Patho First Aid Flashcards by ricardo rangel

What is occurring? Activation of cytotoxic caspases that mediate cellular breakdown. Char. by deeply eosinophilic cytoplasm, cell shrinkage, and basophilia. DNA laddering is a sensitive indicator; during karyorrhexis, endonucleases cleave at internucleosomal regions, yielding 180-bp fragments.

Apoptosis

How well did you know this?

Not at all

Perfectly

This process involves tissue remodeling in embryogenesis. Increase in BAX and a decrease in Bcl triggers this.

Intrinsic pathway

How well did you know this?

Not at all

Perfectly

This factor prevents cytochrome c release by binding to and inhibiting Apaf-1. If it is over expressed (e.g. follicular lymphoma) then Apaf-1 is overly inhibited leading to decreased caspase activation and tumorgenesis.

Bcl-2

How well did you know this?

Not at all

Perfectly

2 pathways: Ligand receptor interactions (FasL binding to Fas [CD95]). 
Immune cell (cytotoxic T-cell release of perforin and granzyme B). After Fas crosslinks with FasL, multiple Fas molecules coalesce, forming a binding site for a death domain-containing adapter protein, FADD (which binds inactive caspases, activating them).

Extrinsic pathway.

Defective Fas-FasL interaction is the basis for autoimmune disorders (thymic medullary negative selection).

How well did you know this?

Not at all

Perfectly

Enzymatic degradation and protein denaturation of a cell resulting from exogenous injury. Intracellular components leak; inflammatory process. Heart, liver, kidney; occurs in tissues supplied by end-arteries; increase in cytoplasmic binding of acidophilic dye. Proteins denature first, followed by enzymatic degradation.

Necrosis- Coagulative

How well did you know this?

Not at all

Perfectly

Enzymatic degradation and protein denaturation of a cell resulting from exogenous injury. Intracellular components leak; inflammatory process. Brain, bacterial abscess; occurs in CNS due to high fat content. In this case, enzymatic degradation is due to the release of lysosomal enzymes.

Necrosis - Liquefaction

How well did you know this?

Not at all

Perfectly

Enzymatic degradation and protein denaturation of a cell resulting from exogenous injury. Intracellular components leak; inflammatory process. TB, systemic fungi, Nocardia.

Necrosis - Caseous

How well did you know this?

Not at all

Perfectly

Enzymatic degradation and protein denaturation of a cell resulting from exogenous injury. Intracellular components leak; inflammatory process. Enzymatic (pancreatitis [saponification]) and nonenzymatic (e.g. breast trauma); calcium deposits appear dark blue on staining.

Necrosis - Fatty

How well did you know this?

Not at all

Perfectly

Enzymatic degradation and protein denaturation of a cell resulting from exogenous injury. Intracellular components leak; inflammatory process. Vasculitis (e.g. Henoch-Schönlein purpura, Churg-Strauss syndrome), malignant hypertension; amorphous and pink on H&E.

Necrosis- Fibrinoid

How well did you know this?

Not at all

Perfectly

Enzymatic degradation and protein denaturation of a cell resulting from exogenous injury. Intracellular components leak; inflammatory process. Dry (ischemic coagulative) and wet (infection); common in limbs and GI tract.

Necrosis - Gangrenous

How well did you know this?

Not at all

Perfectly

What is occurring? ATP depletion, cellular/mitochondrial swelling (decr. ATP–> decr. activity of Na+/K+ pumps); nuclear chromatin clumping. Decreased glycogen; fatty change. Ribosomal/polysomal detachment (decr. protein synthesis); membrane blebbing.

Cell injury that is reversible with O2.

How well did you know this?

Not at all

Perfectly

What is occurring? Nuclear pyknosis, karyorrhexis, karyolysis; Plasma membrane damage (degradation of membrane phospholipid). Lysosomal rupture. Mitochondrial permeability/vacuolization; phospholipid-containing amorphous densities within mitochondria (swelling alone is reversible).

Cell injury with irreversible damage.

How well did you know this?

