acidophilic.

Question 22

2 forms of fat necrosis

Answer 22

traumatic fat necrosis

enzymatic fat necrosis

Question 23

It occurs after a severe injury to tissue with high fat content, such as the
breast.

Answer 23

traumatic fat necrosis

Question 24

a complication of acute hemorrhagic pancreatitis (a severe

inflammatory disorder of the pancreas)

Answer 24

enzymatic fat necrosis

• involves proteolytic and lipolytic pancreatic enzymes diffuse into inflamed tissue and literally digest the parenchyma.
• Fatty acids are then liberated by the digestion of fat and form calcium soaps (saponification, or soap formation). Vessels are eroded, with resultant hemorrhage.
• Appear as grossly visible chalky- white areas which enable the surgeon or the pathologist to identify the lesion.
• Histologic morphology: necrosis takes the form of shadowy outlines of necrotic fat cells with basophilic calcium deposits surrounded by inflammatory reaction

Question 25

an orderly cell death which causes the cell to shrink and condense to disassemble its cytoskeleton and alter its cell surface so that phagocytic cells can attach to it and digest it rapidly before any leakage of its contents occurs, and neighboring cells usually remain healthy

Answer 25

apoptosis

Question 26

apoptosis greek term for

Answer 26

falling away from

Question 27

purpose of apoptosis

Answer 27

- Eliminate cells that are no longer needed. | - Maintain a steady number of various cell populations in tissue

Question 28

Progression is through a series of changes marked by a lack of inflammatory response include blebbing of plasma membrane, cytoplasmic shrinkage, and chromatin condensation

Answer 28

apoptosis

Question 29

In apoptosis, there is also involution and shrinkage of affected cells and cell fragments, resulting in small round eosinophilic masses often containing chromatic remnants as exemplified by

Answer 29

councilman bodies in viral hepa

Question 30

physiologic apoptosis

Answer 30

- Destruction of cells during embryogenesis, implantation, organogenesis, developmental involution, and metamorphosis - Involution of hormone dependent tissues upon hormone withdrawal, such as endometrial cell breakdown during menstrual cycle, ovarian follicular atresia in menopause, regression of lactating breast after weaning, prostatic atrophy after castration. - Cell loss in proliferating cell populations, such as immature lymphocytes in the bone marrow and thymus and B lymphocytes in germinal centers that fail to express useful antigen receptors, and epithelial cells in intestinal crypts, so as to maintain a constant number (homeostasis) -Elimination of potentially harmful self-reactive lymphocytes, either before or after they have completed their maturation, to prevent autoimmune reactions. -Death of host cells that have served their useful purpose, such as neutrophils in an acute inflammatory response and lymphocytes at the end of an immune response. In this case they are deprived of necessary survival signals, such as growth factors

Question 31

pathologic apoptosis

Answer 31

-DNA damage, Radiation, cytotoxic anticancer drugs and hypoxia can damage DNA, either directly or by production of free radicals. If repair mechanism cannot cope with the injury, the cell triggers intrinsic mechanisms that induce apoptosis. Elimination of the cell is a better alternative than risking malignant transformation. -Accumulation of misfolded proteins, improperly folded proteins arise from mutations in the genes encoding these proteins or because of extrinsic factors such as damage caused by free radicals. Excessive accumulation of these misfolded proteins in the ER is called ER STRESS, culminates in apoptotic cell death. Apoptosis caused by accumulation of misfolded proteins has been invoked as the basis of several degenerative diseases of the CNS and other organs. -Cell death in certain infections, particularly viral infections, in which loss of infected cells is largely due to apoptosis that may be induced by the virus (adenovirus and HIV infections) or by the host immune response (as in viral hepatitis). This is a T cell mediated response to viral proteins in an attempt to eliminate reservoirs of infection. -Pathologic atrophy in parenchymal organs after duct obstruction, such as in the pancreas, parotid gland and the kidney

Question 32

Necrosis caused by accumulation of misfolded proteins has been invoked as the basis of several degenerative diseases of the CNS and other organs. T or F

Answer 32

False. Apoptosis

Question 33

cells smaller, cytoplasm is denser and the organelles, although relatively normal, are more tightly packed represents what morphology of apoptosis

Answer 33

cell shrinkage

Question 34

This is the most characteristic feature of apoptosis wherein chromatin aggregates peripherally under the nuclear membrane, into dense masses of various shapes and sizes.

Answer 34

chromatin condensation

Question 35

Plasma membranes are thought to remain intact during necrosis until the last stages hence, do not spill their contents into extracellular environment and usually do not trigger inflammation and keeps neighboring cells healthy. T or F

Answer 35

False. necrosis

Question 36

4 main pathways of abnormal intracellular accumulations

Answer 36

- Inadequate removal of a normal substance secondary to defects in mechanisms of packaging and transport (fatty change) - Accumulation of an abnormal endogenous substance as a result of genetic or acquired defects in its folding, packaging, transport, or secretion (mutated forms of a1-antitrypsin) -Faillure to degrade a metabolite due to inherited enzyme deficiencies (storage diseases) -Deposition and accumulation of an abnormal exogenous substance when the cell has neither the enzymatic machinery to degrade the substance nor the ability to transport it to other sites

Question 37

characterized by the accumulation of intracellular parenchymal triglycerides and is observed most frequently in the liver, heart, kidney

Answer 37

fatty change

Question 38

fatty change results from

Answer 38

- decrease production of APOPROTEINS required for transport - overproduction fat cells - increased transport of triglycerides to affected cells

Question 39

Fatty change is thus linked to the disaggregation of ribosomes and consequent decreased protein synthesis caused by failure of ATP production in CCl4- injured cells. T or F

Answer 39

True

Question 40

used by cells to synthesize cell membranes

Answer 40

cholesterol

Question 41

The extracellular cholesterol may crystallize in the shape of long needles, producing quite distinctive clefts in tissue sections. T or F

Answer 41

False. cholesterol esters

Question 42

plaques, smooth muscle cells and macrophages within the intimal layer of the aorta and large arteries are filled with lipid vacuoles, most of which are made up of cholesterol and cholesterol ester

Answer 42

atherosclerosis

Question 43

Intracellular accumulation of cholesterol within macrophages is also characteristic of acquired and hereditary hyperlipidemic states

Answer 43

xanthomas -Clusters of foamy cells are found in the subepithelial connective tissue of the skin and in tendons, producing tumorous masses known as xanthomas.

