General pathology Flashcards
Cell survival depends on the presence of ……
a balanced environment (homeostasis), with constant supply of energy and active transport processes
Cell injury occurs if …..
the cell can not fully adapt to the insult (change)
* Injury causes reversible changes at the beginning, but may progress to irreversible damage and cell death
The ability of the cell to tolerate injury depends on ….., ….., …… & ……
severity, duration, type of stimuli & the ability of the cell to adapt
Hypoxia leads to insufficient ATP. Low ATP causes ……, ……. & …..
failure of the Na-K pump
increased glycolysis
progressive detachment of ribosomes from the RER
* Hypoxia is caused by
1. Ischemia
2. Reduced blood O2 carying capacity
3. poisoning of the enzymes in the ETC (by cyanide, rotenone, antimycin A “produced by bacteria”)
Chemical cell injury causes ……
disruption of the chemical processes or the physical structure of the cell
Cloudy swelling is …..
results from damage to the ETC complex, leading to low ATP, followed by failure of the Na-K pump, influx of water and Ca, and efflux of K
- ER will be dilated, and ribosomes are detached from its surface
- If ATP supply is not restored, irreversible injury occurs
Production of toxic oxygen intermediates will causes …..
membrane damage
* Also, production of some lipid products may have a detergent like effect on the plasma membrane
Mitochondrial swelling occurs because of …..
Ca accumulation
* This leads to inhibition of oxidative phosphorylation
Karyorrhexis is ……
Karyolysis is …..
- nuclear fragmentation
* dissolution of the nucleus
Coagulation necrosis is ….. . The common causes are ….
the most common type of cell injury for cells with little number of lysosomes
- Homogenous eosinophilic mass with loss of the nucleus but preservation of the cell shape
- Usually caused by thermal or toxin injuries, or sudden ischemia
- The heart is the most common example
- Dry Gangrene is another example
Liquefactive necrosis is ….. . Suppuration is …..
cellular destruction by hydrolytic enzymes. Occurs usually in the brain & pancreas
* suppuration is liquefaction by leukocytic enzymes, and the product is Pus
What is the difference between Autolysis and heterolysis?
- Heterolysis refers to apoptosis induced by extrinsic hydrolytic enzymes
- Autolysis is apoptosis of a cell by its own enzymes.
Casseous necrosis is …..
combination of liquefactive and coagulative nerosis.
- Tissue is grossly soft, friable and cheese like
- It is a characteristic of tuberculosis, granulomas and fungal infections.
- Squamous carcinoma has casseous center due to rapid growth
Spilling of pancreatic lipase on adjacent adipose tissue causes ….
enzymatic fat necrosis
* Occurs due to pancreatic necrosis
Gummatous necrosis is characterized by ……
differs from liquifactive and coagulative necrosis by its gelatin like appearance
* Seen in late stage syphilis
Apoptosis is characterized by …..
- minimal inflammation
- Chromatic condenses (due to low pH), and bleb appear on the cytoplasmic membrane (deformation)
- Break down of DNA into small fragments
- Energy production is not affected
Anthracotic pigmentation is …..
accumulation of coal dust particles in cells
* It is a type of exogenous pigments
Lipofuscin is …..
It is found in …..
What is the source?
a type of endogenous pigments. Also called wear and tear pigments. Appear in the heart, brain & liver. Derived from lipid peroxidation
* Other types of endogenous pigments is hemosidrin, melanin, bilirubin
Dystrophic calcification is caused by ….., while metastatic calcification is caused by …..
- percipitation of Ca phosphate in area of necrosis, due to low pH
- hypercalcemia due to malignancy or hyperparathyroidism
Atrophy is …… and is caused by …..
loss of cell/organ size
- caused by disuse, malnutrition, aging, ischemia, or lack of hormonal or neural stimulation
- Organ atrophy is due to loss of cells, or decrease cell size, or both
Hypertrophy is …..
increased cell/organ size (weight lifters, and cardiac muscle in hypertension)
- Also due to endocrine overstimulation.
- Could be physiologic (lactating breast) or pathologic (cancers)
Hyperplasia is …..
increase in cell numbers, often with hypertrophy
- Nerve, cardiac & skeletal cells can not exhibit hyperplasia
- Physiological (partial hepatectomy, breast growth) or pathological (lymphoid hyperplasia due to antigen stimulation)
Metaplasia is ……
reversible change of one cell type to another due to irritation
* Chronic smoking causes metaplasia of the bronchoalveolar epithelium
What are the cardinal signs of acute inflammation?