Not at all

Perfectly

What is the difference between a red and pale infarct?

Red infarcts-occurs in tissues that have multiple blood supplies (like the liver, lungs, and intestines), thus having reperfusion readily available.

Pale infarcts - occurs in solid tissues with a single arterial blood supply, such as the heart, kidney, and spleen.

How well did you know this?

Not at all

Perfectly

Reduction in the size and/or number of cells. Causes include: Decr. in endogenous hormones (e.g. post-menopausal ovaries), incr. exogenous hormones (e.g. factitious thyrotoxicosis, steroid use), decr. blood flow/nutrients, decr. metabolic demand (paralysis), incr. pressure (nephrolithiasis), occlusion of secretory ducts (cystic fibrosis).

Atrophy

How well did you know this?

Not at all

Perfectly

What is characterized by: rubor (redness), dolor (pain), calor (heat), tumor (swelling), and functio laesa (loss of function)?

Inflammation

How well did you know this?

Not at all

Perfectly

What is occurring? Neutrophil, eosinophil, and antibody mediated. Rapid onset (seconds to minutes), lasts minutes to days. Outcomes include complete resolution, abscess formation, and progression to chronic…

Acute inflammation

How well did you know this?

Not at all

Perfectly

What is occurring? Mononuclear cell and fibroblast mediated; characterized by persistent destruction and repair. Associated with blood vessel proliferation, fibrosis. Granuloma: nodular collections of epitheloid macrophages and giant cells. Outcomes include scarring and amyloidosis.

Chronic inflammation

How well did you know this?

Not at all

Perfectly

This process involves the cell body following axonal injury. Changes reflect incr. protein synthesis in effort to repair the damaged axon. Characterized by round cellular swelling, displacement of the nucleus to the periphery, dispersion of Nissl substance throughout cytoplasm.

Chromatolysis

How well did you know this?

Not at all

Perfectly

Calcium deposition in tissues secondary to necrosis. Tends to be localized (e.g. on heart valves). Seen in TB (lungs and pericardium), liquefaction necrosis of chronic abscess, fat necrosis, infarcts, thrombi, schistosomiasis, Mönckberg arteriosclerosis, congenital CMV + toxoplasmosis, psammoma bodies. Not directly assoc. with hypercalcemia (Px are normocalcemic).

Dystrophic calcifications

How well did you know this?

Not at all

Perfectly

Widespread deposition of calcium in normal tissues secondary to hypercalcemia (e.g. 1*hyperparathyroidism, sarcoidosis, hypervitaminosis D) or high calcium-phosphate product (chronic renal failure, long term dialysis). Calcium deposits predominantly in interstitial tissues of kidney, lungs, and gastric mucosa (these tissues lose acid quickly; incr. pH favors deposition). Px usually not normocalcemic.

Metastatic calcification

How well did you know this?

Not at all

Perfectly

What process is occurring?

Margination and rolling
Tight-binding.
Diapedesis- leukocyte travels between endothelial cells and exits blood vessels.
Migration- leukocyte travels through interstitium to site of injury or infection guided by chemotactic signals.

Leukocyte extravasation

How well did you know this?

Not at all

Perfectly

Collagen arrangement: parallel vs. disorganized
Extent: confined to borders of original wound vs. extend beyond borders of original wound.
Recurrence: infrequently recur following resection vs. frequently recur following resection.

Scar formation: hypertrophic vs. keloid scars

How well did you know this?

Not at all

Perfectly

What describes macrophages with granular yellow-brown “wear and tear” pigment associated with normal aging. Formed by oxidation and polymerization of autophagocytosed organellar membranes. Autopsy of elderly person will reveal deposits in heart, liver, kidney, eye, and other organs.

Lipofuscin

How well did you know this?

Not at all

Perfectly

Tumor nomenclature that denotes mesenchymal origin and implies malignancy.

Sarcoma

How well did you know this?

Not at all

Perfectly

Tumor nomenclature that describes epithelial origin. It implies malignancy. Usually it spreads lymphatically and includes renal vein, hepatic vein.

