Pathology: Block 1 Flashcards
Cell injury depends on what 3 things?
Type of injury
Duration/severity
Type of cell
List 4 examples of cell systems that are vulnerable to injuries
Membrane- integrity
Mitochondria- ATP supply
RER- protein synthesis
Nucleus- genetics
Define Ischemia, Hypoxia, and Anoxia
Difference between the 2?
Ischemia- insufficient blood flow, lacks O2 and nutrients
Hypoxia- reduces O2
Anoxia- complete lack of O2, impedes cell respiration, NaK pump failure= 0 ATP
Of the 3 forms of reduced O2 supply to tissues, which one is fastest?
Ischemia causes injury faster than hypoxia
How/why does ischemia-reperfusion injury cause damage?
Returning O2 to site activates free radicals which releases MORE radicals and cytotoxic enzymes
What are the 5 types of cellular adaptations that can occur from adverse/prolonged stimuli?
Atrophy Hypertrophy Hyperplasia Metaplasia Dysplasia
Define Hyperplasia and what causes it
Increased size due to an increase in the NUMBER of cells
Hormone / chronic injury
Define Metaplasia
Reversible change in TYPE of cell
What is the sequence of changes from metaplasia to cancer if a stimulus is not removed?
Metaplasia
Dysplasia
Neoplasia
Cancer
Define Dysplasia
Disorderly arrangement/layering of cells
Define Necrosis
Premature/unnatural death of organs/tissue which then release inflammatory factors
What are the 3 types of necrosis
Coagulative- most common form
Liquefactive
Caseous
What causes coagulative necrosis?
What part of this process allows the superficial tissue to retain it’s shape/structure?
Rapid hypoxia or anoxia
Rapid inactivation of hydrolytic enzymes prevents tissue lysis
Where does coagulative necrosis most commonly occur?
Solid organs
Where does liquefactive necrosis commonly occur?
Brain, lytic enzymes change tissue to pus
What causes casous necrosis?
TB/Fungal infections cause cells to fall apart
What is the difference in final events between necrosis and apoptosis?
Necrosis- non membrane= inflammation
Apoptosis- membrane= phagocytosis
Define Dystrophic Calcification
Give two examples
Pathological calcification that occurs in dead/dying tissue from any type of necrosis
(atheromas of athersclerosis)
Define Metastatic Calcification
Give two examples
Pathological calcification that occurs in normal tissue other disease process causes secondary hypercalcemia
(hyperparathyroidism, multiple myeloma, Vitamin D toxicity, renal failure)
What are 4 processes found in the pathogenesis of inflammation/
Circulation
Permeability
WBC response/activation
Mediators
What step of the inflammation pathogenesis process does chemotaxis occur?
3- WBC response/activation
What step of the pathogenesis process does WBC adhesion get activated?
4- by cytokines (mediators)
Acute/immediate inflammation response brings in what WBC?
Neutrophils- granulocytic cells in blood circulation
Chronic inflammation includes what physiological changes and what kind of WBCs?
Vascular proliferation and tissue changes/scars
Lymphocytes and macrophages- agranulocytic cells in tissues
What are the cardinal signs of inflammation?
Redness- erythema/rubor
Heat- calor
Pain- dolor
Swelling- tumor
What are the 3 major steps of acute inflammation?
Dilation
Increased permeability
Emigration of leukocytes
What is the body’s first response to injury?
What causes this reaction?
Dilation- induced mostly by histamine
What are 3 types of mediators that would be found during the second step of the acute inflammation process?
Histamine
Bradykinin
Leukotrienes
During what step of the acute inflammation process do WBCs accumulate and become active?
3- emigration of leukocytes
What are the sequence of signs/symptoms of the acute inflammation process?
Warmth
Erythema
Edema
What are the 2 classes of inflammation mediators?
Plasma derived- from liver
Cell derived- cells
What are the 3 types of plasma-derived mediators?
Acute-phase proteins
Factor 7 (Hageman factor)
Complement proteins
What are the two types of cell-derived mediators?
Preformed (Mast, Platelets, Neutrophil macrophages)
Newly synthesized (leukocytes, leukocyte macrophages, endothelial macrophage lymphocytes)
Histamine is what type of mediator?
Where does it come from?
Cell derived
Mast, Basophil, Platelet
Leukotrienes and prostaglandins are what type of mediators?
Cell-Derived Arachidonic acid derivatives
Arise from membranes to be metabolized through either LOX or COX pathways
What does the Lipoxygenase pathway produce?
Leukotrienes- chemotaxis and permeability
Lipoxins- phagocytosis
What does the Cyclooxygenase pathway produce?
Prostaglandin
Thromboxane
Prostacyclin
What are the functions of prostaglandins?
Vasodilation
Vascular permeability
Pain
Fever
What are the functions of thromboxane?
Platelet aggregation
Thrombosis
Vasoconstriction
What are the functions of prostacyclin?
Counteracts Prostaglandins and Thromboxane so effects don’t become too extreme
Why are anti-inflammatory drugs taken?
COX inhibitors
Inhibit prostaglandin and thromboxanes
What are the functions of bradykinins?
Same as histamine but at slower pace
Amplifly/prolong inflammatory response
Begins coagulation
Creates pain
How are bradykinins formed?
Activation of hageman factor (coagulation factor 7)
What 2 things comprise the complement system?
Innate and Adaptive immunity
What are the 3 functions of the complement system?
Prolongs inflammation
Phagocytosis via opsonization
Cell lysis- membrane attack complex
Define the Complement System
Cascade of proteins acting through separate pathways to end in Membrane Attack Complex to destroy a cell
Define the Complement System Alternate Pathway?
Bacterial/fungal endotoxins/snake venom
Does NOT use Ag-Ab complex
What sequence of events starts the Complement’s Alternate Pathway?
IgA and properdin activate complement B and D to influence C3
Define the Complement Lectin pathway
Starts w/ carbohydrate binding on bacterial surface
How are Plymorphonuclear Neutrophils visually identified?
