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USMLE STEP 1 > Pathology > Flashcards

Pathology Flashcards

1
Q 
Apoptosis 
What is it?
What is required?
Phys
Inflammation 
Histo 
Clean up?
A

Programmed cell death
ATP required
Cytosolic caspases mediate cellular breakdown
No inflammation
Shrinkage, Pyknosis (nuc shrinkage), Basophilia, Blebbing, Nuclear Fragmentation (karyorrhexis), Apoptotic bodies
Phagocytosis

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2
Q

Intrinsic Apoptosis Pathway
What process is it involved with?
Mechanism
Mito involvement

A

Tissue remodeling in embryogenesis and after exposure to injurious stimuli
Growth factor withdrawn from proliferating cells
Changes in proportions of anti and pro apoptotic factors lead to ↑ mito permeability and ctyochrome c release

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3
Q

Extrinsic Apoptosis Pathways

A

Fas ligand binding to Fas Receptor (CD95)

Tc cells release Perforin and Granzyme B

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4
Q

Necrosis
What causes it?
Process?
Inflammation?

A

Exogenous injury
Enzymatic degradation and protein denaturation –> Intracellular components extravasate
Inflammation

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5
Q

Coagulative Necrosis

A

Heart, Liver, Kidney

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6
Q

Liquefactive Necrosis

A

Brain, Bacterial Abscess, Pleural Effusion

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7
Q

Caseous Necrosis

A

TB, Systemic Fungi

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8
Q

Fatty Necrosis

A

Peripancreatic fat (saponification via lipase)

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9
Q

Fibrinoid Necrosis

A

Blood vessels

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10
Q

Gangrenous Necrosis
Dry
Wet
Where?

A

Dry: Ischemic Coagulative
Wet: Bacteria
Limbs and GI tract

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11
Q

Reversible Cell Injury
What is required?
PathoPhys
Histo

A

Oxygen
↓ ATP synthesis, ↓ Glycogen
Swelling (impaired Na/K pump), Chromatic clumping, Fatty Change, Ribosomal detachment

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12
Q

Pro-apoptotic Mito protein

A

Bax

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13
Q

Anti-apoptotic Mito Protein

A

Bcl-2

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14
Q

Irreversible Cell Injury
Pathway
What happens to the cell?
Histo

A

Ca influx –> caspase activation
Plasma membrane damage, Lysosomal Rupture, Mito Permeability
Pyknosis, Karyolysis, Karyorrhexis

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15
Q

Location of Brain susceptible to ischemic injury

A

ACA/MCA/PCA boundary area

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16
Q

Location of Heart susceptible to ischemic injury

A

Subendocardium of LV

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17
Q

Location of Kidney susceptible to ischemic injury

A

Straight segment of PT in medulla

Thick Ascending Limb in medulla

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18
Q

Location of Liver susceptible to ischemic injury

A

Central Vein (zone III)

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19
Q

Location of Colon susceptible to ischemic injury

A

Splenic Flexure and Rectum

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20
Q 
Red Infarcts 
What kind of infarct?
What kind of tissue?
Organs?
When?
A 
"Red = Reperfusion"
Hemorrhagic 
Tissue with collaterals 
Liver, Lungs, Intestines 
Following reperfusion
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21
Q

Hypoxic Ischemic Encephalopathy affects what kind of cells?

A

Pyramidal Cells of Hippocampus and Purkinje cells

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22
Q

Pale Infarcts
What kind of tissue?
Organs?

