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First aid Chs Part 1 > Pathology > Flashcards

Pathology Flashcards

1
Q

what apoptosis pathway is used in tissue remodeling in embryogenesis?

A

Intrinsic pathway

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2
Q

What occurs in the intrinsic pathway?

A

Increased Bax (pro-apoptotic) and decreased Bcl-2 (anti-apoptotic) lead to increased cytochrome C –> activation of cellular caspases

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3
Q

What two methods can activate the Extrinsic apoptotic pathway?

A
  1. ligand receptor interactions - Fas-L with Fas-R (CD 95)

2. cytotoxic T cell releases perforin and granzyme B

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4
Q

Is ribosomal detachment (decreased protein synthesis) an irreversible or a reversible form of cellular injury?

A

reversible with the presence of O2

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5
Q

what electrolyte influx can cause activation of caspases?

A

Calcium influx

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6
Q

what is the real cause of reperfusion injury?

A

damage due to free radicals

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7
Q

what do you get with free radical oxidation of lipids?

A

Lipofuschin - yellow brown granules in the cytoplasm

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8
Q

what are the acute inflammation cytokines?

A

IL-1, IL-6, TNF-alpha

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9
Q

what is the chronic inflammatory cytokine?

A

TNF alpha

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10
Q

what are the possible outcomes of acute inflammation ?

A

Complete resolution, abscess formation, progression to chronic inflammation

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11
Q

what are the possible outcomes of chronic inflammation?

A

Scarring and amyloidosis

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12
Q

what is a granuloma?

A

A form of chronic inflammation; nodular collections of epithelioid macrophages and giant cells

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13
Q

If you have a patient with granulomatous inflammation, what might you want to treat your patient with and why?

A

Infliximab because it blocks TNF-alpha

make sure to do a PPD first! Infliximab can cause reactivation of TB

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14
Q

Is metaplasia reversible or irreversible?

A

Metaplasia is a reversible change where one cell type is replaced by another due to a stressor

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15
Q

Name the 4 steps of leukocyte extravasation.

A
  1. Rolling
  2. Tight binding
  3. Diapedesis (leukocyte travels between endothelial cells and exists blood vessel)
  4. Migration (leukocyte travels through interstitium to site of injury or infection guided by chemotactic signals
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16
Q

What are the chemotactic signals released in response to bacteria?

A

CILK

C5a, Il-8, LTB4, Kallikrein

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17
Q

what induces the selectins on the endothelial cells to make them sticky?

A

IL1, IL6, TNF-alpha

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18
Q

A patient presents with neutrophilia, recurrent bacterial infections, absent pus formation and delayed separation of the umbilical cord. What is the deficiency and what is the defect?

A

This patient has leukocyte adhesion deficiency. The defect is in LFA-1 integrin (CD18) on phagocytes

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19
Q

Name 3 enzymes that can eliminate free radicals

A
  1. catalase
  2. superoxide dismutase
  3. glutathione peroxidase
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20
Q

what 3 vitamins are considered antioxidants?

A

Vitamins A, C, E

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21
Q

What are the 3 phases of wound healing and their time frame?

A
  1. Inflammatory - immediate
  2. Proliferative - 2 to 3 days after wound
  3. Remodeling - 1 week after wound
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22
Q

what are the mediators in the inflammatory phase of wound healing and what are the characteristics?

A

Mediators: Platelets, neutrophils, macrophages

Characteristics: Clot formation, increased vessel permeability and neutrophil migration into tissue; macrophages clear debris 2 days later

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23
Q

What are the mediators in the proliferative phase of wound healing and what are the characteristics?

A

Mediators: Fibroblasts, myofibroblasts, endothelial cells, keratinocytes, macrophages

Characteristics: Deposition of granulation tissue and collagen, angiogenesis, epithelial cell proliferation, dissolution of clot and wound contraction (mediated by myofibroblasts)

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24
Q

what are the mediators in the remodeling phase of wound healing and what are the characteristics?

A

Mediator: Fibroblast

Characteristics: Type III collagen replaced by type I collagen, increased tensile strength of tissue

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25
Q

what induces and maintains granuloma formation?