Segmented nucleus and cytoplasm w/ granules
“neutrophilic granulocytes”
What are 4 unique characteristics of PMNs?
1st to appear in acute inflammation
Phagocytic
Granules kill w/ O2 radicals
Produces cytokines, promotes fever
PMNs make up ? % of circulating WBCs?
Eosinophils make up ? %
60-70%
2-3%
Eosinophils are associated with ? activity?
Interact w/ basophils during Allergic reactions
and Parasitic infections
What are 2 unique characteristics about eosinophils?
Slower to sites than PMNs but survive longer (seen w/ chronic inflammation)
Have mobility, phagocytic and bactericidal actions similar to PMNs
Basophils are predominant in allergic reactions mediated by what?
IgE
Basophils are precursors of what cells?
Mast cells
What is the other 2 names of macrophages?
Tissue mononuclear cells
Histiocytes
Where are macrophages derived from?
Blood monocytes
How are macrophages visually identifiable?
One large nucleus
What two cells are longer living than PMNs and are seen in chronic infectious states?
Eosinophils
Macrophages
Platelets contain granules with what 4 substances?
Histamine
Coagulation proteins
Cytokines
Growth factors
Acute inflammatory reactions have what 3 outcomes?
Complete resolution
Healing by scar/fibrosis
Chronic inflammation
Chronic inflammation is characterized by what 3 characteristics?
Mononuclear infiltration
Tissue destruction
Repair
What 4 things can cause chronic inflammation?
Resistant microbes
Immune responses
Toxic substances
Foreign bodies
Systemic inflammation is AKA ?
Acute phase reaction
What are the 3 acute-phase proteins?
What are they indicative from?
CRP
Fibrinogen
Serum amyloid
Acute-Phase Reaction
What are the clinical S/Sx of systemic inflammation?
Fever from PMN released pyrogens Leukocytosis Inc HR/BP Decreased sweating Anorexia
Fever during systemic inflammation triggers what reaction to occur in the brain?
Prostaglandin synthesis in hypothalamus
Systemic inflammation that presents with anorexia, somnolence and malaise are secondary to what event?
Cytokine impact on brain cells
Define Serous Inflammation
Mildest form of inflammation
Caused by physical agents
Define Fibrinous Inflammation
Exudate w/ fibrin and cellular debris
Bacterial infection
Define Purulent Inflammation
Yellow fluid of dead PMNs/tissue debris
Bacterial infection
What is the difference between fibrinous and purulent inflammation locations?
Purulent can be on mucosa, skin or internal organs
Abscesses
Define Ulcerative Inflammation
Surface tissues broken down from underlying inflammation
Define Pseudomembranous Inflammation
Combined ulcerative inflammation w/ fibrino-purulent exudate
C. Diff is an example of what type of inflammation?
Pseudomembranous
Define Granulomatous Inflammation
Chronic inflammation, not acute
Macrophage and fibroblasts create barrier
TB, histoplasmosis, sarcoidosis and parasites are what type of inflammation?
Granulomatus
What starts the wound healing and tissue repair process that is critical to the survival of an organism?
Inflammatory response
What are the two types of wound healing/tissue repair reactions?
Regeneration
Scar formation
Define the Regeneration Reaction of wound healing
Proliferation of residual/uninjured cells and tissue replacement by stem cells
Define the Scar Formation reaction of wound healing
When injured tissues are incapable of regeneration or severe damage has occurred to supporting structures
Scar formation occurs from what type of tissue?
Fibrous connective
What does scar tissue have and what does it lack?
Structure stability for integrity
Cannot replace function of lost cells
What are the 4 steps of the wound healing process?
Hemostasis
Inflammatory
Proliferative
Remodeling
Wound resolution and consequences depend on what?
Type of cells injured
Define Labile Cells and their wound healing capabilities
Continuously divide and self-replace
Easily regenerate for wound healing
What type of cells are most affected by chemo/radiation therapy?
Labile- skin, GI tract, hematopoietic
Give 3 examples of Labile Cells
Skin
GI tract
Hematopoietic
Define Stable Cells and their wound healing capabilities
Rarely self-divide but can be stimulated to replicate
Where are Stable Cells found?
Kidney proximal renal tubule
Liver
Define Permanent Cells and their wound healing capabilities?
Non dividing cells that lack the capacity to replicate
No new cells form, only fibrous scarring
Where are Permanent Cells found within the body?
Neurons
Myocardium
What cells are least affected by chemo/radiation therapy?
Neurons
Myocardium
Permanent cells
Define Angioblasts and when do they arrive during the wound healing process?
Precursors to blood vessels
Appear 2-3 days after injury
When do Fibroblasts arrive during the wound healing process and what is their function?
Several weeks later
Re-establishes the extracellular matrix by producing fibrinoectin and collagen
Myofibroblasts are hybrid properties of what two things?
Smooth muscles
Fibroblasts
What are myofibroblasts purpose during the wound healing process?
Contract pulling margins inward
Reduces wound size allowing proliferating epithelium to fill in the injured site
What events happen during the Hemostasis phase of wound healing?
Vasoconstriction then dilation
Platelet activation
Coagulation
Fibrin + platelet + RBC=clot
What events happen during the Inflammation phase of wound healing?
Vessels leak into wound and cause localized swelling
Controls bleeding and prevents infection
What events happen during the Proliferation phase of wound healing?
New tissue from collagen and fibronectin
Epithelialization
Wound contracts and new vessels are formed
During epitheliazation, what layer of the skin differentiates?
Deep basal differentiate into layers
What events happen during the Tissue Remodeling phase of wound healing?
Maturation phase
Begins 21 days after injury
Collagen is remodeled and wound fully closes
Define Stricture
Tubular structures are narrowed by the healing process
Define First/Primary Intention
Clean, uninfected laceration that is healed by epitherlial regeneration as the principal mechanism
During what part of wound healing does tensile strength increase with time?
First/Primary intention
Define Secondary Intention
Large/complex wound healing for dirty/ulcerated wounds
Secondary intention includes what two processes?
