Final review Flashcards
What does the word lentigo mean?
small, pigmented spots on skin with clearly defined edge surrounded my normal appearing skin
what is ment by the word nevus
nest, melanocytic nevi are nests of multi layered melanocytes found in moles.
what is a nevocellular nevi?
benign tumors of melanocyts that have sharp well defined edges stable in shape size and golor.
what is a dysplastic nevi?
Larger tumor of melanocytes that have irregular borders and pigment variation., changing in size, elevated and firm.
dysplastic nevus syndrome?
autosomal dominant conditions that give one and increased risk of melanoma
what can acanthosis nigricans be an indication of?
hyperinsuleniema associated with obesity or sometimes assiciated with a malignancy
what is seborrheic keratosis
stuck on keratin filled epidermal speudocysit
what is is called when you suddenly get a lot of seborrheic kerotosis lesions?
signs of leser-trelat, may indicate a underlying malignance
What is the test for Psorisis?
Auspits sign, scrape away scale and there is pinpoint bleeding
What is the test for Pemphigus?
Nikolskis sign, pressing on blister causes the edges to easily expand and its very breakable.
What causes pemphigus?
IgG between epidermal keratinocytes that cause blisters
bullae?
blisters
what can be a hallmark feature of pemphigus?
intraepidermal acanthosysis
what happens if you use steroids on tenia, fungal infections.
it will go away for a bit then come back with a vengance.
why does steroids not work on fungus?
because it decreases the immune system so the fungus can get a better foothold.
erythema multiforme?
Hypersensitivity to drugs or something, targoid lesions, bullae.
what is the most serious form of erythema multiforme?
stevens johnson syndrome, extensive involvement of skin and mucus membranes.
Erythema nodosom?
shins, 12-20 year olds, raised erythematous (red) painfull nodules of subcutaneous fat.
what is erythema nodosom sometimes associate with?
granulomatous diseases and strep, although most of the time there is no known cause, it goes away on its own eventually.
What layers are involved in Squamous cell carcinoma?
Keratinocytes invade down into the dermis, rarely metastasize.
what is indicative of keratocanthoma?
rapidly growing dome shaped nodules with a keratin filed center
what ususally will cure SCC?
complete excision
what is the most common tumor in the western world?
Basal cell carcinoma
how invasives is basal cell carcinoma?
locally invasive, arising from basal cells of hair follicles
what does basal cell carcinoma look like
pearly borders, papules.
what is the growth pattern of BSC?
invasive nests of basaloid cells with a palisading growth pattern
Pathology
study of the essential nature and charasteristic of disease, signs, symptoms, complications, patogenesis etc.
disease
impairment of the noamal states
homeostasis
maitenance of a harmonious environmet within body, cell, etc
comorbidity
property of disease that gives it a a specific virulence/sequelae
iatrogenic
doctor aquired disease
symptoms
subjective from patient view
signs
objective from doctors view
death
no pulse, heart sound or spontaneous respiration, no nucleus in most cells a cell either
sub-clinical
no signs or symptoms of infection because the immune system is keeping the infection down
illness
unhealthy condition of the body or mind (sickness/disease)
etiology
underlying cause of disease
pathogenesis
course that a disease takes from start to finish
Morphology
presence/conformation of damaged cells and tissues from the infection
functional disease
what happens when we know the disease exists but have not discovered any gross or microscopic morphologic changes yet.
syndrome
group of signs and symptoms that occur together and characterize a particular abnormality or condition.
Eosin
RED and PINK :stains cytoplasm, RBCs and collagen
Hematoxylin
BLUE and PURPLE : unclei, bacteria
what are the common causes of cell injury?
hypoxia, infections, immunologic reactions, congenital disorders, chemical injury, physical injory
what is the most common cause of cellular injury
hypoxia, inability to synthesize sufficient ATP by aerobic oxidation
How do infections cause injury?
direct infection, toxins and inflammatory responses of host
Vit A
squamous metaplasia, immune deficiency, night blindness
Cit C
scurvy
vit D
rickets, osteomalacia
Vit K
bleeding diathesis
Vit B12
megaloblastic anemia, neuropathy, spinal cord degeneration
Folate, B9
megaloblastic anemia, neural tube defects
Niacin, B3
pellagra, diarrhea, dermatitis dementia and death
when does cloudy swelling occur?
intracellular proteins accumulate in cytoplasm, the leaking is from hypoxia and cellular degeneration.
why does cloudy swelling occur?
cell is no longer able to maintain homeostasis of ionic and fluid balance. Lack of ATP shuts down necessary pumps,
where do free radicals come from?
oxygen derived, uv light, metabolism, inflammation, smoking, ionizing radiation, air polution
what does the release of cytocrome C causes?
triggers apoptosis
what releases cytocrome C and why?