Carcinoma

What is the associated neoplasm with this condition: Acanthosis nigricans (Hyperpigmentation and epidermal thickening)?

Visceral malignancy (esp. stomach)

What is the associated neoplasm with this condition: Actinic keratosis

Squamous cell carcinoma of the skin

What is the associated neoplasm with this condition: AIDS

Aggressive malignant lymphomas (non-Hodgkin) and Kaposi sarcoma.

What is the associated neoplasm with this condition: Autoimmune diseases (e.g. Hashimoto thyroiditis, SLE)

Lymphoma

What is the associated neoplasm with this condition: Barrett esophagus (chronic GI reflux)

Esophageal adenocarcinoma

What is the associated neoplasm with this condition: Chronic strophic gastritis, pernicious anemia, postsurgical gastric remnants.

Gastric adenocarcinoma

What is the associated neoplasm with this condition: Cirrhosis

Hepatocellular carcinoma

What is the associated neoplasm with this condition: Cushing's Syndrome

Small cell lung cancer

What is the associated neoplasm with this condition: Dermatomyositis

Lung cancer

What is the associated neoplasm with this condition: Dysplastic Nevus

Malignant melanoma

What is the associated neoplasm with this condition: Hypercalcemia

Squamous cell lung cancer

What is the associated neoplasm with this condition: Immunodeficiency states

Malignant lymphomas

What is the associated neoplasm with this condition: Lambert-Eaton myasthenic syndrome

Small cell lung cancer

What is the associated neoplasm with this condition: Myasthenia Gravis, pure RBC aplasia

Thymoma

What is the associated neoplasm with this condition: Paget disease of bone

Secondary osteosarcoma and fibrosarcoma

What is the associated neoplasm with this condition: Plummer-Vinson syndrome (decr. iron)

Squamous cell carcinoma of the esophagus

What is the associated neoplasm with this condition: Polycythemia

Renal cell carcinoma, hepatocellular carcinoma

What is the associated neoplasm with this condition: Radiation exposure

Leukemia, sarcoma, papillary thyroid cancer,and breast cancer

What is the associated neoplasm with this condition: SIADH

Small cell lung cancer

What is the associated neoplasm with this condition: Tuberous sclerosis (facial angiofibroma, seizures, intellectual disability)

Giant cell astrocytoma, renal angiomyolipoma, and cardiac rhabdomyoma.

What is the associated neoplasm with this condition: Ulcerative colitis

Colonic adenocarcinoma

What is the associated neoplasm with this condition: Xeroderma pigmentosum, albinism

Melanoma, basal cell carcinoma, and especially squamous cell carcinomas of skin.

Weight loss, muscle atrophy, and fatigue that occur in chronic disease (e.g. cancer, AIDS, heart failure, TB). Mediated by TNF-gamma, and IL-6.

Cachexia

What describes the condition in where there is the abnormal aggregation of proteins (or their fragments) into beta-pleated sheet structures. --> damage and apoptosis.

Amyloidosis

Deposition of proteins from Ig light chains. Can occur as a plasma cell disorder or associated with multiple myeloma. Often affects multiple organ systems, including renal (nephrotic syndrome), cardiac (restrictive cardiomyopathy, arrhythmia), hematologic (easy bruising), GI (hepatomegaly), and neurologic (neuropathy).

Amyloidosis- AL (primary)

Seen with chronic conditions, such as rheumatoid arthritis, IBD, spondyloarthropathy, protracted infection, fibrils composed of serum Amyloid A. Often multisystem like AL amyloidosis.

Amyloidosis- AA (secondary)

Fibrils composed of B2-microglobulin in Px with ESRD and/or on long-term dialysis. May present as carpal tunnel syndrome.

Dialysis related amyloidosis

Due to deposition of normal (wild-type) TTR in myocardium and other sites. Slower progression of cardiac dysfunction relative to AL amyloidosis.