Regeneration
Scarring
During what phase of wound healing is a large scar and inflammatory reaction more intense?
Secondary intention due to abundant granulation tissue
What type of medication/mineral must be avoided during wound healing?
Glucocorticoids- anti-inlfammatory affect weakens scar
What are 3 types of wound healing complications?
Dehiscence- separation of margins due to tension or infection
Hypertrophic- thicker than expected
Keloid- Taller and wider scar than original wound (more common in dark skin individuals)
List 4 parts of Inate Immunity
Mechanical Barriers- skin/cilia
Phagocytic cells- neutrophil, macrophage
NK Cells- special t-lymphocytes
Protective Proteins- lysozyme, properdin
Where are Lysozyme and Properdin proteins found and what are their purpose?
Lysozyme- body fluid protective protein
Properdin- alternate complement
Acquired immunity is the “learned” immunity and is based off of responses to ?
Ags- any chemical/biological substance that induces a specific immune response
Acquired Immunity words towards what end goal?
Immunocompetence- body’s ability to mount appropriate immune responses now and for future events
Difference between Primary and Secondary Lymphoid tissue?
Primary- B/T lymphocytes production
Secondary- B/T colonized in lymph nodes
Tonsils, adenoids and spleens are heavily colonized by which lymphocyte?
What colonizes GI/Bronchial mucosa?
B Lymphocytes
MALT
70% of circulating lymphocytes are ?
T-cells
Function of CD4 cells
Part of Ag response
Help B lymphocytes produce Abs
What cell secretes cytokines?
CD4- secrete interleukin
What does interluekin cause once it’s secreted?
Stims macrophages to become phagocytic
Triggers IgE/immunoglobulins to activate eosinophil and basophils
Function of CD8 cells?
Suppress unwanted Ab production
Mediates killing of foreign cells
CD4 cells are AKA?
CD8 cells are AKA?
4- Helper-T cells
8- Suppressor/cytotoxic cells
Function of NK cells?
Subset of T-cell that lacks an Ag receptor
Recognizes cells infected by viruses
What does the CD in CD4 or CD8 cells stand for?
Cluster Differentiation
What cell is essential for Ab production?
B Cells
Why are B cells essential for Ab production?
Congegrate in nodes/spleen and activate Ab production gene to form Ag receptors on cell surfaces
What is triggered when Ag attaches to B cell surfaces?
Plasma Cells
Define Plasma Cell
Fully differentiated decendents of B cells w/ numerous ER
Function of Plasma Cells
Mass Ab production and release into circulation
Abs are AKA and have what two parts?
Immunoglobulins w/ heavy and light chains
What are the Heavy and Light Chains of Abs?
Heavy- determines Ab property/function that is specific and unique to each class Light- variable for targeted Ag
RBCs have _____ and serum has _____
RBC= Ag Serum= Ab
What Ag and Abs does Group A blood have?
RBC= A Ag Serum= anti-B Abs
What Ag and Abs does Group B blood have?
RBC= B Ag Serum= anti-A Abs
What Ag and Abs does Group O blood have?
RBC= No Ags Serum= anti-A and anti-B Abs
What Ag and Abs does Group AB blood have?
RBC= both A and B Ags Serum= No Abs
What blood type if the universal RBC donor?
What blood type is the universal RBC recipient?
O- donor
AB- recipient
What is the Rh factor?
D antigen on surface of RBCs
How/when are Anti-D antibodies formed since they’re not naturally occurring?
Rh neg PT exposed to Rh pos
Female birthing Rh pos baby or transfusion of Rh pos blood
What happens to Rh factors of a mother during pregnancy?
Rh neg exposed to Rh pos forms IgG Abs that can cross placenta
1st Rh pos baby- not harmed due to lack of Rh Abs in mother
2nd Rh pos baby will be killbed by Anti-D Abs
What is the purpose/use of RhoGam?
Given to mother w/ing 12hrs of deliver to destroy fetal Rh pos RBC and prevents her from forming Anti-D Abs
Define Cross-Match blood transfusion
Type and Cross
Donor serum mixed w/ recipient RBCs
Recipient serum mixed with donor RBCs
Define Type and Screen blood transfusion
PT blood is typed but not cross-matched
What type of blood transfusion locks in donor blood for a specific recipient/PT?
Cross-Match/ Type and Cross
What type of blood transfusion identifies a “soft reserve” and allows for greater blood bank flexibility?
Type and Screen
During a Emergency Release blood trasnfusion what type of blood is pushed out?
Type O RBCs
What are the 3 types of blood transfusions?
Cross-Match
Type and Screen
Emergency Release
What type of transfusion reaction has the highest risk?
Whole blood
What is a “minor” transfusion reaction?
Reaction to preservative
Urticaria, fever, bronchospasms
Minor transfusion reactions can be reduced by using ?
Leukocyte-poor RBCs
What is a “major” transfusion reaction?
ABO mismatch
Fever/chills, back pain, dyspnea, renal failure
What steps are take and what things are given to a PT after a “major” transfusion reaction?
Stop transfusion
IV fluids
IV BiCarb
Donor and PT blood to lab
Define Hypersensitivity reaction
Abnormal immune response to exogenous Ag or endogenous auto-antigens
What are the 4 classifications of hypersensitivity reactions?
1- anaphylactic/atopic
2- cytotoxic Ab-mediated
3- immune complex
4- cell mediated/delayed type
Type I hypersensitivity reaction is what type of response?
IgE mediated response
Allergin sensitized B cells->Plasma Cells->IgE
Which hypersensitivity reaction requires a prior exposure for the reaction to take place?
Type I
What happens during a Type I hypersensitivity reaction if PT is re-exposed?
Ag-Ab complex form on Basophils or Mast Cells
Histamine released and increases permeability->edema->emigration of inflammatory cells
What are the inflammatory cells involved in a Type I hypersensitivity?
Eosinophils
Give four clinical examples of Type I hypersensitivities?