Mitochondria when its disfunctional and cant make enough atp it becomes permeable.
what pumps fail in mitochondria causing and influx of Na/ water and efflux of K
Na/K ATPase pumps start to fail
pyknosis is what?
degeneration and condensation of necular chromatin
Karyorrhexis is what?
nuclear fragmentation,
karyolysis is?
dissolution of nucleus
what is the significance of anaplasia
cells divide rapidly but do not bear any resemblance to the normal cells, whether in structure or function.
What are the two chief findings of anaplasia?
brick like or random pattern, with dramatic increase of nuclear:cytoplasmic ratio.
Primay intentions closure
wound edges are close enough to meet and close, decreases scarring
Secondary intention closure
wound edges are far apart, so fills from bottom up with granulous tissue and fibrin
tertiary intention closure
keep would open to prevent infection etc so can close later
hypoplasia
defective formation or incomplete development of a part
agenesis iis what?
absence or failure of formation entirely
what is another name for primay stem cells?
labile
where are labile, primary stem cells found?
in epidermis, GI tract, etc, and are continuously dividing
Stable stem cells are what?
low replication but can be induced to divide
what stem cell type is found in hepatocytes, renal tubular epithelia, alveoli and pancreatic acini
stable stem cells
Where are permanent stem cells found?
don’t ever divide, are found in nerve cells, cardiac and skeletal muscles.
what are the three stages of fracture healing?
procallous, fibrocartilaginous callous, osseus callous
procallous
hematoma to provide anchorage but w/o structureal integrity
fibrocartilaginous callous
fibrous ball around fracture
pathologic fractures
caused by disease sequale, like osteoporosis etc
traumatic fractures
cause by trauma
type of traumatic fractures?
transverse, linear, non-displaced, comminutes, greenstick, spiral, compound
communited fracture
bone broken into many pieces
Karyotype
number and visual appearance of the chromosomes in the cell nuclei of an organism or species
ideogram
schematic representation of chromosomes showing the relative size of the chromosomes and their banding patterns
P arm?
short arm
Q arm
long arm
how many pairs of autosomes
22 pairs of autosomes
how many total pairs of chromosomes
23 pairs total.
gene once ment what ?
only protein coding sequence of DNA
what is a gene now?
any functional unit of a chromosome outside medical circles.
what percent of genome is protein coding?
only about 5%
what is locus on chromosome?
exact physical location of a gene on a chromosome, it the same in all people
alleles?
used to describe the two or more possible variations of a gene within a population
genotype
combo of alleles, it?s the actual sequence
penotype
the physical reflection of genotype, presence or absence
what is a single nucleotide polymorphism, SNP?
DNA sequence variation of single nucleotide between members of a species or paired chromosomes.
where does SNPs occur more often
in non coding reions
Imprinting of X chromosome
Naturally occuring in females, X inactivation. Only one of the two X chromosomes will be active in cell.
Imprinting in general
some genes are only active when transmitted by specific sexed parent, so in the other partent its inactived.
when does imprinting of autosomal genes happen?
during gametogenesis and its maintained in somatic cells.
what are the 5 points of control for gene expression?
chromatin, transcriptional, translational, post transcript, translate
why would dna wrap around histones
DNA is negative and histones are positively charged.
where does histone methylation occur
at CpG islands, it ususally down regulates transcription
what does histone acetylation do?
up regulating of transcricption cuz it allow unwinding of DNA from histone.
what is promoter region?
CpG islands ususally, where the polymerase is told to sit down and get ready to copy
transudate
edema fluid with low protein content and low specific gravity, produces non pitting edema
exudates
fluid with high protein content and cells and a higher specific gravity
what are the three parts of virchows triad?
hypercoagulability, stasis and vascular wall injury
What causes hypercoaguability?
clotting disorders, oral contraceptives, malignancy, pregnancy sepsis
what causes stasis?
atrial fibrillation, immobility, venous obstruction, venous insufficency,
vascular wall injury?
trauma/surgery, venepuncture, heart valve disease, replcement, atherosclerosos, catherters.
embolism
moving clot in bloodstream that leaves site of orgin and it occludes vessel
what is thrombosis?
non moving clot in arteries, heart chambers, causings infarct, etc.
when do fat emboli happen?
bone fractures
most common thrombosis?
thromboemboli
gas emboli
decompression sickness
amniotic fluid emboli
labor complications
tumor emboli
bacteria, drug use
where do most pulmonary emboli arise from
deep vein thrombosis, diagnosed by spiral CT
what is the most common outcome from pulmonary emboli?
nothing, 75% are asymptomatic and go away on their own
newspaper test?
transeudate fluid is if you can read news paper through test tube of fluid
countries with highes HIV?