A

Solid tissues with a single blood supply

Heart, Kidney, Spleen

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23
Q

Reperfusion injury is due to…

A

Free Radicals

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24
Q

Hypovolemic Shock
Output
TPR
Presentation

A

Low output
↑ TPR
Cold and Clammy

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25
Cardiogenic Shock Output TPR Presentation
Low output ↑ TPR Cold and Clammy
26
``` Septic Shock Output TPR Vasculature Presentation ```
High output ↓ TPR Dilated arterioles, High venous return Hot
27
Atrophy What is it? Possible causes?
Reduction in size or # of cells ↓ hormones, innervation, blood flow nutrients ↑ pressure Occlusion of secretory ducts
28
Characteristics of Inflammation
Redness, Heat, Swelling, Loss of Function
29
Vascular component of inflammation
↑ vascular permeability, vasodilation, endothelial injury
30
Cellular component of inflammation
Neutrophil mediated
31
``` Acute component of inflammation Mediators Onset Duration Possible outcomes ```
Neutrophils, Eosinophils, Abs Seconds to minutes Minute to days Resolution, Abscess, Chronic inflammation
32
``` Chronic component of inflammation Mediators Characteristic Associated with... Outcomes ```
Mononuclear cells Persistent destruction and repair Blood vessel proliferation. Fibrosis Scarring, Amyloidosis
33
Granuloma Histo Pathway
Nodular collection of Epithelioid Macrophages and Giant Cells Th1 secretes IFNγ which activates Macs which secrete TNFα
34
Leukocyte Extravasation | Steps w/ mediators
1.Rolling: Vasculature: E and P selectins. Leukocyte: Sialyl-Lewis 2. Tight Binding V: ICAM. L: LFA1 (integrin) 3. Diapedesis (between endothelial cells) V: PECAM. L: PECAM 4. Migration
35
Leukocyte (neutrophil) chemotactic factors
"CLIK" | C5a, LTB4, IL8, Kallikrein
36
How do free radicals damage cells?
Membrane lipid peroxidation Protein modifications DNA breakage
37
Free Radicals What causes them? How are they eliminated?
Radiation, Metabolism of drugs, Redox rxns, Nitric Oxide (NO), Transition metals, Leukocyte oxidative burst Enzymes (Catalase, SOD, Glutathione Peroxidase), Decay, Antioxidants (A, C, E)
38
Free Radical Diseases
ROP, Bronchopulmonary Dysplasia, CCl4 --> liver necrosis (fatty change), Acetominophen OD, Hemochromatosis, Reperfusion
39
Would Healing Phases
Inflammatory, Proliferative, Remodeling
40
Would Healing Inflammatory Phase When? Mediators What happens?
Immediate Platelets, Neutrophils, Macrophages Clot formation and ↑ permeability
41
Would Healing Proliferative Phase When? Mediators What happens?
2-3 days after injury Fibroblasts, Myofibroblasts, Endothelial cells, Keratinocytes, Macrophages Deposition of granulation tissue and collagen. Angiogenesis, Epithelial cell proliferation, Dissolution of clot, Wound contraction (via myofibroblasts)
42
Would Healing Remodeling Phase When? Mediators What happens?
1 week Fibroblasts Collagen III replaces Collagen I --> ↑ tensile strength of tissue
43
Granulomatous Diseases
TB Fungal Infections (Histoplasmosis, Coccidioidomycosis) Treponema Pallidum (Syphilis) M Leprae (Leprosy) Bartonella Henselae (cat scratch disease) Sarcoidosis, Crohn's Disease, Wegener's, Churg Strauss Berylliosis, Silicosis
44
``` Transudate Cellularity? Protein? Specific gravity Causes ```
