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My step 1 mnemonics > Pathology > Flashcards

Pathology Flashcards

1
Q

Neurons most vulnerable to hypoxic-ischemic insults include

A

Purkinje cells of the cerebellum and

pyramidal cells of the hippocampus and neocortex (zones 3, 5, 6).

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2
Q

Red infarct

A

liver, lung, intestine, testes

LITL

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3
Q

Free radicals damage cells via

A

membrane lipid peroxidation, protein modification, DNA breakage.

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4
Q

Free radicals are produced via:

A 
radiation exposure (eg, cancer therapy)
metabolism of drugs (phase I)
redox reactions
nitric oxide (eg, inflammation)
transition metals
WBC (eg, neutrophils, macrophages) oxidative burst

MR! MR! WoN!

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5
Q

Free radicals can be eliminated by

A

Protein metal carriers (eg, transferrin, ceruloplasmin).
Antioxidants (eg, vitamins A, C, E)
Spontaneous decay
Enzymes (scavenging) (eg, catalase, superoxide dismutase, glutathione peroxidase)

PASE

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6
Q

Dystrophic calcification

A

fat necrosis
abscesses
infarcts
liquefactive necrosis

atherosclerotic plaques
thrombi

congenital CMV
rubella
schistosomiasis
TB (lung and pericardium) and other granulomatous infections
toxoplasmosis
CREST syndrome

psammoma bodies

FAIL AT CREST momma!

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7
Q

Lipofuscin locations

A

heart, colon, liver, kidney, eye, and other organs.

KLECH

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8
Q

Localized Amyloidosis

A

A- Alzheimer disease (beta-amyloid protein)
D - Diabetes mellitus (Type 2) -Islet amyloid polypeptide (IAPP)
A - atrial amyloidosis - Isolated (ANP )
M - Medullary thyroid cancer - Calcitonin (A Cal)
S - Systemic Senile (age-related) amyloidosis [Normal (wild-type)transthyretin (TTR)]

ADAM’S amyloid

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9
Q

Histamine causes

A

Rubor (redness) and calor (warmth)
Tumor (swelling)
Dolor (pain)
“triple positive”

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10
Q

Bradykinin causes

A

Rubor (redness) and calor (warmth)

Dolor (pain)

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11
Q

NO cause

A

Rubor (redness) and calor (warmth)

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12
Q

Prostaglandins cause

A

Rubor (redness) and calor (warmth)

Dolor (pain) (PGE2)

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13
Q

Seratonin + Leukotrians cause

A

Tumor (swelling)

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14
Q

Fever explain process

A

Pyrogens (eg, LPS) induce macrophages to release IL-I and TNF -> inc COX activity in perivascular cells of the hypothalamus -> inc PGE2 -> inc temperature set point.

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15
Q

Acute phase reactants

UPREGULATED

A 
Ferritin
Fibrinogen
SAA
Hepcidin
CRP

More Fn FiSH in the C! (sea).

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16
Q

Acute phase reactants

DOWNREGULATED

A

Albumin

Transferrin

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17
Q

Erythrocyte sedimentation rate increased by

A

Most anemias
Infections
information (eg, giant cell [temporal] arteritis,
polymyalgia rheumatica)
Cancer (eg, metastases, multiple myeloma)
Renal disease (end-stage or nephrotic syndrome)
Pregnancy
Inflammation and infection CRAP

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18
Q

Erythrocyte sedimentation rate decreased by

A 
Sickle cell anemia (altered shape)
Polycythemia (Inc RBCs "dilute" aggregation factors)
HF
Microcytosis
hypoFibrinogenemia

Shape Size Amount and FF

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19
Q

Acute inflammation mediators

A

I - Inflammasome
M - mast cells

T - Toll-like receptors
A - arachidonic acid metabolites
N - neutrophils
ned

in the

B - basophils
E - eosinophils
A - antibodies (preexisting)
C - complement
H - Hageman factor (factor XII)
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20
Q

Acute inflammation outcome

A

S - Scarring
C -Chronic inflammation (antigen presentation by macrophages and other APCs - activation of CD4+ Th cells)
R - Resolution and healing (IL-10, TGF-beta)
A - Abscess (acute inflammation walled off by fibrosis)
P - Persistent acute inflammation (IL-8)

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21
Q

Leukocyte extravasation steps

A

Margination and rolling -> Tight binding (adhesion) -> Diapedesis (transmigration) -> Migration.