African, South africa, nigeria, kenya Mozambique and india
why do 10% of hemopheliacs not progress to AIDS
maybe they don’t have CCR5 receptors
Acute phase of HIV
infection, reduced CD4 with viremia, seroconversion, mono, flulike symptoms
lantent phase HIV
lymphadenopathy, viral replication. Low virema, oppurtunistic infection, 10 years
what are the two neoplasms that are often seen in AIDS
hairy leukoplakia and kaposi sarcoma, then non hodgkin lymhoma
what labs to monitor HIV infection
CD4 count, and HIV1 RNA viral load via PCR
what is a mitotic body?
they are the dividing cells in a tissue
what do mitotic bodies tell you about cancer?
if there are more mitotic bodies than their should be for specific tissue then you would know tissue was dividing more rapidly and suspect cancer
where do sarcomas arise
muscles and connective tissue
how do sarcomas spread
blood stream
where do carcinomas arise?
epithelium
how do carcinomas spread?
lymphatic system
what is an adenocarcinoma?
glandular cancer
what cells are most sensitive to ionizing radiation?
cells in mitosis or the G2 phase, the are replicating their genome
does oma mean the cancer or not?
OMA means swelling or tumor, it doesn’t indicate cancer one way or the other.
Ames test
detects mutagenic effect on DNA, doesn’t show epigenetic changes
what cancer kills most males?
hepatocellular carcinoma
what cancer kills most females?
cervical cancer
when does cancer peak in first world?
80-84 years
MEN I
pitutary adenoma, parathyroid hyperplasia and pancreatic tumors.
MEN II
parathyroid hyperplasia, phenochromocytoma, medullary thyroid carcinoma.
MEN IIB
mucosal neuromas, marfinaoid body habitis, pheochromocytoma, meullary thyroid carcinoma,
what does MEN stand for?
multiple endocrine neoplasia, a familiar cancer syndrome
paraneoplastic syndrome
may serve as signal for neoplastic diagnosis, when neoplasm is causing a change but its something that isn’t directly related to tumor growth, like suddenly you are super tired all the time, it may be hormonal
preneoplastic disorders
Acquired (hep B) - increase liklyhood of reaching a cancerous stage and corelate directly with cancer, HepB,
direct acting Initiatior is what?
direct acting chemical carcinogens that modify DNA to cause cancer,
Indirect initiatior is what?
chemical carcinogen gets altered by our body to become an active carcinogen
genotoxic mechanisms
employ DNA damage, chromosomal misentegration
non-genotoxic mechanisnm
Employ chronic irrication, cell death ROS , epigenetic to cause problems.
what does a person look for to find promoter region?
Promoter region alterations, these alterations have been found in all cancers that have been studies.
what type of solar radiation is most carcinogenic?
UVB
how does UVB cause cancer
produces dyrimidine dimers in DNA leading to transcritional errors and mutations of proto-oncogenes and tumor supressor genes.
what type of radaions used in hospital
ioniing ratiation
what is neutron radiation not used?
because governments have outlawed it because they don’t want it used against them.
what are the three activities are protoonca genes involved in?
growth, cellular differentiation, gene regulation
gain of function
oncogenes, one hit process, create more active protein to stimulate cell cycle
loss of function
tumor supressors, two hit process, creates no active proteins , inhibits cell cycle
how do viruses cause cancer or tumors
by carrying in oncogenes or by incerting into a tumor supressor gene and breaking it.
why may two of the same cancers at same stage in two people progress different?
because at each cell divisions, mutations make each cancer different. They may have starteted the same but will continue to be even more different. So one may be hormone sensitive but the other wont
7 thing to make tumor be malignant
self sufficent, insufficient inhibitory signals, evade apoptosis, limitless replication, sustained angiogensis, ability to invade, and defects in DNA repair
what is the guardian of the genome?
P53
where does P53 work?
prevents cell with damaged DNA from entering the S phase.
Li-fraumeni syndrome?
germ line rotation of p53, it increases rates of tumors, childhood sarcomas leukemia, breast cancer
what two genes regulate apoptosis?
P53 promotes apoptosis and BCL-2 inhibits apoptosis
what is the limit of fine needle aspiration?
Does grading (histology) well, it cant determine staging (size, metastisist)it will show that there are cell changes but cant tell if its moved, can’t determine stage
what is an abnormal vein growth
non fractal growth pattern, it looks evil and twisted.
name two nonoclonal antibodies?
