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Pathology Flashcards

1
Q

what pathways does apoptosis have

A

intrinsic and extrinsic pathways

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2
Q

general occurrences during apoptosis (4)

A
  1. eosniphilic cytoplasm
  2. cell shrinkage
  3. karyorrhexis (nuclear fragmentation)
  4. apoptotic bodies
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3
Q

what happens in karyorrhexis?

A

endonucleases cleave at internucleosomal regions into 180bp fragments

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4
Q

what does radiation therapy do to cells

A

free radicals and dsDNA breakage –> apoptosis of tumors and surrounding tissue

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5
Q

when does intrinsic pathway apoptosis occur? (3)

A
  1. regulating factor taken away from proliferating cells
  2. after injurious stimuli
  3. anti/pro apoptotic factor ratio
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6
Q

examples of intrinsic pathway apoptosis (4)

A
  1. removal of IL-2 after completed immuno reaction
  2. radiation, toxins, hypoxia
  3. BAX and BAK (pro-apoptotic)
  4. Apaf-1 (pro-apoptotic)
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7
Q

pro-apoptotic factors (3)

A

BAX
BAK
Apaf-1

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8
Q

anti-apoptotic facotrs (1)

A
  1. Bcl-2
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9
Q

What does Bcl-2 do

A

binds to Apaf-1 and inhibits it so that it cannot release cytochrome C

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10
Q

too much bcl-2?

A

too little apaf-1 and you get tumorgenesis (ex follicular lymphoma)

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11
Q

what mechanism is extrinsic pathway apoptosis?

A
  1. ligand receptor

FasL to Fas (CD95)

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12
Q

CD95?

A

Fas

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13
Q

thymus negative selection is what pathway of apoptosis

A

extrinsic pathway

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14
Q

necrosis definitino

A

enzymation degradation and protein denaturation 2/2 exogenous injury

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15
Q

where does coagulative necrosis occur (3)

A

tissue supplied by end-arteries

  1. heart
  2. liver
  3. kidney
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16
Q

order of what happens in coagulative necrosis

A
  1. proteins degrade first

2. enzymatic degradation

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17
Q

where does liquefactive necrosis occur and when

A

occurs in CNS 2/2 high fat content

brain bacterial abscess

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18
Q

order of what happens in liquefactive necrosis

A
  1. enzymatic degradation from lysosomal release

2. Then protein degradation

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19
Q

when does caseous necrosis occur (3)

A
  1. TB
  2. systemic fungi
  3. nocardia

acid fast?

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20
Q

where does fatty necrosis occur (2)

A
  1. pancreas

2. breast

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21
Q

pancreatitis leads to what?

A

saponification

fatty necrosis

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22
Q

what does fatty necrosis look like on staining

A

calcium deposits appear dark blue

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23
Q

what does fibrinoid necrosis look like on stain

A

amorphous and pink on H&E

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24
Q

where can you see fibrinoid necrosis? (2)

A

vessels

  1. vasculitidies (HSP, churg-strauss)
  2. malignant HTN
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25
Q

types of gangrenous necrosis

A
  1. dry

2. wet

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26
Q

when is there dry gangrenous necrosis

A

ischemic coagulative

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27
Q

when is there wet gangrenous necrosis

A

infection

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28
Q

common locations for gangrenous necrosis (2)

A
  1. limbs

2. GI tract

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29
Q

Examples of causes of atrophy (7)

A
  1. low endogenous hormones (post-menopause ovaries)
  2. high exogenous hormones (thyroid, steroids)
  3. low innervation (MN damage)
  4. low blood flow/nutrients
  5. low metabolic demand (paralysis)
  6. high pressure (nephrolithiasis)
  7. occlussion of secretory ducts (CF)
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30
Q

Examples of reversible cell injury (7)