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22
Q

Margination and rolling defective in

A

leukocyte adhesion deficiency type 2 (dec. Sialyl Lewis X)

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23
Q 
Tight binding (adhesion) defective
in
A

leukocyte adhesion
deficiency type I (dec. CDl8
integrin subunit)

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24
Q

Margination and rolling molecules: location and target - Sialyl LewisX

A

on: LEUKOCYTE

binds:
E-selectin (upregulated by TNF and IL-I)

P-selectin (released from Weibel Palade bodies)
on: VASCULATURE/STROMA

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25
Q

Margination and rolling molecules: location and target - L-selectin

A

on: LEUKOCYTE
binds: GlyCAM-1, CD34 on VASCULATURE/STROMA

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26
Q

Tight binding (adhesion) molecules: location and target -ICAM-1 (CD54)

A

on:VASCULATURE/STROMA

binds: CDll/18 integrins
(LFA-1, Mac-I) on LEUKOCYTE

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27
Q

Tight binding (adhesion) molecules: location and target - VCAM-1 (CDI06)

A

on: VASCULATURE/STROMA
binds: VLA-4 integrin on LEUKOCYTE

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28
Q

Diapedesis (transmigration) WBC molecules: location and target - PECAM-1 (CD31)

A

on: VASCULATURE/STROMA
binds: PECAM-1 (CD31) on LEUKOCYTE

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29
Q

Migration - molecules: location and target - chemotactic signals

A

on: VASCULATURE/STROMA

Chemotactic factors: C5a, IL-8, LTB4, kallikrein, platelet-activating
factor

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30
Q

CD# of GlyCAM-1

A

CD34

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31
Q

CD# of PECAM-1

A

CD31

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32
Q

CD# of VCAM-1

A

CDI06

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33
Q

CD# of ICAM-1

A

CD54

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34
Q

CD# of LFA-1, Mac-I

A

CDll/18 integrins

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35
Q

Chronic inflammation OUTCOMES

A

Scarring, amyloidosis, and neoplastic transformation

SAN

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36
Q

Chronic inflammation STIMULI

A 
Persistent infections (eg, TB, T pallidum, certain fungi, and viruses) - type IV hypersensitivity,
autoimmune diseases, prolonged exposure to toxic agents (eg, silica) and foreign material.

Things that are not supposed to be there.

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37
Q

Wound healing MEDIATORS - FGF mediates

A

Stimulates angiogenesis

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38
Q

Wound healing MEDIATORS - TGF beta mediates

A

Angiogenesis, fibrosis

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39
Q

Wound healing MEDIATORS - VEGF mediates

A

Stimulates angiogenesis

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40
Q

Wound healing MEDIATORS - PDGF mediates

A
  • Induces vascular remodeling
  • smooth muscle cell migration
  • Stimulates fibroblast growth (for collagen synthesis)
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41
Q

Wound healing MEDIATORS - Metalloproteinases mediates

A

Tissue remodeling

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42
Q

Wound healing MEDIATORS - EGF mediates

A

Stimulates cell growth via tyrosine kinases (eg, EGFR/ErbBl)

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43
Q

PDGF Secreted by

A

activated platelets and macrophages

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44
Q

PHASE OF WOUND HEALING - Proliferative (day 3-weeks after wound)
EFFECTOR CELLS.

A

Fibroblasts, myofibroblasts, endothelial cells, keratinocytes, macrophages.

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45
Q

Granulomatous inflammation infections ETIOLOGIES

A 
• Bacterial: Mycobacteria (tuberculosis,
leprosy), Bartonella henselae (cat scratch
disease; stellate necrotizing granulomas),
Listeria monocytogenes (granulomatosis
infantiseptica), Treponema pallidum
(3° syphilis)
• Fungal: endemic mycoses (eg,
histoplasmosis)
• Parasitic: schistosomiasis

BLT w/ MAYO and Mushroom for SHIZEL!

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46
Q

Granulomatous inflammation NON-infections ETIOLOGIES in general:

A

Immune-mediated

Vasculitis

Foreign material

Chronic granulomatous disease

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47
Q

Granulomatous inflammation NON-infections ETIOLOGIES - Immune-mediated:

A

sarcoidosis, Crohn disease, 1° biliary cholangitis, subacute (de Quervain /granulomatous) thyroiditis

Sick Chicks Big Tits

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48
Q

Granulomatous inflammation NON-infections ETIOLOGIES (Vasculitis):

A

Granulomatosis with polyangiitis (Wegener)

Eosinophilic granulomatosis with polyangiitis (Churg Strauss)

Giant cell (temporal) arteritis

Takayasu arteritis

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49
Q

Granulomatous inflammation NON-infections ETIOLOGIES (Foreign material):

A

berylliosis

talcosis

hypersensitivity pneumonitis

50
Q

Types of collagen in Hypertrophic and Keloid

A

Hypertrophic: 3
Keloid: 1 & 3

51
Q

Hallmarks of cancer - in general, the 3 subtypes:

A

Growth, Don’t die, Tissue changes.