CA-125 and CA 19-9
CA-125 non clonal antibody for what?
ovarian cancer
CA-19-9 non clonal antibody for what
pancreatic cancer
BRCA -1
brest cancer
tumor grading
more histological and not prognosis indicatior
tumor staging
T is size, N is lympnode spread, M is mestatic.
TNM is what?
degree of size, lymNode and metastasis, indicator of prognosis
grade 4 cancer means?
glands are fuses, no intervening stroma
Stage 4 cancer means
metastasis - spreading, poor prognosis
Genetic instability in tumor supression
malignant cells are more prone to mutate and accumulate additional defects without dying.
what does genetic instability mean for cancer reoccurance
there was a selective growth advantage for the new cancer, so will more resistance to treatment etc.
seeding
spread within the same cavity/chamber
transplantation
no clean margins, surgical insision could spread by indroducing cell toblood
sister mary joseph
discovered periumbical nodes correlated to pancreatic cancer
what three cancers like to move to brain
skin, breast and lung
what threee cancers like to move to bone
breast lung and prostate then kidney and thyroid
what causes osteoblastic lesions
prostate cancer - builds bumps on bone
What causes osteolytic lesions
renal and breast cancers - thins out bone
how could you test for metastasis to spine?
tuning fork
Induction treatment
only treatment, used for advanced disease or when no other treatment exhists
Neoadjuvant
chemo first, followed by another treatment
adjuvant
combination with other modality, given after other treatments are used.
salvage
hail mary, for those that fail to respond to initial chemo
what tumors are more sensitive to XRT (radiosensitive)
seminomas and lymphomas - because their cells have high turnover
what tumor cells are radio resistane
epithelial and carcomas, because they have a lower cell turnover
NCCN?
national comprehensive cancer network, shows staging and therapies for it.
bitter almonds
cyanide
friity
diabetic
garlic
organophosphates, arsenic, DMSO
mothballs
naphthalene, camphor
how often do patients with CO poisoning turn red
not very often but it does cause blood to be very red even though its not carrying oxygen
what poisoning often happens in conjunction with CO poisoning
cyanide poising because of the burning furniture in fires.
what is ment by heavy metals
metals or metalloids of environmental concern, denser than iron
Do radioisotopes bioconcentrate
yes, they do as they are eaten and move up the food chain.
before what date should things not have cesium?
before 1924
how can you increase toxicity of HG
methylate it and it becomes more water soluble and can cross the BBB.
what are the two main toxicities of mercury poisoning?
neruotoxicity (brain) and nephrotoxicity (kidney
is arsinic always poisonous?
no it can be in some species genome
what does acure arsenic poisoning cause?
CAN toxicity and hemorragic gastroenteritis
what does chronic arsenic cause
malaise, abdominal pain, skin changes, mees lines.
mees lines arsenic
horixontal white lines on nails
what do lead lines look like
they are not on nails they are at the gingivodental line
why is lead worse for children
CNS toxicity,
Pica
desire to eat dirt or ice, may be genetic condition
basophilic stippling?
seen with microcytic anemia in lead poisoning. Ribosome are spread showing small dots at periphery
why do those who start smoking at 30+ not get COPD
because they thart after epithelial transition ends at about 20. this also makes it so that cumulative effects take longer
what is the 20 pack year thing.
packs per day times years smoking. 20 = cancer in the othd view.
what illness can second hand smoke cause in children
sids, otitis media and asthma/URI
what is photochemical smog?
chemical reaction of sun, NO, and VOCs in atmosphere leading to ground level ozones and particles and aldehydes, Nos
what was in smog in 1905?
soot, and sulfer from burining coal
how is ozone formed?
in atmosphere when NO is broken by sun, and some os for osone.
why is silicosis the most common pneumoconiosis?
caused by inhalation of dust or pollutants in smok with silica
sillicoderosis
inhale dust and sillica, swelling of lungs
caplans syndrome
pneumoconiosis in combination with multiple pulmonary rheumatoid nodes found in rheumatoid arthritis.
silicates
adding another atom to silica to make mineral
silicon
chemical element, but almost always in combo with O2
silicone
polymer of silicone with C and O. solid liquid or gel
Pathogonomic
symptom/sign that is character of diesase, that will tell you a specific disease without a doubt
what is eggshell calcification
indicates silicosis on an xray, it is pathogonomonic
why does inhaling particles cause fibrosis?
magrophage igestion trigger frbrogenic respons via growth factors, promote collagen deposition
where do asbestose fibers localize
in septum of alveolus and distal lung.
what are asbestosed fibers in lungs cause
rod or dumbell shaped
cancer of asbestose
mesothelioma that involves lower lobes and pleura
asbestose exposure increases lung cancer by how much
5 times then 55 times if the ysmoke to.