Anaphylaxis
Asthma
Atopic dermatitis
Allergic Rhinitis
What events occur during a Type II hypersensitivity
IgG or IgM mediated Ag-Ab complex
Ab bind to Ag in basement membrane and activates complement system->MAC->Cytotoxicity
During what type of hypersensitivity do Abs target a specific tissue or cell of the body?
Type 2
What are the intrinsic or extrinsic causes of a Type 2 hypersensitivity?
Intrinsic- autoimmune
Extrinsic- Drug, Virus, Chemical are seen a foreign and mimics an autoimmune response
What are 5 clinical examples of Type 2 Hypersensitivities
Transfusion Reaction Graves Disease Goodpasture's Syndrome Myasthenia Gravis Hemolytic Anemia
Define and explain Graves Disease
Hyperthyroidism AKA thyrotoxicosis
Auto-Abs bind to TSH receptor and stims over production of thyroid hormone
Define and explain Goodpasture’s Syndrome
Auto-Ab attacks collagen in lungs and kidneys
Causes damage to renal glomeruli (blood and protein) and SOB/bloody cough
Define and explain Myasthenia Gravis
Auto-Abs attach to Ach receptors on striated muscle cells blocking Ach stimulation leading to severe muscle weakness
Define and explain hemolytic anemia
Auto-Abs against RBC Ags
Results in clumping/destruction of RBCs w/ the fragments collecting in spleen (splenomegaly), hemolyzed RBCs cause bilirubin and jaundice
What is the less common hypersensitivity reaction?
Type 3
Define and explain Type 3 hHypersensitivy?
Ag-Ab complex mediation that incorrectly deposit on structure and become trapped on semi-permeable membranes where they accidentally activate complement systems to recruit WBCs leading to cell damage
What are 3 clinical examples of Type 3 hypersensitivity?
Systemic Lupus Erythematosus
Post Strep Glomerulonephritis
Polyarteritis nodos
What mediates Type 4 Hypersensitivity?
Previously sensitives T Cells or macrophages
NO Ab involvement
Define and explain Type 4 hypersensitivity?
No Ab involvement
Macrophages take up Ag and presents to T cells causing cytokine release transforming macrophages to epithelioid cells and formation of granulomas
What are 2 clinical examples of Type 4 Hypersensitivity?
Contact dermatitis
Granulomatus reactino from TB, Fungi or sarcoidosis
What does contact dermatitis result in?
Wheal formation
Vesicles
What type of hypersensitivity is a TB test?
Delayed type
Autoimmune diseases can be diagnosed when what 3 situations exist?
Auto-Abs documented
Immune mechanism causes pathologic lesion
Disorder has an immune origin
What are the two forms of autoimmune diseases?
Systemic- multi-organ
Specific- limited to one organ
What are examples of systemic autoimmune diseases?
Lupus Erythematosus Rheumatic fever RA Systemic sclerosis Polyarteritis nodosa
What are examples of organ-specific diseases?
Brain- MS Thyroid- Hashimotos Blood- AI hemolytic anemia Kidney- glomerulonephritis Muscle- myastenia gravis Skin- pemphigus vulgaris
What are some characteristics of Systemic Lupus Erythematosus?
Common in women
Type 3 hypersensitivity
Triggers synthesis of more self cells
Anti-Nuclear Abs to nuclear proteins
What are the criteria for diagnosing Systemic Lupus Erythmatosus?
Arthritis Renal disorder Dermatitis Serositis Neurologic disorder Vasculitis Hematologic disorder
What are skin S/Sx of Systemic Lupus Erythmatosus?
Malar rash (butterfly rash that spares nasolabial folds)
Discoid rash
Oral/pharyngeal ulcer
Photosensitivity
Define Immunodeficiency/Immune Compromise
Inadequate immune response causing reduces resistance to infections
What is lymphopenia a disease example of?
Immunodeficiency
What are the two types of immunodeficiency diseases?
Primary- congenital: T/B cell differentiation affected
Acquired- more common: immunosuppression, marrow dysfunction, diabetes, AIDS
What kind of virus is HIV?
Retrovirus- replicating by reverse transcriptase in T Cells
What is the CD4:CD8 ratio in HIV?
4:8= 2:1 AIDS= .5:1
Crisis phase symptoms of HIV occur when CD4 counts drop below?
Less than 200
What are the opportunistic infections seen in AIDs?
Cytomegalovirus Candida Crytpococcus TB Herpes simplex
What kind of tumors are seen in AIDS PTs?
Kaposi sarcoma
Lymphoma
Define Neoplasia
New Growth
How are tumors named?
-oma suffix
What kind of origin does carcinoma and sarcoma have?
Carcinoma- epithelial
Sarcoma- mesenchymal
What are the 3 exceptions to tumor name appearing benign but is not?
Melanoma
Lymphoma
Leukemia
What are the benign types of epithelial tumors?
Pailloma
Adenoma
What is the malignant type of epithelial tumor?
Carcinoma
What are the benign and malignant mesenchymal tumors?
Benign: oma suffix
Malignant: - sarcoma suffix
What is the hallmark S/Sx of anaplasia?
Anaplasia- lack of differentiation
Due to slow growth, benign tumors retain what characteristic?
Encapsulated- makes tumor mobile, discrete and palpable
Due to rapid growth, malignant tumors generally possess what 2 characteristics?
Poorly demarcated from surrounding normal tissue
Locally invasive allowing for metastases
What is the most reliable feature that separates malignant from benign tumors?
Locally invasive
What characteristic marks a tumor as malignant?
Metastasis
Metastasis risk increases with what 4 things?
Non-differentiated
Aggressive local invasion
Rapid growth
Large size
What are the three pathways that tumor metastasis spread?
Hematogenous spread
Lymphatic spread
Seeding of body cavities/surfaces
What 2 organs and what part of the organ are most frequently involved in hematogenous spreading?
Liver
Lungs
Veins penetrated easier
Define sentinel lymph node
First node to receive lymphatic drainage from primary tumor site
What procedure is often used to detect metastatic cells?