Hypocellular Low protein Less than 1.012 ↑ hydrostatic pressure, ↓ oncotic pressure, Na retention
45
``` Exudate Cellularity? Protein? Specific gravity Causes ```
Cellular Protein rich Greater than 1.02 Lymphatic obstruction or Inflammation
46
Iron Poisoning MoA Acute Chronic
Peroxidation of membrane lipids Acute gastric bleeding Chronic: Metabolic acidosis, Scarring --> GI obstruction
47
Amyloidosis What is it? What does it cause? Appearance of tissue?
Abnormal aggregation of proteins into β-pleated sheets Cell damage and apoptosis Waxy appearance
48
AL Amyloidosis What kind of protein? What disorders present with it? Organ systems affected
Ig Light chains Plasma cell disorder or Multiple Myeloma Renal (nephrotic), Cardiac (failure, arrhythmia), Hematologic (easy bruising), Hepatomegaly, Neuropathy
49
AA Amyloidosis What kind of protein? What diseases? Systems involved?
Amyloid A fibrils RA, IBD, Spondyloarthropathy, Chronic Infections Multiple systems like in AL
50
Dialysis Related Amyloidosis What kind of protein? What kind of pt? Presentation
β2 microglobulin ESRD on long term dialysis Carpal tunnel syndrome and other joint issues
51
Heritable Amyloidosis Genetics Disease
Transthyretin (TTR or prealbumin) gene mutation | ATTR neurologic/cardiac amyloidosis
52
Age-Related (Senile) Amyloidosis What kind of protein? Organs affected Progression
wt TTR Systemic: deposited in myocardium and other sites Slower progression of cardiac dysfunction vs AL
53
Organ Specific Amyloidosis What is affected? Example with protein
A single organ | Alzheimer's Disease due to deposition of amyloid-β protein from APP
54
Anaplasia
Abnormal cells lacking differentiation
55
Desmoplasia
Fibrous tissue formation in response to neoplasm
56
Tumor Grade
Degree of cellular differentiation
57
Tumor Stage | TNM
Degree of localization/spread based on site and size Tumor Size Node Involvement Metastases
58
Tumor stage vs grade re prognostic value
Stage has more prognostic value
59
Epithelium tumor names Benign Malignant
Adenoma, Papilloma | Adenocarcinoma, Papillary carcinoma
60
Tumor of Blood Vessels Benign Malignant
Hemangioma | Angiosarcoma
61
Tumor of Smooth Muscle Benign Malignant
Leiomyoma | Leiomyosarcoma
62
Tumor of Striated Muscle Benign Malignant
Rhabdomyoma | Rhabdomyosarcoma
63
Tumor of Connective Tissue Benign Malignant
Fibroma | Fibrosarcoma
64
Tumor of Bone Benign Malignant
Osteoma | Osteosarcoma
65
Tumor of Fat Benign Malignant
Lipoma | Liposarcoma
66
Cachexia Presentation Disease with it? Mediated by
Wt loss, Muscle atrophy, Fatigue Cancer, AIDS, Heart Failure, TB TNFα, IFNγ, IL6
67
Neoplasm of Down Syndrome
ALL, AML
68
Neoplasm of Xeroderma Pigmentosum or Albinism
Melanoma, Basal Cell Carcinoma, Squamous Cell Carcinoma of the Skin
69
Neoplasm of Chronic Gastritis, Pernicious Anemia, Postsurgical Gastric Remnant
Gastric Adenocarcinoma
70
Neoplasm of Tuberous Sclerosis
Giant Cell Astrocytoma, Renal Angiomyolipoma, Cardiac Rhabdomyoma
71
Neoplasm of Actinic Keratosis
Squamous cell carcinoma of the skin
72
Neoplasm of Barrett's Esophagus
Esophageal adenocarcinoma
73
Neoplasm of PVS
Squamous cell carcinoma of the esophagus
74
Neoplasm of Paget's Disease of Bone
Osteosarcoma, Fibrosarcoma
75
Neoplasm of Immunodeficiency States
Malignant Lymphomas
76
Neoplasm of AIDS