- Rubor
- dolor
- calor
- tumor
- loss of function
Transudate is caused by ……., while exudate is caused by ……
- pressure difference between the vasculature and the interstitial space
- due to increased permeability of the vessels and chemotactic factors. Contains proteins and cells
Inflammation begins with vascular …… followed by ……
- transient vasoconstriction
- vasodilation of the affected area (flow will be slow and the vessels leak). caused by histamin, prostaglandin, bradykinin
Increased vascular permeability in acute inflammation is caused by …
contraction of the pericytes (embedded in the basement membrane and wrap around endothelial cells of capillaries and venules)
What is the effect of the following on the vasculature:
- Serotonin
- bradykinin
- leukotriens
- Histamine
- Vasoconstriction, increase permeability
- vasodialtion, increase permeability
- vasoconstriction, increase permeability
- vasodilation, increase permeability
* histamine & serotonin are vasoactive amines. Stored in mast cells, basophils, platelets
* leukotriens cause bronchoconstriction (asthma) and increase mucus secretion in the airway
* Vasoactive amines act specifically on venules (not capillaries)
Extravasation of fluid allows leukocytes to ….
marginate, roll & adhere to the endothelium via specific receptor, form pseudopods between cells, cross the basement membrane towards the stimulus
* This whole process is called diapedesis
An example of bacterial chemotactic factor is ……
N-formylmethionine
The most important chemotactic factors for neutrophils are ….. & …..
C5a & IL-8
Explain phagocytosis
- The particle to be engulfed is opsonized with C3b & IgG
- Binding of the particle to Fc or CR1 receptor on the phagocyte
- Engulfment & binding of the vacuole to lysosome
- Break down of materials with acid, reactive oxygen, proteases & lysozymes
Corticosteroids …… leukocyte migration
inhibits
* Also, stabilizes the lysosomal membranes
The main cells in acute inflammation are ….., and in chronic are …..
neutrophil, mast cells
monocyte (macrophage), lymphocytes, plasma cells
What is the composition of the cellular infiltrate in chronic inflammation??
- Macrophage
- Fibroblasts (collagen deposition resulting in scarring)
- Eosinophils, lymphocytes & plasma cells
- occasionally, some neutrophils
If a substance can not be completely removed, …… inflammation incurs.
chronic granulomatus
* examples are tuberculosis (casseating granuloma), sarcoids (non casseating granuloma), gout, crohn’s disease, fungal and parasitic infections
Granulomas are …….
- 5 - 2 mm aggregation of macrophages, walling off a foreign body to prevent further spread of infection
* The hallmark of granuloma is the presence of epithelioid cells (which are elongated macrophages with eosinophilic cytoplasm & large ER, golgi, vesicles, indicating a secretory rather than digestive function)
* It is often surrounded by plasma cells, lymphocytes & fibroblasts
When does repair process start? and what are the types?
- Starts soon after the inflammatory process begins
* Regeneration (same cell types), or replacement (by connective tissue, forming a scar)
Define :
- Labile cells
- Stable cells
- Permanent cells
- regenerate throughout life (i.e epithelium)
- Regenerate at a slow rate, usually dormant unless stimulated (i.e liver, pancreas, kidney, vascular endothelium & smooth muscles)
- Can not replicate (skeletal & cardiac muscles and neurons)
Growth factors include …..
- PDGF & transforming growth factor (TGF)
- cytokines (IL-1 & TNF), which stimulate collagen synthesis
* Collagen is broken down by collagenase from macrophages and neutrophils
Scurvy is ……
delay wound healing caused by Vit C deficiency.
* Vit. C is necessary for cross linking of collagen (which is essential for its tensile strength)
What is the difference in union between primary and secondary intention??
- Occurs when wound edges are closely approximated
- Occurs when the skin edges are not in contact. Large amount of granulation tissue is formed & wound contraction is mediated by myofibroblasts
Describe the process of primary union by first intention
- clotted blood fills the gap, forming a scab
- neutrophils line the wound
- epithelial lining is formed within 24-48 hours
- macrophages replace neutrophils. Epithelium thickens
- collagen is laid down across the incision
- the scar becomes increasingly avascular
* Full maturation of the scar requires up to one year
Congestion is …..
excessive amount of blood in an area secondary to diminished venous outflow
* The blood acquires are bluish hue
Factors that inhibit thrombosis are ….., ….. & ……
Factors facilitate thrombosis are …….
- PGI-2 & NO2 & plasmin (degrades fibrin clot)
* tissue factor (activates F VII) & exposure of subendothelial collagen (activates F XII)
Endothelial growth over and within the thrombus forms …..
new vessels
* the thrombus is incorporated into the vessel
Von Willbrand diseases causes …..
functional factor VIII deficiency
* PTT is prolonged, PT & bleeding time are normal
Describe the morphology of the thrombus
- the head is composed of fibrin and platelets
- The tail is composed of RBC & fibrin
* Lines of Zahn are alternating layers of fibrin, platelets & RBC in the tail of the thrombus
What is the difference between mural and occlusive thrombi??