52
Q

Hallmarks of cancer - Growth

It generally consists of…

A

Growth signal self-sufficiency

Anti-growth signal insensitivity

53
Q

Hallmarks of cancer - Don’t die

It generally consists of…

A

Evasion of apoptosis

Limitless replicative potential

54
Q

Hallmarks of cancer - Tissue changes

It generally consists of…

A

Sustained angiogenesis

Tissue invasion

Metastasis

Warburg effect

55
Q

Growth signal self-sufficiency:

A

Mutations in genes encoding:
• Proto-oncogenes - t growth factors - autocrine loop (eg, inc. PDGF in brain tumors)
• Growth factor receptors - constitutive signaling (eg, HER2/neu in breast cancer)
• Signaling molecules (eg, RAS}
• Transcription factors (eg, MYC)
• Cell cycle regulators (eg, cyclins, CDKs)

56
Q

Anti-growth signal insensitivity:

A
  • Mutations in tumor suppressor genes (eg, Rb}

* Loss of E-cadherin function - loss of contact inhibition (eg, NF2 mutations}

57
Q

Evasion of apoptosis:

A

Mutations in genes that regulate apoptosis (eg, TP53, BCL2 - follicular B cell lymphoma).

58
Q

Limitless replicative potential:

A

Reactivation of telomerase - maintenance and lengthening of telomeres - prevention of
chromosome shortening and cell aging.

59
Q

Sustained angiogenesis

A

Inc. pro-angiogenic factors (eg, VEGF} or dec. inhibitory factors. Factors may be produced by tumor or stromal cells.

Vessels can sprout from existing capillaries (neoangiogenesis}

Endothelial cells are recruited from bone marrow (vasculogenesis).

Vessels may be leaky and/or dilated.

60
Q

Tissue invasion

A

Loss of E-cadherin function - loosening of intercellular junctions - metalloproteinases degrade
basement membrane and ECM - cells attach to ECM proteins (eg, laminin, fibronectin} - cells
migrate through degraded ECM (“ locomotion”} - vascular dissemination.

61
Q

Metastasis

A

Tumor cells or emboli spread via lymphatics or blood - adhesion to endothelium - extravasation and homing. The site of metastasis can be predicted by the site of the primary tumor, as the target organ is often the first-encountered capillary bed (“seed and soil” theory). Some cancers show organ tropism (eg, lung cancers commonly metastasize to adrenals).

62
Q

Warburg effect

A

The shift of glucose metabolism away from mitochondrial oxidative phosphorylation toward glycolysis.

63
Q

Immune evasion in cancer

A
  • Dec. MHC class I expression by tumor cells - cytotoxic T cells are unable to recognize tumor cells.
  • Tumor cells secrete immunosuppressive factors (eg, TGF-beta) and recruit regulatory T cells to down-regulate immune response.
  • Tumor cells up-regulate immune checkpoint molecules, which inhibit the immune response.
64
Q

Antibodies targeting PD-1

A

Nivolumab

Pembrolizumab

65
Q

Antibodies targeting PD-L1/2

A

Atezolizumab
Durvalumab
Avelumab

66
Q

Antibody targeting CTLA-4

A

Ipilimumab

67
Q

CTLA-4 on T cells outcompetes CD28 for

A

B7 on APCs

68
Q

CD# of B7

A

80/86

69
Q

These tumors metastasize to the brain

A

Lung> breast > melanoma, colon, kidney.

70
Q

These tumors metastasize to the Liver

A

Colon&raquo_space; Stomach > Pancreas (Cancer Sertintly Penetrates).