A
  1. ATP depletion
  2. cellular/mito swelling 2/2 ATPase dysfunction
  3. ribosome detachment 2/2 swelling
  4. MB blebbibg 2/2 swelling
  5. nuclear chromatin clumping
  6. low glycogen
  7. fatty change
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31
Q

Examples of irreversible cell injury (4)

A
  1. nuclear pyknosis, karyorrhexis, karyolysis
  2. plasma MB damage
  3. lysosomal rupture
  4. mitochondrial permeability/vacuolization
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32
Q

Examples of damage from ROS (6)

A
  1. retinopathy of prematurity
  2. bronchopulmonary dysplasia
  3. CCl4 –> liver necrosis and fatty change
  4. Acetaminophen o/d
  5. Fe overload
  6. Reperfusion injury esp after thrombolytic therapy
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33
Q

ischemia susceptible region of heart

A

subendocardium (LV)

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34
Q

ischemia susceptible region of kidney (2)

A
  1. straight segment of proximal tubule (medulla)

2. thick ascending limb (medulla)

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35
Q

ischemia susceptible region of liver

A

area around central vein (zone III)

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36
Q

ischemia susceptible region of colon (2)

A
  1. splenic flexure

2. rectum

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37
Q

chromatolysis … what is it?

A

attempt at increasing protein synthesis following axonal damage

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38
Q

what do you see in chromatolysis? (3)

A
  1. round cellular swelling
  2. displacement of nucleus to periphery
  3. dispersion of RER throughout cytoplasm
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39
Q

what does nissl substance stain?

A

RER

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40
Q

red infarct from what

A

hemorrhagic

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41
Q

where does red infarct occur? (3)

A

loose tissue with multiple blood supplies

  1. liver
  2. lungs
  3. intestines

Red = Reperfusion

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42
Q

pale infarct where (3)

A

solid tissue with single blood supply

  1. heart
  2. kidney
  3. spleen
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43
Q

distributive shock

  • TPR
  • CO/venous return
  • PCWP
A

low TPR
high CO/venous return
low PCWP

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44
Q

what does distributive look like?

A

warm dry skin 2/2 vasodilation

need to use pressors b/c unresponsive to fluids 2/2 vasodilation

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45
Q

Cardiogenic shock

  • TPR
  • CO/venous return
  • PCWP
A

high TPR
low CO/venous return
elevated PCWP

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46
Q

Hypovolemic shock

  • TPR
  • CO/venous return
  • PCWP
A

high TPR
low CO/venous return
decreased PCWP

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47
Q

treating cardiogenic/hypovolemic shock

A

responds to fluids

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48
Q

Acute cellular inflammatory response

  • onset time
  • duration time
A
  • seconds-minutes

- lasts minutes to days

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49
Q

Acute cellular inflammatory response

  • involved cells
  • what happens
A
  • neutrophils, eosinophil, Ab-mediated

- resolution, abscess formation, progression to chronic inflammation

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50
Q

Chronic cellular inflammatory response

  • cells involved
  • what happens
A
  • mononuclear cells and fibroblasts for persistent destruction and repair
  • granuloma (nodular collection of epithelioid macrophage and giant cells)
  • scarring and amyloidosis
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51
Q

what is it that leads to increased ESR in inflammation

A

fibrinogen coats RBCs and causes them to aggregate

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52
Q

high ESR states (5)

A
  1. most anemias
  2. infection
  3. cancer (MM)
  4. pregnancy
  5. autoimmune d/o
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53
Q

low ESR states (3)

A
  1. sickle cell (shape lowers ESR)
  2. polycythemia (dilute)
  3. CHF (unknown reason)
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54
Q

4 steps of leukocyte extravasation

A
  1. margination and rolling
  2. tight-binding
  3. diapedesis
  4. migration through interstitium
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55
Q

factors involved in leukocyte margination and rolling

- cellular to endothelial interaction

A

cellular to endothelial reaction:

  • Sialyl-Lewis …P-selectin
  • Sialyl-Lewis …E-selectin
  • L-selectin … GlyCAM-1 and CD34
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56
Q

factors involved in leukocyte tight-bonding

  • cellular to endothelial interaction
A
  • CD11/18 integrins (LFA-1, Mac-1) … ICAM-1 (CD54)

- VLA-4 integrin … VCAM-1 (CD106)

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57
Q

factors involved in leukocyte diapedesis

  • cellular to endothelial interaection
A
  • PECAM-1 (CD31) … PECAM -1 (CD31)
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58
Q

factors involved in leukocyte migration

-cellular to endothelial interaction

A
  • various things … chemotaxis mediated through C5a, IL-8, kalligkrein, Plt-activating factor
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59
Q

examples of exudate causing stuff (4)

A
  1. lymphatic obstruction
  2. inflammation
  3. infection
  4. maligancy
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60
Q

examples of transudate causing stuff (3)

A
  1. CHF (hydrostatic pressure)
  2. cirrhosis (decresaed oncotic pressure)
  3. Na retention
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61
Q

what’s the specific gravity number differentiating exudate and transudate

A

1.012

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62
Q

phases of wound healing (3)

when do they occur

A
  1. inflammatory (immediate)
  2. proliferative (2-3 days)
  3. remodeling (1 week later)
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63
Q

what does EGF do in wound healing

A

stimulates cell growth via TyrKin Rec

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64
Q

TGF-beta does what in wound healing (3)

A

angiogenesis
fibrosis
cell cylce arrest

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65
Q

PDGF does what in wound healign (3)

A
  1. vascular remodeling
  2. SMC migration
  3. stimulate fibroblast growth for collagen synthesis
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66
Q

cells involved in inflammatory wound healing (3)

A
  1. platelets
  2. neutrophils
  3. macrophages (a little later just to clean up)

clotters and eaters

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67
Q

cells involved in proliferative wound healing (5)

A
  1. fibroblasts
  2. myofibroblasts
  3. endothelial cells
  4. keratinocytes
  5. macrophages

the rebuilders, supporters, and clean up

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68
Q

cells in remodeling wound healing

A

fibroblasts

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69
Q

what collagen stuff happening in wound healing

A

collagen III replaced by collagen I –> increases tensile strength of tissue

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70
Q

pathogenesis of granulomatous disease

A

TH1 cells secrete IFN-g –> activates macrophages –> they release TNF-alpha –> induces and maintains granuloma formation

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71
Q

examples of granulomatous diseases (13)

A
  1. TB
  2. Sarcoidosis
  3. Crohn
  4. Fungal
  5. myco leprae
  6. Syphilis
  7. Wegener granulomatosis
  8. Churg-Strauss
  9. Bartonella (cat scratch)
  10. Berrylliosis
  11. Listeria monocytogenes
  12. Francisella tularensis
  13. schistosomiasis
72
Q

types of calcification (2)

A
  1. dsytrophic

2. mestastatic

73
Q

dystrophic calcification caused by what

A

local deposits 2/2 necrosis

74
Q

calcium state in dystrophic calcification

A

usually normocalcemic

not a/w hyper-Ca

75
Q

metastatic calcification caused by what

A

diffuse deposits 2/2 hypercalcemia OR

high calcium-phosphate product

76
Q

states of hypercalcemia (3)

A
  1. primary hyperparathyroidism
  2. sarcoidosis
  3. hypervitamoniosis D
77
Q

states of high calcium-phosphate product (4)

A
  1. CRF
  2. secodnary hyperparathyoriodism
  3. long-term dialysis
  4. warfarin
78
Q

where is calcium usually in metastatic calcification?

  • what environments
  • examples
A

alklaloid environments

interstitial tissue of:
1. kidneys
2. lungs
3. gastric mucosa
b/c they lose acid quickly
79
Q

how does Fe poisoning kill?