Malignant Lymphomas and Kaposi Sarcoma
77
Neoplasm of autoimmune disease
Lymphoma
78
Neoplasm of Acanthosis Nigricans
Visceral Malignancy (Stomach, Lung, Uterus)
79
Neoplasm of Dysplastic Nevus
Malignant Melanoma
80
Neoplasm of Radiation Exposure
Leukemia, Sarcoma, Papillary Thyroid Cancer, Breast Cancer
81
abl What kind of protein? Tumor Product
Oncogene CML Tyrosine Kinase
82
c-myc What kind of protein? Tumor Product
Oncogene Burkitt's Lymphoma Transcription factor
83
bcl2 What kind of protein? Tumor Product
Oncogene Follicular and undifferentiated lymphoma Anti-apoptotic molecule
84
HER2/neu (c-erbB2) What kind of protein? Tumor Product
Oncogene Breast, Ovarian, Gastric Carcinoma Tyrosine Kinase
85
ras What kind of protein? Tumor Product
Oncogene Colon Carcinoma GTPase
86
L-myc What kind of protein? Tumor Product
Oncogene Lung Tumor Transcription Factor
87
N-myc What kind of protein? Tumor Product
Oncogene Neuroblastoma Transcription Factor
88
ret What kind of protein? Tumor Product
Oncogene MEN 2A and 2B Tyrosine Kinase
89
c-kit What kind of protein? Tumor Product
Oncogene GI stromal tumor Cytokine Receptor
90
Rb What kind of protein? Tumor Product
Tummor Suppressor Retinoblastoma, Osteosarcoma Normally inhibits E2F thus blocking G1 --> S transition
91
p53 What kind of protein? Tumor Product
Tummor Suppressor Most human cancers, Li-Fraumeni Syndrome Transcription factor for p21. Normally blocks G1 --> S transition
92
BRCA1 and BRCA2 What kind of protein? Tumor Product
Tummor Suppressor Breast and Ovarian Cancer DNA repair protein
93
p16 What kind of protein? Cancer
Tummor Suppressor | Melanoma
94
BRAF What kind of protein? Tumor Product
Tummor Suppressor Melanoma B-raf
95
APC What kind of protein? Cancer?
Tummor Suppressor | Colorectal cancer
96
WT1 What kind of protein? Tumor
Tummor Suppressor | Wilm's Tumor (Neuroblastoma)
97
NF1 What kind of protein? Tumor Product
Tummor Suppressor Neurofibromatosis type 1 RAS GTPase activating protein (RAS GAP)
98
NF2 What kind of protein? Tumor Product
Tummor Suppressor Neurofibromatosis type 2 Merlin (Schwannomin) protein
99
DPC4 What kind of protein? Tumor Product
Tummor Suppressor Pancreatic Cancer "Deleted in Pancreatic Cancer"
100
DCC What kind of protein? Tumor Product
Tummor Suppressor Colon Cancer "Deleted in Colon Cancer"
101
PSA Function When is it elevated? Screen utility?
Follow prostate carcinoma Prostate carcinoma, BPH, Prostatitis Questionable
102
Prostatic Acid Phosphatase maker for...
Prostate carcinoma
103
CEA marker Name Cancers associated with it?
CarcinoEmbryonic Antigen Colorectal and Pancreatic Cancer Gastric, Breast, and Medullary Thyroid Carcinoma
104
α-FetoProtein Normally made by Marker for what kind of cancers?
Normally made by fetus | Hepatocellular carcinoma, NonSeminomatuous germ cell tumor (ovary, testis)
105
βhCG: Marker for what kind of tumors?
Hydatidiform moles and Choriocarcinomas (Gestational trophoblastic disease)
106
CA-125 marker for
Ovarian Cancer
107
S-100 marker for
Melanoma, Neural tumors, Schwannomas
108
ALP marker for
Metastases to bone, Liver, Paget's Disease of bone
109
Bombesin marker for...
Neuroblastoma, Lung, and Gastric Cancers
110
TRAP Name Marker for...
"Trap the Hair Animal" Tartrate Resistant Acid Phosphatase Hairy Cell Leukemia (B cell neoplasm)