71
Q

These tumors metastasize to the Bone

A

Prostate, Breast> Kidney, Thyroid, Lung
PB/KTL

Prostate - Blastic
Breast - Mixed
Kidney - Lytic 
Thyroid - Lytic 
Lung - Lytic + blastic
72
Q

BCR-ABL
JAK2
GENE PRODUCT

A

Non-receptor tyros ine kinase

73
Q

BRAF GENE PRODUCT

A

Serine/threonine kinase

74
Q

BCL-2 GENE PRODUCT

A

Antiapoptotic molecule (inhibits apoptosis)

75
Q

c-KIT GENE PRODUCT

A

CytoKlne receptor

76
Q

KRAS GENE PRODUCT

A

GTPase

77
Q

BRAF ASSOCIATED NEOPLASM

A

Ly - lymphoma (NON-Hodgkin )
M - Melanoma
P - papillary thyroid carcinoma
H - hairy cell leukemia

78
Q

BCL-2 ASSOCIATED NEOPLASM

A

Follicular and diffuse large B Cell Lymphomas

79
Q

c-KIT ASSOCIATED NEOPLASM

A

Gastroi ntestinal stromal tumor (GIST)

80
Q

KRAS ASSOCIATED NEOPLASM

A

C - Colon cancer
L - lung cancer
i
P - pancreatic cancer

81
Q

RET
ALK
HER2/neu (c-erbB2)

A

Receptor tyrosine kinase

82
Q

RET

A

MEN 2A and 2B, papillary thyroid carcinoma

83
Q

ALK

A

Lung Adenocarcinoma (Adenocarcinoma of the Lung Kinase)

84
Q

HER2/neu (c-erbB2)

A

Breast and gastric carcinomas

BiG

85
Q

PTEN GENE PRODUCT

A

Negative regulator of P13k/AKT pathway

86
Q

PTEN ASSOCIATED CONDITION

A

Breast, prostate, and endometrial cancer

87
Q

APC GENE PRODUCT

A

Negative regulator of beta-catenin/WNT pathway

88
Q

CDKN2A GENE PRODUCT

A

p16, blocks G1 -> S phase

89
Q

CDKN2A ASSOCIATED CONDITION

A

Melanoma, pancreatic cancer

90
Q

BRCA1/BRCA2 GENE PRODUCT & ASSOCIATED CONDITION

A

DNA repair protein
Breast, ovarian, and pancreatic cancer

BOP

91
Q

NF1 GENE PRODUCT & ASSOCIATED CONDITION

A

Neurofibromin (Ras GTPase activating protein)

Neurofibromatosis is type 1

92
Q

VHL GENE PRODUCT

A

Inhibits hypoxia-inducible factor la

93
Q

Cigarette smoke Carcinogen cause

A 
R - Renal cell carcinoma: Kidney
A - adenocarcinoma (Pancreas)
T - Transitional cell carcinoma: Bladder
S - Squamous cell carcinoma: CELL
Cervix
Esophagus
Larynx
Lung (+small cell)
94
Q

Alkaline phosphatase IMPORTANT ASSOCIATIONS

A

Metastases to bone or liver, Paget disease of bone, seminoma (placental ALP).
Exclude hepatic origin by checking LFTs and GGT.

95
Q

a -fetoprotein IMPORTANT ASSOCIATIONS

A 
Hepatocellular carcinoma
Endodermal sinus (yolk sac) tumor
Mixed germ cell tumor
Ataxia-telangiectasia
Neural tube defects.
(HE-MAN is the alpha male!)

Normally made by the fetus. Transiently elevated in pregnancy. High levels associated with neural tube and abdominal wall defects, low levels associated with Down syndrome.

96
Q

Calcitonin IMPORTANT ASSOCIATIONS

A

Medullary thyroid carcinoma (alone and in MEN2A, MEN2B).

97
Q

hCG IMPORTANT ASSOCIATIONS

A

hydatidiform moles
Choriocarcinomas (gestational trophoblastic disease),
Gonadal - testicular cancer
Mixed germ cell tumor.

hCG Matters

98
Q

Radon EXPOSURE & IMPACT

A

A by-product of uranium decay, and accumulates in basements.

Lung cancer (2nd leading cause after cigarette smoke)

99
Q

GFAP STAIN

A

NeuroGlia (eg, astrocytes, Schwann cells, oligodendrocytes) -> Astrocytoma, Glioblastoma

100
Q

S-100 STAIN

A

Neural crest cells -> Melanoma, schwannoma, Langerhans cell histiocytosis

101
Q

Vimentin STAIN

A

Mesenchymal tissue (eg, fibroblasts, endothelial cells, macrophages) -> Mesenchymal tumors (eg, sarcoma), but also many other tumors (eg, endometrial carcinoma, renal cell carcinoma, meningioma)

102
Q

P-glycoprotein

A

Also known as multidrug resistance protein I (MDRI). Classically seen in adrenocortical carcinoma but also expressed by other cancer cells (eg, colon, liver). Used to pump out toxins, including chemotherapeutic agents (one mechanism of dec. responsiveness or resistance to chemotherapy over time).