Biopsy of sentinel nodes
Where is malignancy seeding often seen?
Peritoneal cavity
What is the criteria used to determine the extent a tumor has spread?
Staging- based on clinical exam, radiology, biopsy and surgery offers more prognostic value than grading
What procedure/method is better for predicting a PTs outcome
Staging
What is the most common method of staging?
TNM System
T- Tumor size T1T2T3T4
N- number of lymph nodes w/ cancer NXN0N1
M- metastasis MOM1
How is cancer grading conducted?
Histologic exam of tumor
What method/procedure is used for treatment planning of certain cancers?
Grading
Cancer grading reflects the degree of _______
Differentiation
Less differentiation= aggressive
What is the Cancer Grading system?
X- unknown I- well differentiated, low grade II- Moderate diff, intermediate III- poor diff, high grade IV- undifferentiated, high grad
What are examples of chemical carcinogens?
Asbestos Nitrosamines Naphthylamine dyes Arsenic Aflatoxin
What are examples of carcinogen microbes?
H. Pylori
S. Haematobium
What are examples of viral carcinogens?
Oncovirus
HPV
Epstein-Barr Virus
Hep B
UV light radiation causes what three types of cancer?
SCC
BCC
Melanoma
What types of ionizing radiation are carcinogens?
A, B, G
What is the link between skin damage from radiation and treatment?
Tissues easily damaged by radiation can be readily treated by radiation therapy
What type of cells are most sensitive by ionizing radiation?
Stem Cells Hematopoietic Reproductive Epidermis- skin/intestine 1st trimester fetus
What tissues are least sensitive to ionizing radiation?
Nerve cells
Bone
Muscle
Define proto-oncogenes?
Normal cellular genes that regulate cell growth and differentiation
Define Oncogenes?
Mutated/damaged proto-oncogene leading to uncontrolled cell growth
Proto-oncogenes can be changed into oncogenes by what 4 mechanisms?
Point Mutation
Gene Amplification- more copies=inc malignancy
Translocation- causes over-expression of adjacent gene
Insertion of viral genome
Define Tumor Suppressor Gene
Anti-oncogene w/in normal cells due to protective action against oncogene activation
Name 3 examples of genetic causes of cancer?
Familial adenomatous polyposis coli
Neurofibromatosis Type 1
Wilms’ tumor (nephroblastoma)
What are Cafe Au Lait spots associated with?
Neurofibromatosis Type 1
Where can tumor markers be isolated from?
Blood
Urine
Stool
Cancerous tissue
What are malignant cell tumor markers?
Retention of functions essential for survival
Regression to fetal/embryonic functions
Tumor markers may be used for what 4 things?
Diagnosis
Predict response
Assess treatment response
Monitoring
Tumor marker do not generally recommended for routine screening with what exception?
Prostate Specific Antigen
What is Alpha-fetoprotein tumor marker used for detecting?
Liver
Testicles
Ovaries
What is CA-125 tumor marker used for detecting?
Ovarian
Lung
Breast
What is Carcinoembryonic Antigen tumor marker used for detecting?
Colon
Lung
Breast
Ovary
What is Human Chorionic Gonadotropin tumor marker used for detecting?
Testicular
Breast
Most cancer occur during _____ of life and are caused by _____?
Mid-later
Environmental causes
What are the dominant risk factors for most cancers?
Environmental influences
What are the top two environmental factors of cancer epidemiology?
Smoking
Alcohol
What does the CAUTION acronym mean for cancer?
Change in bowel/bladder A sore that doesn't heal Unusual bleeding/discharge Thickening lump on breast Indigestion Obvious wart/mole change Nagging cough/hoarseness
Define Cachexia
Common Sx in cancer PTs
Wasting away of body fat/muscle
Weak, anorexia, anemia
Define Paraneoplastic Syndrome
Earliest sign of occult neoplasm
Hypercalcemia
Hypercoagulability
What is the most common S/Sx in Paraneoplastic Syndrome?
Hypercalcemia
Define Hereditary Disorder
Define Familial Disorder
Define Congenital disorder
H= derived from parents F= through generations C= present at birth but are NOT genetic
__% of pediatric pediatric inpatients have a genetic disorder?
20%
Define Morphogenesis
Evolution/development of organ/body part
What happens with errors of morphogenesis?
Incompatible w/ life
Spontaneous abortion during 1st trimester
Define Agenesis
Absence of organ
Organ contain primordial tissue
Define Aplasia
Entire organ mass is comprised of primordial tissue
Define Atresia
Absence/closure of a body opening
Define Hypoplasia
Underdevelopment of tissue/organ/body
Define Involution Failure
Persistence of embryonic structures long into development
What types of morphogenesis errors usually result in non-viable births?
Agenesis
Aplasia
__% of congenital defects are idiopathic
75%
Define Teratogens
Agents known to cause fetal malformations
What are the 3 types of teratogens
Physical- radiation
Chemical- ETOH (most preventable teratogen)
Microbial- TORCH
Define TORCH syndrome
Toxoplasmosis Other Rubella- german measles Cytomegalovirus Herpes
Define Genome
Complete set of chromosomes
Define Keryotype
What can it be AKA?
Full chormosome set contained w/in a nucleus
AKA- chromosomal count/code
Define Genotype
Genetic form
Set of instructions that may/not be expressed
Define Phenotype
Physical form
Unique appearance that can be effected by environment
What two parts make up the observed phenotype?
Expressed genotype
Environmental influence
What are the 3 types of chromosome structural abnormalities?
Deletion
Inversion/breakage
Translocation
Define Numerical Abnormality
Loss/gain of chromosome
Define Aneuploid
Cells possessing abnormal numbers of chromosomes
Define Euploid
Normal number of chromosomes
Define 47XXY
Define 45XO
Klinefelters syndrome (male) Turners syndrome (female)
What are the odds of females delivering a baby w/ Downs?