- mural: adherent to the vessel wall. non occlusive, affects large vessels
- Occlusive: mostly in the cerebral, coronary, femoral & mesenteric vessels. restricts blood flow. arterial causes infarct, venous ones rarely occlude vessels and tend to embolize
DIC can be diagnosed by …..
prolonged PT & PTT, presence of fibrin splits and low platelets
* There is consumption of hemostatic factors & activation of the fibrinolytic pathway leading to bleeding diathesis
Embolism is ….. . What are the types??
occlusion of a vessel by a mass, often dislodged from its site of formation
- pulmonary: usually from DVT origin
- systemic: originate in the heart.
- paradoxical: crossed the right side to the left side of circulation through a septal defect, gaining access to the systemic circulation
- other: cassion disease (gas), fat emboli, amniotic fluid emboli, tumor cells etc…
Infarction is ……
What are the factors that affect its development?
ischemic necrosis of the tissue due to occlusion of the vessels
- presence of a collateral circulation
- rate of occlusion of the vessel
- vulnerability of the tissue to hypoxia
- O2 carrying capacity of blood
* Most common sites of infarction are heart, brain, lungs and intestine
Shock is ……
What are the most common types??
Decrease in tissue perfusion
* vascular collapse due to reduced blood volume (hypovolemic shock), cardiac output (cardiogenic shock), vascular tone (neurogenic shock, due to anesthesia or spinal injury). Also there is septic shock (caused by G-ve septicemia, which releases vasodilatory mediators)
Neoplasm is ……
uncoordinated tissue growth, which continues to grow even after the cessation of the original stimuli that invoked the growth.
Define:
- Anaplasia
- Desmoplasia
- Dysplasia
- loss of cell differentiation and tissue organization. A hallmark of aggressive malignancies
- excessive fibrous tissue formation in the tumor stroma*
- abnormal, atypical cellular proliferation of non differentiated cells (unlike metaplasia)
* Stroma is the fibrous framework of an organ/tumor
Carcinoma is ……
Carcinoma in situ is …..
Sarcoma is …..
- cancer of epithelium
- cancer of epithelium without invading the basement membrane
- cancer of non epithelial tissues (mesenchymal)
What are the factors considered when grading a tumor?
degree of anaplasia, size of nucleus, number of mitoses, chromatin content, nucleoli and nuclear : cytoplasm ratio
* Low “stage” tumors are the localized tumors. Higher stage is for the spread tumors
What does each of the following tumor markers indicate:
- alpha fetoprotein (AFP)
- hCG
- CA 125
- Carcinoembryonic antigen (CEA)
- Prostatic acid phosphatase
- hepatoma, teratoma (an encapsulated tumor with tissue or organ components resembling normal derivatives of all three germ layers), testes tumor
- choriocarcinoma, hydatidiform mole (pregnancy of non-viable fertilized egg), germinoma (germ cell tumor, not differentiated)
- ovarian cancer
- ulcerative colitis, carcinoma of the lung, and smokers (without tumor)
- prostate cancer extending outside the capsule
- Carcinoid tumors produce
- Oat cell tumors of the lung produce
- Squamous cell carcinoma of the lung produces
- 5hydroxyindoleacetic acid (5-HIAA) which is a serotonin derivative
- ADH & ACTH
- PTH
* Carcinoid tumor is tumor of neuroendocrine system. Common sites are the gut and the respiratory tract
What are the routes for cancer metastasis?
- Body cavities, where tumor cells is seeded in fluids (ascites, pleural effusion)
- Hematogenous: common for all types of cancers, with the lung being the target
- Lymphatic spread: common for epithelial carcinomas
- Transplantation: via mechanical manipulation (needle tracts, surgical incision).. Rare
Somatic mutation is …..
mutations after germ cell line maturation. Usually monoclonal
* Occur in any cell in the body, except germ cells, so they can’t be passed to the offspring
Malignant transformation from viral infection is possible. T/F??
True
* Hepatitis B genome has been found in heptoma cells
Direct acting chemical mutagens are …..
mutagens causing direct alteration by modifying DNA (e.g alkylating agents)
Procarcinogens are ……. and they require …..
chemicals requiring metabolic conversion before becoming active.
- They require an initiating agent and a promoter
- Cell exposure to the initiating agent causes irreversible cellular change
- The promoter just increases the rate tumor progress
UV radiation produces ……, while ionizing radiation causes ……..
