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Pathology I > Final Exam: immune deficiency - malignant bone tumor > Flashcards

Final Exam: immune deficiency - malignant bone tumor Flashcards

1
Q

B cell deficiency increases susceptibility to _______; while T lymphocytes increase susceptibility to _________

A

Bcell = Bacterial infection

TLymph =Viral and fungal infections

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2
Q

A specialized protein in the blood usually formed in response to antigen

A

Antibody

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3
Q

An agent which initiates production of specific antibodies against itself

A

Antigen

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4
Q

An agent which alone is not antigenic but exhibits antigenic properties when attached to other protein molecules

A

Haptens

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5
Q

Type 1 hypersensitivity is

A
  • Anaphylactic
  • Mediated by IgE bound to mast cells and basophils
  • Results in rapid release of histamine
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6
Q

What are examples of local type 1 hypersensitivity reactions (3)?

A

Hay fever, food allergies, skin reactions

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7
Q

What are examples of systemic type 1 hypersensitivity reactions (2)?

A

Widespread vasodilation

Bronchospasm

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8
Q

Type 2 hypersensitivity

A
  • antibodies directed toward antigens located on cell surfaces or in ECM
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9
Q

Antibody dependent mechanisms of Type II hypersensitivity (3)

A
  1. Complement mediated mechanisms: lysis of target cell, opsonization, phagocytosis e.g. transfusion or drug reactions
  2. Antibody dependent cytotoxicity: NK cells target tissue elements with bound antibody
  3. Antireceptor antibodies: non-cytotoxic mechanisms, antibodies activate or block cell membrane receptors e.g. Graves’ disease — antibodies mimic TSH; myasthenia gravis — antibodies block ACh receptors
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10
Q

Graves’ disease

A

antibodies mimic TSH

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11
Q

Myasthenia gravis

A

antibodies block ACh receptors

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12
Q

Type 3 hypersensitivity

A

Is an immune complex injury

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13
Q

Immune complex

A

Antigen and antibody that form in blood and tissue fluids

Activate complement and elicit inflammatory responses and tissue damage

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14
Q

What is the type 3 hypersensitivity that is:

Formation of circulating immune complexes in sensitized host

A

Serum sickness

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15
Q

**What is the type 3 hypersensitivity that is:

Multiple autoantibodies contribute to injury of various structures

A

Systemic lupus erythematosus (SLE)

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16
Q

**What is the type 3 hypersensitivity that is:

Associated with local immune complex injury

A

Arthus reaction

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17
Q

Type 4 hypersensitivity

A

Delayed hypersensitivity

Sell mediated, especially T-lymphocytes. Skin rashes in certain virus infections and in contact dermatitis, and granulomatous diseases

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18
Q

Example of type 4 hypersensitivity (3)

A

Tuberculosis
Leprosy
Acute rheumatic fever

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19
Q

A system of cell surface proteins know as major histocompatability (MHC) antigens

A

Human leukocyte antigens (HLA)

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20
Q

MHC gene products are grouped into 3 classes:

A

Class I: presented on nucleated cells and platelets

Class I & II associated with antigen presenting and production of cell surface glycoproteins

Class III: genes are associated with complement

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21
Q

HLA-B27

A

90X greater chance of developing ankylosing spondylitis

Note: HLA-DR3/4 = type 1 diabetes

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22
Q

Chronic multisystem inflammatory disease that commonly affects skin, kidneys, serosal membranes, joints, heart, CNS

A

Systemic lupus erythematosus (SLE)

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23
Q

***Classic triad of SLE

A

Butterfly rash
Joint pain
Fever

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24
Q

***Endocarditis is characterized by

A

patchy vegetation’s on exposed surfaces of valves

25
Q

***What are (6) environmental risk factors for SLE?

A 
UV light
Drugs
Psoralens (figs, parsnips)
Estrogen (e.g. pregnancy)
Viruses
Stress
26
Q

***How do you diagnose lupus?

A

ANA: Antinuclear antibodies to double stranded DNA and smith antigens

Note: Serum ANA levels correlate with severity of disease.
Note #2: ANA is sometimes present in non-SLE population too.

27
Q

SLE heart problems include

A

Pericarditis
Myocarditis
***Endocarditis: patchy vegetation’s on exposed surfaces of valves

28
Q

Overproduction of collagen throughout the body

A

Scleroderma

29
Q

**Describe diffuse and localized patterns of scleroderma

A

Diffuse: early widespread skin involvement with rapid progression and visceral effects (ANA)

Localized: only skin of face and fingers. CREST syndrome (calcinosis, raynaud’s phenom, esophageal dysfunction, sclerodactyly, telangiectasias)

30
Q

What is CREST syndrome?