Over 45y/o= 1:25
Prenatal counseling is required for women older than __y/o
35
What are the clinical characteristics of Down’s Sydrome?
Retardation Epicanthal folds Macroglossia Simian Crease Internal organ defects Hematologic disorders
What is the incidence reate of Klinefelters Syndrome?
1:700
Little/no sperm production
Rarely passed/inherited
What are the clinical characteristics of Klinefelters?
2* characteristics not fully developed at puberty
Body habitus
Learning disability
What are the incidence rates of Turner’s Syndrome?
1:3000
Ovaries don’t mature or atrophy
What are the clinical characteristics of Turner’s Syndrome?
2* characteristics not developed at puberty
Body habitus
Heart defects
What are the 3 main patterns of single gene disorders?
Autosomal dominant
Autosomal recessive
Sex-linked
Define Autosomal Dominant
Homozygous AA or heterozygous Aa
Dominant traits expressed
A will over ride a in heterzygous pairing
Define Autosomal Recessive
Homozygous aa
Recessive trait might be expressed in phenotype
Define Sex-Linked Disorder
Primarily recessive disorders w/ X-linked chromosomes
X and Y are not direct alleles of each other
What are examples of autosomal dominant disorders?
Marfans Familial hyperchoesterolemia Polycystic kidney disease Huntingtons Osteogenesis imperfecta
What is the incidence rate and characteristics of Marfan’s Sydrome?
1:5000
CT issue of fibrillin
Why is the lack of fibrillin in Marfan’s Syndrome important?
What happens without it?
Glue for CT structure
Heart failure/Aortic rupture
What are the clinical characteristics of Marfan’s Syndrome?
Tall/slender habitus w/ elongated head
Elongated fingers, loose joints
Aortic aneurysms
Cataracts/lens detachments
What is the most important and frequently encountered autosomal disorder in the US?
Familial Hypercholesterolemia
Mutated gene the encodes LDL
What are the clinical characteristics of Familial Hypercholesterolemia?
Atherosclerosis/heart disease
Xanthomas- lipid rich nodules
Eyelid deposits
What are the characteristics of Polycystic Kidney Disease?
Abnormal flank pain
PAINLESS hematuria
UTI
Hypertension
When do Huntington’s Disease symptoms start?
What is the life expectancy after diagnosis?
30-40
10-15yrs after due to pneumonia, fall, suicide
What is the pathogenesis of Huntington’s Disease?
Progressive neurological disorder of involuntary movements leading to premature brain death and atrophy
What are the clinical characteristics of Huntington’s Disease?
Chloreiform movements- gyrating movement of trunk and limb
Grimacing face
What is Osteogenesis Imperfects AKA and what is the cause of the disease?
Brittle Bone Disease
Defected Type I Collagen
What are the clinical characteristics of Osteogenesis Imperfecta
Multiple, easy Fx
Can be confused w/ abuse
Blue sclera
What is the largest group/variety of genetic disorders?
Autosomal recessive
Why are autosomal recessive disorders so large/common?
Encoded by genes on on eo f 22 autosomes and NOT the 23rd sex-linked gene
What are the basic features of autosomal recessive disorders?
Only in homozygous w/ both recessive genes present and usually w/ unaffected heterozygous parents
What are the common Autosomal Recessive Disorders?
CF SCA Phenylketonuria Wilson's Disease Hemochromatosis
What PT population is CF most common in?
Caucasian/Norther European
What autosomal recessive disorder is the most lethal?
CF
What is the pathogenesis for CF?
Abnormally thick mucus blocks airway and pancreatic ducts
What are the clinical characteristics of CF?
Pulmonary infections
Pancreatic insufficiency
How is CF diagnosed?
Pilocarpine test- sweat test for excess NaCl in sweat
What is the pathogenesis of SCA?
Hgb defect causes sickling when O2 is low
Define a Sickle Cell Crisis?
Fever
Respiratory disease
Hemolysis of RBCs causing anemia and jaundice
Define Splenic Sequestrian Crisis?
Spleen over removes sickling RBCs causing acute anemia and spleen damage
PKU is the lack of what enzyme?
Phenyalanine hydroxylase- metabolizes phenylalanine into tyrosine
What are the clinical characteristics of PKU?
Excess phylalanine causes melanin synthesis inhibition, PT have fair skin/hair and blue eyes
Continued build up leads to retardation and seizure
What kind of diet do PKU PTs have to follow?
Avoid- meat, fish, nuts, legumes, dairy products and aspartame
What are the X-linked recessive diseases?
Hemophilia Duchenne Muscular Dyst. Fragile X Syndrome Color blindness G6PD Deficiency
How are X-linked recessive diseases passed along?
Mother->son
Only fertile male-> daughters
What form of hemophilia is more rare?
B- 1:30K
What is the pathogenesis for Hemophilia?
Coagulation factor 8 (A) or 9 (B)
What are the clinical characteristics of hemophilia?
B s/sx always severe
Easy nose/oral bleeding
How is hemophilia treated?
Infusion of man-made recombinant clotting factors
Who does Duchenne Musc. Dystrophy effect?
1:3300 males
What is the pathogenesis of Duchenne Muscular dystorphy?
Defected dystophin protein which normally interacts w/ contractile proteins to maintain shape
What are the clinical characteristics of Duchenne Muscular Dystrophy
Affects skeletal muscle
Progressive muscle weakness/wasting
What is the difference between male and females inheritting Fragile X Disease?
Males= mental deficiency
What is the pathogenesis of Fragile X Syndrome?
Amplification of fragile portion of X-chromosome
What are the clinical characteristics of Fragile X Syndrome?
Mental retardation
Macro-orchidism in 90% of prepubertal males
Define Multifactorial Inheritance
Familial disorders don’t follow Mendelian genetic rules
What are the traits/disease features of multifactorial inheritance?
Product of several genes
Ex/endogenous influences
Genes encoding error exhibit dose effect
Sibling risk determined from familial data
What are examples of multifactorial inheritance?