A

peroxidation of cell MB lipids –> cell death

80
Q

what stains show amyloidosis

A

congo red stain

81
Q

what does congo red stain look like in polarized light

A

apple green birefringence

82
Q

what is primary amyloidosis ?

A

AL

deposits of light chains

83
Q

causes of primary amyloidosis (AL)?

A
  1. plasma cell d/o

2. MM

84
Q

what does primary amyloidosis cause? (6)

A
  1. nephrotic syndrome
  2. restrictive cardiomyopathy
  3. arrhyhtmia
  4. easy bruising
  5. hepatomegaly
  6. neuropathy
85
Q

what is secondary amyloidosis?

A

AA

chronic conditions with fibrils made of serum Amyloid A

86
Q

where can you see secondary amyloidosis (4)

A
  1. RA
  2. IBD
  3. Spondyloarthropathy
  4. protracted infection
87
Q

what is P-glycoprotein

A

MDR-1

the channel that pumps out toxins from the cell to keep it alive

88
Q

reversible plasias (3)

A

hyperplasia
metaplasia
dysplasia

89
Q

irreversible plasias (3)

A

anaplasia
neoplasia
desmoplasia

90
Q

what is desmoplasia

A

fibrous tissue formation in response to neoplasm

91
Q

tumor grading has to do with

- what are the numbers

A

differentiation and mitotic activity

1-4 from well differentiated to poorly anaplastic

92
Q

tumor staging based on what

A

localization and spread

93
Q

TNM staging involves?

A

tumor size
node involvement
mets

94
Q

Carcinomas spread how

A

lymphatic spread

95
Q

which carcinomas can spread hematogenously as well as lymphatically (4)

A
  1. RCC via renal vein
  2. HCC via hepatic vein
  3. Follicular carcinoma of thyroid
  4. Choriocarcinoma
96
Q

sarcomas spread how

A

hematogenously

97
Q

benign sarcomas 6)

A
  1. hemangioma (vessels)
  2. leiomyoma (SMC)
  3. rhabdomyoma (striated muscle)
  4. fibroma (connective tissue)
  5. osteoma (bone)
  6. lipoma (fat)
98
Q

Cachexia is mediated by what (3)

A
  1. TNF-alpha
  2. IFN-gamma
  3. IL-6
99
Q

what is called cachectin?

A

TNF-alpha

100
Q

what condition a/w visceral malignancy

A

acanthosis nigricans

101
Q

what condition a/w squamous cell carcinoma of skin

A

actinic keratosis

102
Q

what condition a/w malignant melanoma

A

dysplastic nevus (skin lesions)

103
Q

xeroderma pigmentosum / albinism a/w what neoplasms (3)

A
  1. melanoma
  2. basal cell carcinoma
  3. squamous cell carcinoma of skin
104
Q

what condition a/w aggressive malignant non-Hodgkin lymphoma

A

AIDS

105
Q

what condition a/w Kaposi sarcoma

A

AIDS

106
Q

what condition a/w lymphomas

A

autoimmune (hashimoto, SLE)

107
Q

what condition a/w malignant lymphomas?

A

immunodef

108
Q

what condition a/w ALL and AML

A

Down syndrome

109
Q

what condition a/w thymoma (2)

A
  1. myasthenia gravis

2. pure RBC aplasia

110
Q

what condition a/w esophageal adenocarcinoma

A

barrett esophagus

111
Q

what condition a/w squamous cell carcinoma of esophagus

A

Plummer-Vinson syndrome (low Fe)

112
Q

what condition a/w gastric adenocarcinoma

A
  1. chronic atrophic gastritis
  2. permicious anemia
  3. postsurgical gastric remnants
113
Q

what condition a/w colonic adenocarcinoma

A

UC

114
Q

what condition a/w HCC

A

cirrhosis

115
Q

what neoplasm a/w polycythemia (2)

A
  1. RCC

2. HCC

116
Q

what condition a/w small cell lung cancer (3)