Question 44

This refers to the focal accumulations of cholesterol-laden macrophages in the lamina propria of the gallbladder.

Answer 44

cholesterolosis

Question 45

This lysosomal storage disease is caused by mutations affecting an enzyme involved in cholesterol trafficking, resulting in cholesterol accumulation in multiple organs

Answer 45

niemann-pick disease, type C

Question 46

What are the Intermediate filaments, which provide a flexible intracellular scaffold that organizes the cytoplasm and resists forces applied to the cell,

Answer 46

``` keratin filaments (characteristic of epithelial cells) neurofilaments (neurons) desmin filaments (muscle cells) vimentin filaments (connective tissue cells) glial filaments (astrocytes) ```

Question 47

The neurofibrillary tangle found in the brain in Alzheimer disease contains glial filaments. T or F

Answer 47

False. neurofilaments

Question 48

Certain forms of amyloidosis fall in this category of diseases. These disorders are sometimes called proteinopathies or protein-aggregation diseases

Answer 48

aggregation of abnormal proteins

Question 49

example of intracellular hyaline deposits

Answer 49

reabsorption droplets, russell bodies, alcoholic hyaline (composed of keratin intermediate filaments)

Question 50

Glycogen is found in renal tubular epithelial cells, as well as within liver cells, β cells of the islets of Langerhans, and heart muscle cells. T or F

Answer 50

True

Question 51

In these diseases enzymatic defects in the synthesis or breakdown of glycogen result in massive accumulation, causing cell injury and cell death

Answer 51

glycogen storage diseases, or glycogenoses.

Question 52

most common exogenous pigment

Answer 52

carbon (coal dust) - Accumulations of this pigment blacken the tissues of the lungs (anthracosis) and the involved. lymph nodes - In coal miners the aggregates of carbon dust may induce a fibroblastic reaction or even emphysema and thus cause a serious lung disease known as coal worker's pneumoconiosis

Question 53

an insoluble pigment, also known as lipochrome or wear-and-tear pigment.

Answer 53

lipofuscin

Question 54

it is derived through lipid peroxidation of polyunsaturated lipids of subcellular membranes. Also, it is composed of polymers of lipids and phospholipids in complex with protein

Answer 54

lipofuscin

Question 55

its being a telltale sign of free radical injury and lipid peroxidation

Answer 55

lipofuscin

Question 56

fuscus (latin)

Answer 56

brown (brown lipid)

Question 57

In tissue sections it appears as a yellow brown, finely granular cytoplasmic, often perinuclear, pigment

Answer 57

lipofuscin

Question 58

It is seen in cells undergoing slow, regressive changes and is particularly prominent in the liver and heart of aging patients or patients with severe malnutrition and cancer cachexia

Answer 58

lipofuscin

Question 59

This pigment is formed from tyrosine by the action of tyrosinase, synthesized in melanosomes of melanocytes within the epidermis

Answer 59

melanin

Question 60

Decreased melanin pigmentation is observed in albinism and vitiligo. T or F

Answer 60

True

Question 61

This pigment is a catabolic product of the heme moiety of hemoglobin and, to a minor extent, myoglobin.

Answer 61

bilirubin

Question 62

In various pathologic conditions, bilirubin accumulates and stains the blood, sclera, mucosae, and internal organs, producing a yellowish discoloration called

Answer 62

jaundice

Question 63

jaundice associated with destruction of red cells

Answer 63

hemolytic jaundice

Question 64

jaundice associated with parenchymal liver damage

Answer 64

hepatocellular jaundice

Question 65

jaundice associated with intra- or extrahepatic obstruction of the biliary tract.

Answer 65

obstructive jaundice

Question 66

a hemoglobin-derived, golden yellow-to-brown, granular or crystalline pigment that serves as one of the major storage forms of iron

Answer 66

hemosiderin

Question 67

Iron is normally carried by specific transport protein

Answer 67

transferrins

Question 68

Ferritin is a constituent of most cell types. When there is a local or systemic excess of iron, ferritin does not form hemosiderin granules, which are easily seen with the light micro. T or F

Answer 68

False, they form hemosiderin granules

Question 69

Hemosiderin pigment represents aggregates of ferritin micelle. T or F

Answer 69

True

Question 70

The best example of localized hemosiderosis is

Answer 70

common bruise

Question 71

Local or systemic excesses of iron cause hemosiderin to accumulate within cell

Answer 71

True

Question 72

After removal of iron, the heme moiety is converted first to biliverdin (“red bile”) and then to bilirubin (“green bile”).

Answer 72

False. biliverdin = green bile | bilirubin = red bile

Question 73

the iron released from heme is incorporated into ferritin and eventually hemosiderin.

Answer 73

True

Question 74

causes of hemosiderosis

Answer 74

-increased absorption of dietary iron -hemolytic anemias, in which abnormal quantities of iron are released from erythrocytes -repeated blood transfusions because the transfused red cells constitute an exogenous load of iron