A

Combined effects known of localized scleroderma:

  • Calcinosis — calcific deposits
  • Raynaud’s phenomenon — CT disorders fingers and toes turn cyanotic and whitish
  • Esophageal dysfunction — scarring around esophagus
  • Sclerodactyly - shortening digits
  • Telangiectasias - micro exposed BV on face (ecchymosis)
31
Q

What is the differentiating factor between polymyositis and myasthenia gravis?

A

Polymyositis spaces the extra-ocular muscles

32
Q

What 6 organs are affected in scleroderma?

A 
Skin
GI tract
Musculoskeletal 
Kidneys
Lungs
Heart
32
Q

Polymyositis is

A

Inflammatory damages to skeletal m — groups of muscles degenerate

32
Q

What are the 3 factors of dermatomyositis (which is polymyositis + skin issues)

A

Butterfly rash
Helicotrope eyelids
Purple bumps on knuckles

32
Q

4 questions in 1:
What is the 1˚ cause of osteoporosis (2)?
What is the 2˚ cause of osteoporosis (4)?
Do they present differently?
Do you see serum changes?

A

1˚ Being an old female (menopausal)

2˚ diet/lifestyle, preggo, vitamin D deficiency, endocrine disorders

No, 1˚ and 2˚ present the same way.

No serum changes: composition the same, quantity decreased.

33
Q

What does osteoporotic bone look like (3)?

A

Catfish vertebra
Schmorl’s nodes
Vertebral collapse (dowager hump)

34
Q

What is Osteomalacia associated with and why?

A

Poor calcification of bone matrix; vitamin D deficiency usually

35
Q

What serum changes will you notice with osteomalacia?

A

Low calcium, low phosphate, HIGH alkaline posphatase

36
Q

Looser’s zones associated with

A

Osteomalacia “soft bones”

Looser’s zones are pseudofractures

37
Q

Osteomalacia for young people is called?

A

Rickets (juvenile osteomalacia)

38
Q

Rickets (juvenile osteomalacia) is associated with skeletal deformities (4)

A
  • Rachitic rosary
  • “Pigeon breast”
  • Harrison’s groove
  • Craniotabes
39
Q

Ostoemyelitis is associated with what bone deformity?

A

Brodie’s abscess: common in tibia

40
Q

Infection of marrow and bone

A

Osteomyelitis

41
Q

Pyogenic osteomyelitis vs tuberculous osteomyelitis

A

Pyogenic — infection of hematogenous origin

Tuberculous — Pulmonary Tb can lead to lesions of bone and if its in the spine its Pott’s Disease

42
Q

Von recklinghausen’s disease of bone is associated with what disease

A

Hyperparathyroidism.

Less common now because people are being treated

43
Q

Characteristics of Von recklinghausen’s disease of bone (2)?

A
  • moth eaten x-ray
  • brown tumors

*not all inclusive

44
Q

Paget’s disease (osteitis deformans) is what kind of bone disease and how does it present?

A

Hyperosteolytic bone disease; thick + porous

45
Q

Histologically Paget’s disease

A

Tile-like mosaic

46
Q

Bone scan for Paget’s disease shows

A

Increased activity (hyperosteolytic)

47
Q

Monostotic lesions versus polyostotic lesions in Paget’s disease

A

Mono: tibia - 15% of cases
Poly: multiple sites - 85% of cases

48
Q

Stages of Paget’s disease progression (3)

A
  • Hot (osteoclastic phase)
  • Mixed (osteolytic, osteoblastic)
  • Cold (burned out stage)
49
Q

2˚ metastatic cancer is ___% more common that 1˚ bone tumors.

A

70%

50
Q

___% of metastatic bone disease is osteolytic (not osteoblastic)

A

70%

51
Q

4 most common malignant bone tumors

A
  1. Osteosarcoma 40%
  2. Chondrosarcoma — slooooooow and LARGE, 40-60 yo
  3. Ewing’s sarcoma — 10-15yo. Need to rule out infection as differential diagnosis
  4. Giant Cell Tumor — soap bubbly appearance
52
Q

Codman’s triangle is associated with what malignant bone tumor

A

Osteosarcoma

53
Q

What malignant bone tumor occurs in 40-60 you and is sloooooow and LARGE

A

Chondrosarcoma

54
Q

What malignant bone tumor occurs in 10-15yo and has a differential diagnosis of infection?

A

Ewing’s sarcoma

55
Q

What malignant bone tumor has soap bubbly appearance

A

Giant Cell Tumor

Pathology I (10 decks)

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