ICS Overview Flashcards
Tumour grading, what do stages 1, 2 and 3 mean?
1- Well differentiated
2- Moderately differentiated
3- Poorly differentiated
(how well it resembles original histology)
Name 5 causes of acute inflammation
Microbial infection
Hypersensitivity
Trauma/ Heat/ Cold
Chemical irritants
Bacterial toxins
Ischaemic necrosis
How does acute inflammation present? [5]
Rubor-redness
Calor-heat
Tumour-swelling
Dolor-pain
Loss of function
Carcinogens:
Asbestos causes …….
HPV causes……
UV causes …..
EBV causes …..
Rubber causes ……
Soot causes ……
Asbestos causes mesothelioma
HPV causes cervical cancer
UV causes skin cancer
EBV causes Burkitt’s lymphoma
Rubber causes bladder cancer
Soot causes scrotal cancer
Define apoptosis
Non-inflammatory, programmed and defined sequence of intracellular events leading to remove of a cell without release of harmful products
What are the 4 possible outcomes of acute inflammation?
Resolution
Supparation
Organisation
Progression
Intrinsic pathway of apoptosis:
BAX acts on […] to promote […] release. This activates […] which results in apoptosis.
BAX acts on mitochondrial membrane to promote cytochrome c release. This activates CASPASES which results in apoptosis.
Bax and Bak are members of the Bcl-2 family and core regulators of the intrinsic pathway of apoptosis. Upon apoptotic stimuli, they are activated and oligomerize at the mitochondrial outer membrane (MOM) to mediate its permeabilization, which is considered a key step in apoptosis. Cytochrome c is one of the mitochondrial proteins that is released into the cytosol when the cell is activated by an apoptotic stimulus.
Caspases are a family of endoproteases that provide critical links in cell regulatory networks controlling inflammation and cell death.
Arterial thrombosis:
It begins with an […] that may have a fatty streak. It grows and […]. This causes […] in the intima. This causes […] and […]. RBCs get trapped in fibrin mesh. More protrusion, more disruption, more platelets, positive feedback.
Arterial thrombosis:
It begins with an atheromatous plaque that may have a fatty streak. It grows and disrupts flow. This causes cell death in the intima. This causes fibrin deposition and platelet clumping. RBCs get trapped in fibrin mesh. More protrusion, more disruption, more platelets, positive feedback.
Name 2 inducers of apoptosis
Glucocorticoids
Free radicals
Ionising radiation
DNA damage
What is the goal of Ca channel blockers and how is it achieved?
Give an example of one!
Anti-hypertensive by decreasing Ca available to heart muscles, therefore decreases ionotropy
Amlodipine, Verapamil
DOACs, what does it stand for?
Give an example of one!
How do they work?
Direct oral anti-coagulants
apiXaban, rivaroXaban
They act on active clotting factor X (10)
Very briefly, what do ACE inhibitors aim to do and how do they achieve it?
Give an example of one!
Anti-hypertensive via inhibiting ACE and therefore RAAS system which aims to retain water
Ramipril
What do B2 agonists do?
Give an example and what it treats!
Bronchodilation
SABAs (salbutamol) for COPD
What immune cells are involved in acute inflammation?
neutrophils and monocytes
What’re the 2 main routes of drug administration?
Systemic and Local
What is alteplase used to treat?
Ischaemic strokes
What do B1 agonists do?
Give an example of one and what it treats!
Increase ionotropy and chronotropy of the heart (force and HR)
Dobutamine?
Treats cardiogenic shock
Outcomes of Acute Inflammation, Organisation:
This is when the site is replaced by […] tissue. New […] grow in the exudate, […] migrate and […] occurs.
Outcomes of Acute Inflammation, Organisation:
This is when the site is replaced by granulation tissue. New capillaries grow in the exudate, macrophages migrate and fibrosis occurs.
Connective tissue tumours: What tissue do these involve?
Lipoma
Rhabdomyoma
Leiomyoma
Chrondroma
Osteoma
Angioma
Neuroma
Adipocytes
Striated muscle
Smooth muscle
Cartilage
Bone
Vascular
Nerves
What is the main symptom of opioid overdose?
How is opioid overdose treated?
What is the route of administration?
Respiratory depression
Treated with naloxone intravenously
Name 3 complications of athersclerosis!
Cerebral infarct
MI
Peripheral Vascular Disease
Carotid atheroma-> TIAs
Aortic aneurysm
Gangrene
What’re the 3 parts of Virchow’s Triad? Name 3 examples for each!
Reduction in blood flow- Atrial Fib, Varicose, Immobility, Ventric/venous insuff., Venous obstruction i.e pregnant
Blood vessel injury- Trauma, Surgery, Hypertension, Invasive procedures, Nicotine
Increased coaguability- Sepsis, Smoking, Malignancy, Coagulation disorders, Liver damage
Extrinsic pathway of apoptosis:
[…] or […] binds to CSM receptors. This results in […] activation and therefore apoptosis.
Extrinsic pathway of apoptosis:
FASL or TNF-L binds to CSM receptors. This results in caspase activation and therefore apoptosis.
Fas and FasL are both members of the tumour necrosis factor (TNF) family; Fas is part of the transmembrane receptor family and FasL is part of the membrane-associated cytokine family. When the homotrimer of FasL binds to Fas, it causes Fas to trimerize and brings together the death domains (DD) on the cytoplasmic tails of the protein.
In non-competitive inhibition, the curve shifts […]. The drug has […] affinity, […] efficacy, its […] potent, and the EC50 is […].