A
  1. Cushing
  2. Lambert Eaton
  3. SIADH
117
Q

what condition a/w lung cancer

A

dermatomyositis

118
Q

what condition a/w squamous cell lung cancer

A

hypercalcemia

119
Q

what neoplasms a/w TS (3)

A
  1. giant cell astrocytoma
  2. renal angiomyolipoma
  3. cardiac rhabdomyoma
120
Q

what neoplasms a/w radiation exposure (4)

A
  1. leukemia
  2. sarcoma
  3. papillary thyroid cancer
  4. breast cancer
121
Q

what neoplasms a/w Paget disease of bone (2)

A
  1. secondary osteosarcoma

2. fibrosarcoma

122
Q

examples of oncogenes (10)

A
  1. Bcr-abl
  2. bcl-2
  3. BRAF
  4. c-kit
  5. c-myc
  6. HER2/neu
  7. L-myc
  8. N-myc
  9. Ras
    10 Ret
123
Q

what does Bcr-abl code for and what condition a/w (2)

A

tyrosine kinase

  1. CML
  2. ALL
124
Q

what does bcl-2 code for and what condition a/w (2)

A

anti-apoptotic mitochondrial factor

  1. follicular lymphoma
  2. undifferentiated lymphoma
125
Q

what does BRAF code for

and what condition a/w

A

serine/threonine kinase

melanoma

126
Q

what does c-kit code for and what condition a/w

A

cytokine receptor for stem cell factor

GI stromal tumor (GIST)

127
Q

what does c-myc code for and what condition a/w

A

TF

Burkitt lymphoma

128
Q

what does HER2/neu code for and what condition a/w

A

tyrosine kinase

  1. breast
  2. ovarian
  3. gastric carcinoma
129
Q

what does L-myc code for and what condition a/w

A

TF

lung

130
Q

what does N-myc code for and what condition a/w

A

TF

Neuroblastoma

131
Q

what does Ras code for and what condition a/w (3)

A

GTPase

  1. colon
  2. lung
  3. pancreatic
132
Q

what does Ret code for and what condition a/w (2)

A

tyrosine kinase

  1. MEN 2A
  2. MEN 2B
133
Q

what does BRCA1 and 2 code for and a/w (2)

A

DNA repair enzymes

  1. breast cancer
  2. ovarian cancer
134
Q

what does CPD4/SMAD4 code for and a/w?

A

DPC (deleted in pancreatic cancer)

pancreatic cancer

135
Q

what does DCC code for

A

deleted in colon

colon cancer

136
Q

what does NF1 code for and a/w ?

A

Neurofibormin, a RAS GTPase activating protein

NF1

137
Q

what does NF2 code for and a/w?

A

Merlin (schwannomin) protein

NF2

138
Q

what does p16 code for and a./w?

A

cyclin-dep kinase inhibitor 2A

melanoma

139
Q

what does p53 code for and a/w

A

TF for p21 … blocks G1 to S

most cancers

Fraumeni (AR cancer syndrome): breast, leukemia, adrenal gland

140
Q

what is PTEN and a/w?

A

TSG

breast, prostate, endometrial

141
Q

what does Rb do and a/w? (2)

A

inhibits E2F … blocks G1 to S

  1. retinoblastoma
  2. osteosarcoma
142
Q

what genes mutated in TS

A

TSC1

143
Q

VHL codes what and a/w?

A

inhibits hypoxia inducible factor 1a (HIF-1a)

VHL

144
Q

AlkPhos used to monitor what (4)

A
  1. mets to bone
  2. liver disease
  3. Paget disease of bone
  4. seminoma (placental aklphos)
145
Q

AFP used to monitor what (5)

A
  1. HCC
  2. hepatoblastoma
  3. yolk sac (endodermal sinus) tumor
  4. testicular cancer
  5. mixed germ cell tumor
146
Q

beta-hCG used to monitor what (3)

A
  1. hydatiform moles
  2. choriocarcinomas
  3. testicular cancer
147
Q

what do you use to monitor breast cancer?