A

TNF-alpha from macrophages

This is why anti-TNF drugs can cause granuloma break down as a side effect, and lead to disseminated disease

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26
Q

What are the causes of transudate?

A

Increased hydrostatic pressure
decreased oncotic pressure
sodium retention

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27
Q

What is the specific gravity of transudate?

A

<1.012

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28
Q

What are the causes of exudate?

A

lymphatic obstruction

inflammation

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29
Q

What is the specific gravity of exudate?

A

> 1.020

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30
Q

Name 3 conditions that have a decreased ESR.

A
  1. sickle cell disease
  2. polycythemia vera
  3. CHF
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31
Q

What is the mechanism of iron poisoning that causes problems?

A

Cell death due to peroxidation of membrane lipids and generation of free radicals

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32
Q

what symptoms can you see with acute iron poisoning? chronic iron poisoning?

A

Acute - gastric bleeding - hematemesis with abdominal pain or hypovolemic shock

Chronic - metabolic acidosis, scarring leading to FI obstruction

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33
Q

A pathology report shows abnormal aggregation of proteins or their fragments into Beta pleated sheet structures leading to cell damage and apoptosis. The tissue also has a waxy appearance. what is the diagnosis?

A

Amyloidosis

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34
Q

what two growth factors allow for sustained angiogenesis in cancer?

A

vEGF and bFGF (basic fibroblast growth factor)

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35
Q

What is the general neoplastic progression in cancer?

A

Normal to hyperplasia to carcinoma in situ to invasive carcinoma to metastasis

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36
Q

Abnormal proliferation of cells with loss of size, shape and orientation

A

Dysplasia

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37
Q

Describe carcinoma in situ

A
  • neoplastic cells have not invaded basement membrane
  • high nuclear/cytoplasmic ratio and clumped chromatin
  • neoplastic cells encompass entire thickness
38
Q

Increase in the number of cells

A

Hyperplasia

39
Q

one adult cell type is replaced by another (metalastic cells are not atypical and are NOT malignant) often occurs secondary to irritation and/or environmental exposure.

A

Metaplasia

This is reversible

40
Q

Abnormal growth with loss of cellular orientation, shape and size in comparison to normal tissue maturation, commonly pre-neoplastic

A

Dysplasia

This is reversible

41
Q

Abnormal cells lacking differentiation, resemble primitive cells of the same tissue, often equated with undifferentiated malignant neoplasms. Little or no resemblance to tissue of origin

A

Anaplasia

This is irreversible

42
Q

A clonal proliferation of cells that is uncontrolled and excessive. May be benign or malignant.

A

Neoplasia

This is irreversible

43
Q

A fibrous tissue formation in response to a neoplasm

A

Desmoplasia

This is irreversible

44
Q

which has more prognostic value: Stage or grade?

45
Q

what term implies epithelial origin and malignancy of a tumor?

46
Q

What term implies mesenchymal origin and malignancy for a tumor?

47
Q

what three cytokines mediate Cachexia?

A

TNF-alpha (nicknamed cachectin). IFN-gamma and IL6

48
Q

What neoplasms are associated with Down syndrome?

A

ALL and AML

49
Q

What neoplasms are associated with xeroderma pigmentosum and albinism?

A

Melanoma, basal cell carcinoma, and especially squamous cell caricnomas of the skin

50
Q

What neoplasms are associated with chronic atrophic gastritis, pernicious anemia and postsurgical gastric remnants?

A

Gastric adenocarcinoma

51
Q

What neoplasms are associated with tuberous sclerosis (facial angiofibroma - adenoma sebaceum, seizures, MR)?

A

Giant cell astrocytoma, renal angiomyolipoma, and cardiac rhabdomyoma

52
Q

What neoplasm is associated with actinic keratosis?

A

Squamous cell carcinoma of skin

53
Q

What neoplasm is associated with barrets esophagus?

A

Esophadeal adenocarcinoma

54
Q

What neoplasm is associated with plummer-vinson syndrome?

A

Squamous cell carcinoma of the esophagus

55
Q

What neoplasm is associated with cirrhosis

A

HCC - follow AFP

56
Q

What neoplasm is associated with ulcerative colitis?