Dwarfism
Hypertenstion
Diabetes
Gout
What are increased/decreased levels of Alpha-Fetoprotein indicative of?
Inc= brain/kidney abnormalities Dec= Down's
What is Chorionic Villus Biopsy used for?
Tissue sample of placenta for chromosomal and enzyme analysis
When is an amniocentesis performed?
12 - 18wks for chemical/chromosomal analysis
Extracellular fluid is a combination of what two liquids and what majority ions?
Interstitial and plasma
High Na, Low K
Intracellular fluid is made up of what ions?
Low Na, High K
How much liquid is required per day to clear byproducts of metabolism?
500-800ml/day
Define Edema
Excess fluid collection in interstitial spaces and body cavities
Interstitial space is AKA ?
Third space
Edema results form an imbalance between what things?
Permeability
Oncotic pressure
Venous pressure- obstruction or overload
Lymphatic obstruction- or inadequate drainage
High permeability causes leakage to where?
Interstitial space
What helps maintain oncotic pressure?
Albumin holds fluid inside of blood vessels
What happens to bodily fluids if there is an increase in hydrostatic pressure?
Pushes fluid outside of vessels
Define Localized Edema
Excess fluid in tissue, organs or body cavities
What is the difference in naming tissue/organ edma and body cavity edema?
Tissue/organ= location + edema Body= hydro + location
Define Generalized Edema
Excess fluid accumulation through out the body
Generalized edema is generally due to one of three things
Heart, liver, kidney failure
Generalized edema is AKA ?
Anasarca
Define Pleural Effusion
Hydrothorax
Fluid in chest
What is the difference between pleural effusion and pulmonary edema?
Pulmonary edema is inside of lung tissue
Pleural effusion is in thoracic cavity/pleural space outside of lung tissue
What are the specific gravities of transudates and exudates?
Trans- low, clear
Ex- high, pus
Transudate can arise from what three things?
Increased hydrostatic pressure- DVT
Decreased oncotic pressure- hypoalbuminemia
Decreased lymph drainage- lymph obstruction
Exudates tend to arise from what process?
Increased permeability, usually from inflammatory process
Pitting edema is usually caused by one of three things?
Hypoalbuminemia- nephrotic syndrome, malnutrition
CHF
Fluid overload- renal disease
How does CHF lead to pitting edema/pulmonary edema?
Insufficient blood from heart
Hyp-perfused kidneys
Renin->aldosterone
Inc Na/water retention from tubules
Inc intravascular press increases hydrostatic press in lungs
Fluid pushed from pulmonary capillaries to lung tissue
Define Hemothorax
Blood between lung and chest wall
Define Hemopericardium
Blood in pericardial sac
Define Hematoma
Blood collection in tissue
Define Hemoptysis
Coughing up blood
Define Hemodynamically Stable
Maintaining adequate blood flow to vital organs
Whats the difference between hematochezia and melena?
Melena- dark blood
Hematochezia- bright red blood in stool
What are 3 superficial skin signs of bleeding?
Petechiae
Purpura- nonblanching bruises
Ecchymosis
Thrombi are made up of what three things?
Platelet
Fibrin
RBCs
Why are thrombi created?
Prevent extravascular blood loss
In normal homeostasis, what balances clotting factors and platelets?
Endothelial cells
Plasmin
Define Virchows Triad
Injury to endothelium
Hemodynamic change
Hypercoagulate state
Where do DVTs usually form?
Leg
Pelvis
Axillary vein
Mesenteric vein
What are risk factors for developing DVTs?
Inactivity Smokers Pregnancy Oral contraceptives Cancer DVT history Aging
What are 4 forms of embolus
Thromboemboli- most common
Liquid
Gas
Solid particle- marrow/fat
What is the most significant result of venous emboli?
PE
Most PEs develop from what/where?
DVTs in leg or pelvis
What are the S/Sx os large emboli?
Sudden chest pain
Sudden SOB
Hemopytsis
Where do arterial emboli usually originate?
Heart
Large arteries
Aortic aneurysms release clots to what 3 locations?
Intestine
Kidney
Leg
What happens if an embolus stops in the brain or intestined?
Brain- ischemic stroke/infarct
Intestine- bowel ischemia/infarct
What happens if an embolus stops in a kidney?
Infarct w/ hematuria
What happens if an embolus stops in a lower extremity?
Small emboli- blue toe necrosis
Large- ischemia, cold pulseless leg
What is the first symptom of ischemia?
Pain
Define White Infarct
Arterial inflow obstruction causing paleness
Necrosis occurs downstream of blockage
Where are White Infarcts usually found?
Solid organs
Define Red Infarct
Venous outflow obstruction causing necrosis upstream of blockage
Where do Red Infarcts normally occur?
Intestine
Testes
Define Shock
Decreased tissue perfusion by blood
What are the 3 mechanisms of shock?
Pump failure- cardiogenic
Fluid Loss- hypovolemic
Loss of tone- Hypotonic/distributive shock
What are the 3 types of Distributive Shock?
Neurogenic
Anaphylactic
Septic
What are 4 causes of cardiogenic shock?
MI
C-fib
Pericardial tamponade
Tension pneumo
What is Beck’s Triad
Hypotension
Muffled heart sounds
JVD
What are symptoms of a pneumothorax?
Inc respiration/air hunger
Dec breath sound on affected side
JVD
Tracheal deviation (late)
What are 3 causes of JVD?
Heart Failure
Cardiac tamponade
Tension Pneumo
What are 2 causes of hypovolemic shock?
Hemorrhage
Water loss
What are the symptoms of hypvolemic shock?
Tachycardia Tachypnea Cold and clammy Increased thirst Light headedness Hypotension Confusion/Altered
What does a decrease in body fluids do to Hct levels?
Hemotoconcentration
Hemodilution if fluids added
Neurogenic shock is due to loss of what part of the NS?
Sympathetic
What are the 3 stages of shock?
Early/compensated
Decompensated
Irreversible
What are the S/Sx of early/compensated stages of shock?