A

CA-15/3

CA-26/29

148
Q

what do you use to monitor pancreatic adenocarcinoma

A

CA-19/9

149
Q

what do you use to monitor ovarian cancer

A

CA-125

150
Q

what do you use to monitor medullary thyroid carcinoma

A

calcitonin

151
Q

what are some neural crest origin cancer (4)

A
  1. melanoma
  2. neural tumo
  3. schwannoma
  4. Langerhans cell Histiocytosis
152
Q

what do you use to monitor neural crest origin cancers

A

S-100

153
Q

what do you use to monitor hairy cell leukemia

A

TRAP

154
Q

EBV can cause what cancer

A
  1. Burkitt lymphoma
  2. Hodgkin lymphoma
  3. nasopharyngeal carcinoma
  4. CNS lymphoma inimmunom
155
Q

What viruses can cause HCC? (2)

A
  1. HBV

2. HCV

156
Q

what virus can cause kaposi sarcoma

A

HHV-8

157
Q

what causes cervical, penile, headneckthroat cancer

A

HPV 16,18

158
Q

H pylori can cause what cancers (2)

A
  1. gastric adenocarcinoma

2. MALT lymphoma

159
Q

adult T-cell leukemias and lymphomas can be caused by what microbe

A

HTLV-1

160
Q

what microbe can cause cholangiocarcinoma

A

liver fluke (clonorchis sinensis)

161
Q

what microbe can cause squamous cell bladder cancer

A

schisotoma haematobium

162
Q

Aflatoxin

  • produced by what
  • causes what cancer
A
  • aspergillus

- HCC

163
Q

Arsenic can cause what cancers (3)

A
  1. angiosarcoma
  2. lung cancer
  3. squamous cell carcinoma
164
Q

asbestos causes what cancer 2)

A
  1. bronchogenic carcinoma
  2. meothelioma

bronchogenic > meso

165
Q

cigarette smoking causes what cancer (6)

A
  1. transitional cell carcinoma
  2. SCC and adenocarcinoma of esphageus
  3. RCC
  4. squamous cell CA or laynx
  5. squamous and small cell CA of lung
  6. adenocarcinoma of pancreas
166
Q

nitrosamines

  • where found
  • causes what cancer
A
  • smoked foods

- gastric cancer

167
Q

2nd leading cause of lung cancer after smoking

A

Radon

168
Q

Vinyl chloride causes what

A

hepatic angiosarcoma

169
Q

what paraneoplastic syndrome a/w Hodgkin lymphoma?

- leads to

A

1,25-VitD –> hypercalcemia

170
Q

what paraneoplastic syndrome a/w small cell lung carcinoma (3)

A

ACTH –> cushing

anti-presyn CaCh –> LES

Autoimmune subacute cerebellar degeneration –> dizzy, ataxia

171
Q

what paraneoplastic syndrome a/w small cell lung CA and some intracranial neoplasms

A

ADH –> SIADH

172
Q

what malignancies have EPO production as neoplastic syndrome? (6)

A
  1. RCC
  2. thymoma
  3. hemangioblastoma
  4. HCC
  5. leiomyoma
  6. pheochromocytoma
173
Q

what malignances have PTHrP production as neoplastic syndrome (3)

A
  1. squamous cell lung CA
  2. RCC
  3. breast cancer
174
Q

psammoma bodies found where (4)

A
  1. Papillary CA thyroid
  2. Serous papillary cystadenoCA of ovary
  3. Meningioma
  4. Malignant mesothelioma
175
Q

which mets go to brain (6)

A
  1. lung
  2. brain
  3. GU
  4. osteosarcoma
  5. melanoma
  6. GI
176
Q

which mets go to liver

A
  1. colon
  2. stomach
  3. pancreas

Step 1 Andre (42 decks)

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