Age-related (senile) systemic amyloidosis

Amyloid deposition localized to a single organ. Most important form is amyloidosis in Alzheimer disease due to deposition of amyloid-beta protein cleaved from amyloid precursor protein (APP). Islet amyloid polypeptide (IAPP) is commonly seen in diabetes mellitus type 2 and is caused by deposition of amylin in pancreatic islets.

Organ-specific amyloidosis

What is this describing? Protein-rich, cellular, specific gravity >1.020 Due to: Lymphatic obstruction, inflammation/infection, malignancy. Thick.

Exudate

What is this describing? Protein poor, hypo-cellular, specific gravity <1.012 Due to: increased hydrostatic pressure (e.g. CHF), decreased oncotic pressure (e.g. cirrhosis), Na+ retention. Thin.

Transudate

Reversible--> Abnormal growth with loss of cellular orientation, shape, and size in comparison to normal tissue maturation; commonly preneoplastic.

Dysplasia

Irreversible--> Loss of structural differentiation and function of cells, resembling primitive cells of same tissue; often equated with undifferentiated malignant neoplasms. May see "giant cells" with single large nucleus or several nuclei.

Anaplasia

Type of tumor: benign epithelium

Adenoma, papilloma

Type of tumor: benign blood vessels

Hemangioma

Type of tumor: benign Smooth Muscle

Leiomyoma

Type of tumor: benign Striated Muscle

Rhabdomyoma

Type of tumor: benign connective tissue

Fibroma

Type of tumor: benign Bone

Osteoma

Type of tumor: benign fat

Lipoma

Type of tumor: malignant epithelium

Adenocarcinoma, papillary carcinoma

Type of tumor (mesenchymal): malignant blood cells

Leukemia, lymphoma

Type of tumor (mesenchymal): malignant blood vessels

Angiosarcoma

Type of tumor (mesenchymal): malignant smooth muscle

Leiomyosarcoma

Type of tumor (mesenchymal): malignant connective tissue

Fibrosarcoma

Type of tumor (mesenchymal): malignant Bone

Osteosarcoma

Type of tumor (mesenchymal): malignant Fat

Liposarcoma

Oncogenes: Gain of function --> Increased cancer risk. Need damage to only 1 allele. Oncogene: BCR-ABL. Gene product: tyrosine kinase

Associated tumor: CML, ALL

Oncogenes: Gain of function --> Increased cancer risk. Need damage to only 1 allele. Oncogene: bcl-2 Gene product: anti-apoptotic molecule (inhibits apoptosis).

Associated tumor: Follicular and undifferentiated lymphomas

Oncogenes: Gain of function --> Increased cancer risk. Need damage to only 1 allele. Oncogene: BRAF. Gene product: serine/threonine kinase

Associated tumor: Melanoma

Oncogenes: Gain of function --> Increased cancer risk. Need damage to only 1 allele. Oncogene: c-kit Gene product: cytokine receptor (for stem cell factor)

Associated tumor: Gastrointestinal stromal tumor (GIST)

Oncogenes: Gain of function --> Increased cancer risk. Need damage to only 1 allele. Oncogene: c-myc Gene product: Transcription factor

Associated tumor: Burkitt lymphoma

Oncogenes: Gain of function --> Increased cancer risk. Need damage to only 1 allele. Oncogene: HER2/neu (c-erbB2) Gene product: Tyrosine kinase

Associated tumor: Breast, ovarian, and gastric carcinomas

Oncogenes: Gain of function --> Increased cancer risk. Need damage to only 1 allele. Oncogene: L-myc Gene product: transcription factor

Associated tumor: Lung tumor

Oncogenes: Gain of function --> Increased cancer risk. Need damage to only 1 allele. Assoc. with overexpression Of ocogene: N-myc Gene product: transcription factor

Associated tumor: Neuroblastoma

Oncogenes: Gain of function --> Increased cancer risk. Need damage to only 1 allele. Oncogene: ras Gene product: GTPase

Associated tumor: colon cancer, lung cancer, pancreatic cancer

Oncogenes: Gain of function --> Increased cancer risk. Need damage to only 1 allele. Oncogene: ret Gene product: Tyrosine kinase

Associated tumor: MEN 2A and 2B

Tumor suppressor genes: Loss of function--> Incr. cancer risk; both alleles must be lost for expression of disease. Gene: APC Gene product: (none)

Associated tumor: colorectal cancer (associated with FAP).