103
Q

Psammoma bodies are seen in:

A 
S - Somatostatinoma
y
M - Malignant Mesothelioma
P - Prolactinoma
T -  thyroid (Papillary carcinoma)
O -  Ovarian serous papillary cystadenocarcinoma
M - Meningioma
104
Q

Paraneoplastic syndromes of Small cell lung cancer

A

ACTH
ADH
Paraneoplastic Encephalomyelitis - Antibodies against Hu antigens in neurons.
Lambert-Eaton myasthenic syndrome - Antibodies against presynaptic (P/Q-type) Ca2+ channels at NMJ.
Paraneoplastic Cerebellar degeneration - Antibodies against antigens in Purkinje cells
Opsoclonus- myoclonus ataxia
A/C ALOE

105
Q

Dermatomyositis MOST COMMONLY ASSOCIATED TUMOR(S)

A

Adenocarcinomas, especially ovarian

106
Q

Acanthosis nigricans & Sign of Leser-Trelat MOST COMMONLY ASSOCIATED TUMOR(S)

A

Gastric adenocarcinoma and other visceral malignancies

107
Q

Hypertrophic osteoarthropathy

MOST COMMONLY ASSOCIATED TUMOR(S)

A

Adenocarcinoma of the lung

108
Q

Hypertrophic osteoarthropathy

DESCRIPTION/MECHANISM

A

Abnormal proliferation of skin and bone at distal extremities -> clubbing, arthralgia, joint effusions, periostosis of tubular bones.

109
Q

Paraneoplastic syndromes of Thymoma

A

Pure red cell aplasia - Anemia with low reticulocytes

Good syndrome - Hypogammaglobulinemia

Myasthenia gravis - Antibodies against postsynaptic ACh receptors at NMJ.

110
Q 
Nonbacterial thrombotic (marantic) endocarditis
DESCRIPTION/MECHANISM
A

Deposition of sterile platelet thrombi on heart valves

111
Q 
Nonbacterial thrombotic (marantic) endocarditis
MOST COMMONLY ASSOCIATED TUMOR(S)
A

Adenocarcinomas, especially pancreatic

112
Q

Polycythemia

DESCRIPTION/MECHANISM & MOST COMMONLY ASSOCIATED TUMOR(S)

A

Inc. Erythropoietin

Pheochromocytoma
Renal cell carcinoma (kidney)
HCC (Liver)
Hemangioblastoma
Leiomyoma (Uterine)

Pheo HULK

113
Q

Inc. PTHrP

MOST COMMONLY ASSOCIATED TUMOR(S)

A

Squamous cell carcinomas of the lung, head, and neck .

Renal, bladder.

Breast, and ovarian carcinomas.

114
Q

1,25-(OH)2 vitamin D3 (calcitriol)

MOST COMMONLY ASSOCIATED TUMOR(S)

A

Lymphoma

115
Q

Anti-NMDA receptor encephalitis

MOST COMMONLY ASSOCIATED TUMOR

A

Ovarian teratoma

116
Q

Anti-NMDA receptor encephalitis

DESCRIPTION/MECHANISM

A 
L - language dysfunction
A - autonomic instability
M - memory deficits
P - Psychiatric disturbance
S - seizures

Dimmed - dyskinesias

117
Q

Opsoclonus-myoclonus ataxia syndrome seen in:

A

Neuroblastoma (children), small cell lung cancer (adults)

118
Q

Paraneoplastic cerebellar degeneration

DESCRIPTION/MECHANISM & MOST COMMONLY ASSOCIATED TUMOR(S)

A

Antibodies against antigens in Purkinje cells.

Small cell lung cancer (anti-Hu), gynecologic and breast cancers (anti-Yo), and Hodgkin lymphoma (anti-Tr)

YO! HuTr!

119
Q

Apocrine metaplasia of the breast…

A

no increased risk for cancer

120
Q

Metastatic calcification

A

In normal tissues - Predominantly in interstitial tissues of:
kidney
lung
gastric mucosa
these tissues lose acid quickly; inc pH favors Ca2+ deposition)Nephrocalcinosis of collecting ducts may lead to nephrogenic diabetes insipidus and renalfailure

121
Q

Metastatic calcification 2° to…

A

2° to hypercalcemia (eg, 1° hyperparathyroidism, sarcoidosis, hypervitaminosis D) or high
calcium-PHOSPHATE product levels (eg, chronic kidney disease with 2° hyperparathyroidism, long-term dialysis, calciphylaxis, multiple myeloma)

Usually abnormal

My step 1 mnemonics (19 decks)

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