A

Colonic adenocarcinoma

57
Q

What neoplasm is associated with paget’s disease of the bone?

A

secondary osteosarcoma and fibrosarcoma

58
Q

What neoplasm is associated with immunodeficiency states?

A

malignant lymphomas

59
Q

What neoplasm is associated with AIDS?

A

agressive malignant lymphomas and Kaposi’s sarcoma

60
Q

What neoplasm is associated with autoimmune diseases?

61
Q

What neoplasm is associated with acanthosis nigricans?

A

Visceral malignancy (stomach, lung, uterus)

62
Q

What neoplasm is associated with dysplastic nevus?

A

Malignant melanoma

63
Q

What neoplasms are associated with radiation exposure?

A

Leukemia, sarcoma, papillary thyroid cancer and breast cancer

64
Q

how much damage do you need for an oncogene to reek havoc?

A

need damage to only 1 allele - results in gain of function leading to increased cancer risk

65
Q

How much damage do you need for a tumor suppressor gene to reek havoc?

A

Need damage to both alleles (two hit hypothesis) - results in a loss of function resulting in an increased cancer risk

66
Q

What is the tumor marker PSA used for??

A

Prostate carcinoma

67
Q

What is the tumor marker prostatic acid phosphatase used for?

A

Prostate carcinoma

68
Q

What is the tumor marker CEA used for?

A

colorectal and pancreatic cancer

69
Q

What is the tumor marker AFP used for?

70
Q

What is the tumor marker beta hCG used for?

A

hydatidiform moles and choriocarcinomas

71
Q

what is the tumor marker CA-125 used for?

A

Ovarian cancer

72
Q

What is the tumor marker S-100 used for?

A

melanoma, neural tumors, schwannomas

73
Q

What is the tumor marker alkaline phosphatase used for?

A

Mets to bone, liver, Paget’s disease of bone

74
Q

What is the tumor marker Bombesin used for?

A

Neuroblastoma, lung and gastric cancer

75
Q

What is the tumor marker TRAP used for?

A

Hairy cell leukemia

76
Q

What is the tumor marker CA-19-9 used for?

A

Pancreatic adenocarcinoma

77
Q

What is the tumor marker Calcitonin used for?

A

Medullary thyroid carcinoma

78
Q

What cancers should you associated with Hepatitis C virus?

A

HCC or papillary thyroid carcinoma

79
Q

What cancers should you associated with HBV or HCV?

80
Q

what cancer should you associate with Clonorchis sinensis?

A

Cholagiocarcinoma

Note this is the liver fluke

81
Q

What cancers should you associate with strep bovis?

A

Colorectal cancer

82
Q

What is the impact of the toxin Vinyl chloride?

A

Angiosarcoma of the liver

83
Q

What is the impact of the toxin Carbon tetrachloride?

A

Centrilobular necrosis, fatty change of the liver

84
Q

What is the impact of the toxin Nitrosamines?

A

Gastric cancer of the stomach

85
Q

What is the impact of the toxin asbestos?

A

Bronchogenic carcinoma>mesothelioma

86
Q

What is the impact of the toxin Arsenic?

A

Skin - SCC

liver - Angiosarcoma

87
Q

What is the impact of the toxin naphthalene?

A

Bladder transitional cell carcinoma

88
Q

What is the impact of the toxin alkylating agents?

89
Q

What paraneoplastic syndromes can secrete EPO leading to polycythemia?

A

“Potentially Really High Hematocrit”

Pheochromocytoma
Renal cell carcinoma
Hemangioblastoma
Hepatocellular carcinoma

90
Q

why do you see hypercalcemia with multiple myeloma?

A

hypercalcemia is due to secretion of local osteolytic factors leading to lytic bone lesions

91
Q

In what 4 conditions can you see psammoma bodies?

A

Papillary adenocarcinoma of the thyroid
Serous papillary cystadenocarcinoma of ovary
meningioma
malignant mesothelioma

PSaMMoma
Papillary, Serous, Meningioma, Mesothelioma

First aid Chs Part 1 (8 decks)

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