Tumor suppressor genes: Loss of function--> Incr. cancer risk; both alleles must be lost for expression of disease. Gene: BRCA1 and BRCA2 Gene product: DNA repair protein

Associated tumor: Breast and ovarian cancer

Tumor suppressor genes: Loss of function--> Incr. cancer risk; both alleles must be lost for expression of disease. Gene: CPD4/SMAD4 Gene product: DPC deletion

Associated tumor: Pancreatic cancer

Tumor suppressor genes: Loss of function--> Incr. cancer risk; both alleles must be lost for expression of disease. Gene: DCC Gene product: DCC deletion

Associated tumor: Colon cancer

Tumor suppressor genes: Loss of function--> Incr. cancer risk; both alleles must be lost for expression of disease. Gene: MEN1 Gene product: (none)

Associated tumor: MEN type 1

Tumor suppressor genes: Loss of function--> Incr. cancer risk; both alleles must be lost for expression of disease. Gene: NF1 Gene product: RAS GTPase activating protein (neurofibromin)

Neurofibromatosis type 1

Tumor suppressor genes: Loss of function--> Incr. cancer risk; both alleles must be lost for expression of disease. Gene: NF2 Gene product: Merlin (schwannomin) protein

Associated tumor: Neurofibromatosis type 2

Tumor suppressor genes: Loss of function--> Incr. cancer risk; both alleles must be lost for expression of disease. Gene: p16 Gene product: Cyclin-dependent kinase inhibitor 2A

Associated tumor: Melanoma

Tumor suppressor genes: Loss of function--> Incr. cancer risk; both alleles must be lost for expression of disease. Gene: p53 Gene product: Transcription factor for p21, blocks G1-->S phase

Associated tumor: most human cancers, Li-Fraumeni syndrome

Tumor suppressor genes: Loss of function--> Incr. cancer risk; both alleles must be lost for expression of disease. Gene: PTEN Gene product: ---

Associated tumor: Breast cancer, prostate cancer, endometrial cancer

Tumor suppressor genes: Loss of function--> Incr. cancer risk; both alleles must be lost for expression of disease. Gene: Rb Gene product: Inhibits EF2; blocks G1--> S phase

Associated tumor: Retinoblastoma, osteosarcoma

Tumor suppressor genes: Loss of function--> Incr. cancer risk; both alleles must be lost for expression of disease. Gene: TSC1 Gene product: Hamartin protein

Associated tumor: Tuberous sclerosis

Tumor suppressor genes: Loss of function--> Incr. cancer risk; both alleles must be lost for expression of disease. Gene:TSC2 Gene product: Tuberin protein

Associated tumor: Tuberous sclerosis

Tumor suppressor genes: Loss of function--> Incr. cancer risk; both alleles must be lost for expression of disease. Gene: VHL Gene product: Inhibits hypoxia inducible factor 1a

Associated tumor: Von Hippel-Lindau disease

Tumor suppressor genes: Loss of function--> Incr. cancer risk; both alleles must be lost for expression of disease. Gene: WT1 and WT2 Gene product:---

Associated tumor: Wilms Tumor (nephroblastoma)

Tumor markers- may be used to monitor tumor recurrence and response to therapy, but not for Dx. --> metastasis to bone, liver, Paget disease of bone, seminoma (placental ALP).

Tumor marker: Alkaline phosphatase

Tumor markers- may be used to monitor tumor recurrence and response to therapy, but not for Dx. --> Normally made by fetus. Hepatocellular carcinoma, hepatoblastoma, yolk sac (endodermal sinus) tumor, testicular cancer, mixed germ cell tumor (co-secreted with beta-hCG).