Can a maximal response be achieved with a high enough drug dose? […]
In non-competitive inhibition, the curve shifts down and right. The drug has less affinity, less efficacy, its less potent, and the EC50 is decreased.
Can a maximal response be achieved with a high enough drug dose? NO
NO because some receptors are MIA and can’t be used to achieve max response
Carcinomas tend to metastasise via […]
Sarcomas tend to metastasise via […]
Carcinomas tend to metastasise via lymphatics
Sarcomas tend to metastasise via haematogenous spread
Carcinoma~ skin/ cells lining internal organs (epithelial)
Sarcoma~ connective tissue (fat/ blood vessles/ nerves/ bones/ muscles)
What cancer never metastasises?
Basal cell carcinoma
Why doesn’t atheroma occur in veins?
lower blood pressure
Name 5 causes of chronic inflammation and an example for each!
Resisting infecting agent- TB
Endogenous material- Necrosis tissue
Exogenous material- Asbestos
Autoimmune disease- Rheumatoid
Prim. granulomatous disease- Crohn’s
Transplant rejection
Metastasis:
It begins with […] from primary tumour. Then […] into vessel lumens. Whilst in the blood it evades […]. It then […] at a remote location. From here […] occurs, allowing it to exit the vessel into new tissue. The tumour then proliferates.
It begins with detachment from primary tumour. Then intravasation into vessel lumens. Whilst in the blood it evades the host’s defence. It then adheres to endothelium at a remote location. From here extravasation occurs, allowing it to exit the vessel into new tissue. The tumour then proliferates.
Define atrophy and give an example of it!
No. or size of cells decreases
In diseases like ALS
Define hyperplasia and give an example of it!
Increased no. of cells (via mitosis)
Bone marrow hyperplasia in those living at high altitude
In competitive inhibition, the drug has […] afffinity, […] efficacy, […] EC50 and the drug is […] potent.
Will the response eventually be maximal if the drug dose is increased enough? […]
In competitive inhibition, the drug has less afffinity, the same efficacy, the same EC50 and the drug is less potent.
Will the response eventually be maximal if the drug dose is increased enough? YES
Define metaplasia and give an example of it!
Change from one cell type to another
Barret’s Eosophagus
(squamous epi. to columnar epi.)
Define thrombosis
Solidification of blood contents in vascular system throughout life
Small emboli may cause […].
Large emboli can cause acute […] [2] problems which present as […] [2].
Massive emboli are often caused by […]
Small emboli may cause idiopathic pulmonary hypertension.
Large emboli can cause acute resp/cardio [2] problems which present as chest pain and shortness of breath [2].
Massive emboli are often caused by long thrombi in leg veins.
If a tumour is malignant, what prefix/ suffix is it given?
Sarcoma
What is a carcinoma?
Malignant or benign?
Tumour of epithelial cells
Malignant
Arterial vs Venous Thrombosis:
Cause?
BP?
Main Constituent?
Complications [2]?
Treatments+i.e?
Atheroma vs Stasis
High vs Low
Platelets vs RBCs
MI/Stroke vs DVT/PE
Anti-platelets (aspirin) vs anti-coagulants (warfarin)
What are the 5 type of blood thinners
DOACs (direct oral anticoag)
Warfarin
LMWH
Alteplase
Antiplatelets
LMWH (blood thinners), what does it stand for?
How do they work?
Low molecular weight heparin
Inhibits clotting factors 3 and 10
When are beta blockers contraindicated?
Absolute asthma in patient
What are the treatments for paracetamol overdose? How does this combination work?
Activated charcoal then acetylcystine
Activated charcoal lines the stomach to protect it, then acetylcystine mops up the paracetamol/toxic products
Benign vs Malignant tumours:
Invade BM?
Exo/Endophytic?
Mitotic activity?
Circumscribed?
Necrosis & Ulceration?
Resemblance to norm tissue?
No vs Yes
Exo vs Endo
Low vs High
Well vs Poorly
Rare vs Common
High vs Low
Outcomes of Acute Inflammation, Supparation:
This is when […] forms and is enveloped by a […] membrane. There may also be scarring.
Outcomes of Acute Inflammation, Supparation:
This is when pus forms and is enveloped by a pyogenic membrane. There may also be scarring.
What is a granuloma?
3 diseases that cause them?
An aggregrate of epithelioid histocytes (Macrophages that mimic epithelial cells and form tight cell junctions)
TB, Leprosy, Crohn’s & Sarcoidosis
What is a mural thrombus?
One that attaches to vessel wall (large like aorta) or cardiac chambers
Define infarction
Cell death caused by ischaemia
Apoptosis vs Necrosis
Inflammatory?
Organelles go where?
CSM status?
Chromatin status?
No vs Yes
Stay in cell vs Splurge out
Intact vs Damaged
Unaltered vs Altered
What is a carcinogen
An environmental agent participating in the cause of tumours
Acute inflammation:
Vasodilation results in increased blood volume and vascular […]. This results in the formation of a cellular exudate which leads to emigration of […]. Initially, they arrive at the site due to […] plasma viscosity and […] blood flow. Then they […] in […], this is called pavementing. From here they exit the vessel and enter surrounding tissue. Diapedesis may occur, this is a […] process indicative of […].
Vasodilation results in increased blood volume and vascular permeability. This results in the formation of a cellular exudate which leads to emigration of neutrophil polymorphs. Initially, they arrive at the site due to increased plasma viscosity and slower blood flow. Then they adhere to endothelium in venules, this is called pavementing. From here they exit the vessel and enter surrounding tissue. Diapedesis may occur, this is a passive process indicative of severe vascular injury.