- pyrimidine dimers in DNA
* chain breaks in the nucleic acids
Oncogenic viruses either have …… or ……
- reverse transcriptase, to produce DNA from viral RNA
- DNA, like papovavirus, adenovirus & herpes virus
* Adenovirus causes upper respiratory tract infections, conjunctivitis, tonsilitis
Immune system dysfunction may cause tumors by …..
loss of cellular surveillance mechanism which inhibit neoplastic cells via recognition of non-self antigens
Lead poisoning (plumbism) can be caused by …….
- contaminated water
- ingesting lead based paint chips
- inhaling highway exhaust
- chewing on painted furniture or pencils
Lead inhibits …..
- hemoglobin synthesis
2. adenylate cyclase activity in the brain and pancreas
Lead poisoning causes ……
- anemia (hypochromic & hypocytic, with RBC stippling)
- encephalopathy (edema, demyelination, delirium, seizures & coma) & peripheral neuropathy (the radial nerve is the most often affected leading to wrist drop)
- renal lesion (Fanconi syndrome): excretion of glucose, aminoacids, phosphate & bicarbonate. Affects the PCT
- Abdominal colics
- Lead lines (in the gums) & epiphyseal radiodensities on Xray
Carbon monoxide blood is ……
cherry red
What are the symptoms of acetaminophen poisoning?
nausea, vomiting, abdominal pain, shock
* Hepatic failure is evident 2-6 days after ingestion of large dose
Salicylates poisoning is characterized by …..
- respiratory alkalosis (due to hyperstimulation of the respiratory center)
- Metabolic acidosis (in large doses, due to accumulation of acids in the blood) & gastritis
- Vomiting, which leads to dehydration
- Petechiae, systemic hemorrhage
Mercury poisoning is caused by ….. , what are the types ??
inhalation of mercury gas
* Mercury inactivates cytochrome oxidase, and damages cell membranes
- acute: necrosis of gastric and colonic epithelium, renal necrosis
- chronic: excessive salivation, gingivitis, gastritis, basement membrane thickening, cerebral & cerebellar atrophy
Triosomy 21 is ……
What are the features?
Down’s syndrome
- epicanthal folds, oblique palpebral fissures
- flat nasal bridge, hypotonia
- horizontal palmar crease
- increaesd incidence of VSD and acute lymphoblastic leukemia (ALL)
- Neurologic changes similar to Alzheimer
Triosomy 18 is ……
What are the features?
Edward’s syndrome
- Rocker bottom feet
- mental retardation
- micrognathia, prominent occipit, low set ears
- Life span is about 3 months
Triosomy 13 is ……
What are the features?
Patau syndrome
- microcephaly, mental retardation
- cleft lip & palate
- VSD, dextrocardia*, polydactyly
- Death in neonatal period
* Dextrocardia: heart is situated on the right side of the body
Cri du chat syndrome is ……
What are the features?
deletion of the short arm of chromosome 5
- cat like cry up to 1 year
- microcephaly, mental retardation, epicanthal folds
- 1 out of 4 have VSD
- Patient may live to adulthood
DiGeorge syndrome is …..
What are the features?
Absence of parathyroid and thymus, caused by deletion of chromosome 22q11 during development (the result is a defect in the third and fourth pharyngeal pouches)
* Causes cardiovascular abnormalities with low set ears
Klinefelter syndrome is …..
disorder of sex chromosome
- karyotype 47,XXY
- Features: testicular atrophy, sterility, small penis, gynecomastia
- Failure of developing secondary sexual characteristics
Turner syndrome is ……
disorder of sex chromosome
- karyotype is 45,XO
- Features: webneck, short stature, broad chest, low hairline, primary amenorrhea with infertility
- Coarctation of the aorta
- Streak ovaries (leads to decreased estrogen & inhibin, which result in high plasma FSH level)
The major copper carrier protein in the blood is …..
Ceruloplasmin
Hemosiderin is derived from …., and is identified by ……
heme, Prussian blue stain
* Iron accumulates in macrophages. Seen after tissue trauma, bone marrow, liver, spleen
Ceroid is derived from …… and occurs after …..
lipofuscin (accumulates in Kuppfer cells)
hepatocellular injury
Hemochromatosis is …..
accumulation of iron throughout the body
* caused by increase iron intake, low iron usage, repeated blood transfusions, hemolytic anemia
Eggshell calcification occurs in …..
the inside of thoracic lymph node, usually in silicosis
* Detected by X ray
Pyknosis means ……
nuclear shrinkage and chromatin condensation
External bevel gingivictomy heal by ……
secondary intention