111
CA-19-9 marker for
Pancreatic Adenocarcinoma
112
Calcitonin marker for
Medullary Thyroid Carcinoma
113
HTLV-1 leads to what cancer?
Adult T cell leukemia/lymphoma
114
HBV and HCV lead to what cancer?
Hepatocellular Carcinoma
115
EBV leads to what cancer?
Burkitt's Lymphoma, Hodgkin's Lymphoma, Nasopharyngeal Carcinoma, CNS lymphoma (in immunosuppressed pts)
116
HPV leads to what cancer?
Cervical carcinoma (16, 18) Penile/anal carcinoma Upper Respiratory SCC
117
HHV8 leads to what cancer?
Kaposi sarcoma, Body Cavity Fluid B cell lymphoma
118
H. pylori leads to what cancer?
Gastric Adenocarcinoma and Lymphoma
119
Liver Fluke (Clonorchis sinensis) leads to what cancer?
Cholangiocarcinoma
120
Aflatoxin Made by what organism? Organ affected? Impact?
Aspergillus Liver Hepatocellular carcinoma
121
Vinyl Chloride Organ affected? Impact?
Liver | Angiosarcoma
122
CCl4 Organ affected? Impact?
Liver | Centriolobular Necrosis and Fatty Change
123
Nitrosamines Where are they from? Organ affected? Impact?
Smoked foods Stomach Gastric Cancer
124
Cigarette smoke Organ affected? Impact?
``` Larynx: Squamous Cell Carcinoma Lung: Squamous and Small cell carcinoma Kidney: Renal cell carcinoma Bladder: Transitional cell carcinoma Pancreas: Pancreatic adenocarcinoma ```
125
Asbestos Organ affected? Impact?
Lung | Bronchogenic carcinoma > Mesothelioma
126
Arsenic Organ affected? Impact?
Skin: Squamous Cell Carcinoma Liver: Angiosarcoma
127
Naphthalene (aniline) Organ affected? Impact?
Bladder | Transitional Cell Carcinoma
128
Alkylating Agents Organ affected? Impact?
Blood | Leukemia
129
Paraneoplastic ACTH Made from... Effect
Small cell carcinoma of the lung | Cushing's syndrome
130
Paraneoplastic ADH Made from... Effect
Small cell carcinoma of the lung and intracranial neoplasms | SIADH
131
Paraneoplastic PTHrP Made from... Effect
Small cell carcinoma of the lung, Renal cell carcinoma, Breast cancer HyperCa
132
Paraneoplastic VitD Made from... Effect
Hodgkin's Lymphoma and some Non-Hodgkin's Lymphoma | HyperCa
133
Paraneoplastic EPO Made from... Effect
Renal Cell Carcinoma, Hemangioblastoma, Hepatocellular carcinoma, Pheochromocytoma Polycythemia
134
Paraneoplastic Abs against presynaptic Ca channels Made from... Effect
Small Cell Carcinoma of the Lung | Lambert Eaton Syndrome
135
Psammoma Bodies Appearance Seen in what?
Laminated, Concentric, Calcific Spherules "PSaMMoma" Papillary Adenocarcinoma of the Thyroid Serous Papillary cystadenocarcinoma of the ovary Meningioma Malignant Mesothelioma
136
Cancer epidemiology in Men Incidence Mortality
Prostate (32%), Lung (16%), Colon/Rectum (12%) | Lung (33%), Prostate (13%)
137
Cancer epidemiology in Women Incidence Mortality
Breast (32%), Lung (13%), Colon/Rectum (13%) | Lung (23%), Breast (18%)
138
Cancers that metastasize to Brain
Lung, Breast, GU, Osteosarcoma, Melanoma, GI
139
Cancers that metastasize to Liver
Colon, Stomach, Pancreas
140
Cancers that metastasize to Bone | What bones are more common?
Prostate (blastic), Breast (lytic and blastic), Lung (lytic), Thyroid, Testes Axial skeleton
141
Metastatic Brain tumors Frequency Location Appearance
50% of brain tumors are metastatic Gray/White Junction Multiple well circumscribed tumors

USMLE STEP 1 (25 decks)

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