Tumor marker: Alpha-fetoprotein

Tumor markers- may be used to monitor tumor recurrence and response to therapy, but not for Dx. --> hydatidiform moles and choriocarcinomas (gestational trophoblastic disease), testicular cancer. Assoc. with pregnancy.

Tumor marker: beta-hCG

Tumor markers- may be used to monitor tumor recurrence and response to therapy, but not for Dx. --> breast cancer

Tumor marker: CA-15-3/CA-27-29

Tumor markers- may be used to monitor tumor recurrence and response to therapy, but not for Dx. --> Pancreatic adenocarcinoma

Tumor marker: CA-19-9

Tumor markers- may be used to monitor tumor recurrence and response to therapy, but not for Dx. --> Ovarian cancer

Tumor marker: CA-125

Tumor markers- may be used to monitor tumor recurrence and response to therapy, but not for Dx. --> Medullary thyroid carcinoma

Tumor marker: Calcitonin

Tumor markers- may be used to monitor tumor recurrence and response to therapy, but not for Dx. --> Very nonspecific but produced by ~70% of colorectal and pancreatic cancers; also produced by gastric, breast, and medullary thyroid carcinomas.

Tumor marker: CEA - Carcinoembryonic Antigen.

Tumor markers- may be used to monitor tumor recurrence and response to therapy, but not for Dx -->Used to follow prostate adenocarcinoma. Can also be elevated in BPH and prostatis. Questionable risk/benefit for screening.

Tumor marker: PSA - prostate specific antigen

Tumor markers- may be used to monitor tumor recurrence and response to therapy, but not for Dx. --> Neural crest Origen (e.g. melanomas, neural tumors, schwannomas, Langerhans cell histiocytosis).

Tumor marker: S-100

Tumor markers- may be used to monitor tumor recurrence and response to therapy, but not for Dx. -->Hairy cell leukemia- a B-cell neoplasm. What is the tumor marker?

Tumor marker: Tartrate-Resistant Acid Phosphate (TRAP)

Irreversible--> A clonal proliferation of cells that is uncontrolled and excessive. Neoplasms may be benign or malignant. These cells are unresponsive to normal regulation of cell division and continue to grow beyond the normal needs of the organism.

Neoplasia

Irreversible--> Fibrous tissue formation in response to neoplasm (e.g. Linitis plastica in diffuse stomach cancer).

Desmoplasia

Reversible --> Increase in the number of cells.

Hyperplasia

Reversible--> One adult cell type is replaced by another. Often secondary to irritation (e.g. Barrett esophagus) and/or environmental exposure (e.g. Smoking induced tracheal/bronchial squamous change).

Metaplasia

An EKG that displays a U waves is demonstrating what imbalance?

Hypokalemia- seen on V2, V3, and V4

Type of collagen required for wound repair? Deficiency in what metal would inhibit collagen reduction.

Collagen 3 is used for wound repair. After a couple of months, zinc is required to reduce it to collagen type 1, thus increasing tensile strength.

What is occurring: basal cell layer proliferates from both sides to go underneath a clot. Key element is granulation tissue. Fibronectin is a very important proteoglycan, adhesion agent, and chemotactic agent involving fibroblasts.

This describes the process of skin healing.

What pathology is associated with a defect in fibrilin (an elastic tissue)?

Ehlers-Danlos - in addition have poor wound healing.

What two AAs are involved in a hydroxylation defect in a Px with scurvy?

Proline and lysine via ascorbic acid.

What is mechanism is responsible for increasing tensile strength in collagen? What effects would,this have on a patient with scurvy?

Crossbridges in the form of a triple helix give tensile strength. These crossbridges anchor to hydroxylated proline and lysine --> thus scurvy patients will have hemorrhaging, hemarthrosis, and poor wound healing.

In a chronically draining sinus tract involving a scar, antibiotics don't seem to work. Ulceration lesion was present at the orifice of this chronically draining tract. What is this?

Squamous cell carcinoma due to a lot of turnover; type 3 collagen converted to type 1, and fibroblasts are involved. A lot of cell division is occurring, which predisposes to mutations and cancer.