Tachcardia
Vasoconstriction
Reduced urine output
Normal BP
What are the S/Sx of decompensated stage of shock?
Compensation begins to fail Hypotension Tachy and SOB Oliguria Acidosis
What are the S/Sx of irreversible stage of shock?
Circulatory collapse
What kind of response is a vasovagal syncope?
Neurocardogenic response
Mild form of neurogenic/cardiogenic shock
What causes a vasovagal syncope?
Tigger stimuli Enhanced PNS vagal tone, bradycardia Dec sympathetic tone, dilation Brain is under perfused and faints
What are the clinical characteristics of a vasovagal syncope?
Prodrome- light head, N/V, tunnel vision, pale
Brief LOC
Supine-restoration
Immediate regain of consciousness w/out amnesia or post-ictal symptoms
What are the two progenitor cells that give rise to blood cell lines?
Myeloid cells
Lymphoid cells
Define Myeloid Cells
Granyles w/ complex nucleus
Neutrophils
Eosinophils
Basophils
Define Lymphoid Cells
Lack granules w/ large, dense nucleus
T/B-Cells
NKCs
Why do RBCs have a biconcave shape?
Increased SA for O2/CO2
What is the structural make up of Hgb?
4 heme groups
4 globins
Arranged in 4 pyrrole rings w/ central Fe molecule
How are the 4 globin chains of Hgb designated?
A
B
G
D
Normally adult heme is Hgb __
A
2A, 2B
What are the 4 RBC indices?
MCV- avg volume/size per RBC
MCH- avg Hgb per RBC
MCHC- avg Hgb concentration per RBC
RDW- variation of RBC volume
What measurement is not a part of RBC indices?
Reticulocyte Count (Retic)- number of immature RBCs in sample
What is the Reticulocyte Count a measurement of?
Reflection of bone marrow production of new RBCs
Distinguishes between inadequate production vs anemic RBC destruction
How to tell between marrow or anemic cause for Reticulocyte Counts?
Marrow responds to anemic state by increasing production (inc Retic count), anemia is not from inadequate production
What are the two anemia classifications?
Etiological/pathogenesis- decreased/abnormal production, inc loss/destruction of RBCs
Morphological- looks or content
What are the clinical features of anemia?
Dec O2 causes hypoxic symptoms
Palesness
SOB
Drowsiness
What are anemia levels for M/W?
M- less than 13g
F- less than 11.5g
Define Decreased Hematopoiesis
Bone marrow failure- aplastic anemia/myelophthisic anemia
Nutrient Deficiency- Fe, B12, protein
Define Aplastic Anemia
Loss of stem cells from bone marrow causing pancytopenia
Define Myelophthisic Anemia
Replacement of bone marrow by cancers/fibrosis/granulomas
Leukemia, multiple myeloma
What are the two causes of Aplastic Anemia?
Idiopathic
Secondary- marrow suppressed by drugs/virus
What is the pathogenesis of Aplastic Anemia?
Marrow becomes hypocellular
Stem cells replaced by fat
What are the clinical features of Aplastic Anemia?
Uncontrolled infections/bleeding
Insidious fatigue/pallor/weakness
What is the treatment for Aplastic Anemia?
Bone marrow transplant
Most PTs that die from Aplastic Anemia die from what?
Sepsis
What is the most common form of anemia?
Fe defficiency
What is the etiology of Iron Deficiency Anemia
Inc Fe loss
Inadequate Fe uptake
Increased Fe requirements
What is the pathology of Iron Deficiency Anemia?
Microctyic/hypchromic
Target cells- abnormal heme distribution
What are the clinical features of Iron Deficiency Anemia
More common in females
Males- secondary to occult bleeding (GI ulcer, cancer)
How is Iron Deficient Anemia treated?
Fe supplements but with investigation to underlying cause
Define Megaloblastic Anemia
B12/Folic acid deficiency
What is the pathology for Megaloblastic Anemia?
Large/hyperchromic RBCs
Hypersegmentation of WBCs
Lack of B12 leads to what specific anemia and caused by what?
Pernicious Anemia
Bowel disease
Stomach surgery
What causes folic acid anemia?
Pregnancy
Lactation
ETOH abuse
What are the clinical features of megaloblastic anemia?
Fatigue
Palor
SOB
Weak
Pernicious anemia has what unique clinical features?
Dec vibratory sense Dec reflexes (permanent)
How is megaloblastic anemia treated?
B12 shots
Folate supplements
What is usually the cause of abnormal hepatopoiesis?
What are 3 examples?
Genetics
Sickle Cell
Thalassemia
Hereditary Spherocytosis
What causes Thalassemia?
Defect in Hgb A, A or B chain
What causes Hereditary Spherocytosis?
RBC structural protein error
What causes Sickle Cell?
Defect during AbA Synthesis causing HbS production
What kind of genetic disorder is Sickle Cell?
Autosomal Recessive
People with HbS below __ % are asymptomatic
40%
What is the pathology of Sickle Cell?
Multiple Organ infarcts
What are the clinical features of Sickle Cell?
Fetal HgF -> adult HbA
Abnormal cell lysis->jaundice
Splenic sequestration crisis
Sickle Cells affects what part of the Hgb chain?
Beta
Sickle Cell affects ? population?
Thalassemia affects ? population?
African/Mid-Eastern
Mediterranean/SE Asia
Define Alpha Thalassemia and Beta Thalassemia
A- A chain defect, less severe
B- B chain defect, severe/lethal
What is the pathology of thalassemia?
RBCs are microcytic and hypochromic with target cells
Hbg electrophoresis IDs subtype HbA2
Thalassemia pathology is similar to what other blood disorder?
Iron deficiency
Define Hereditary Spherocytosis
Structural protein defect of RBC cytoskeleton
Causes dec in RBC flexibility, leading to RBCs lyses and capture in spleen
What is the pathology of Hereditary Spherocytosis?
RBCs are small spherical, not biconcave
Microcytic and hyperchromic (normal Hgb on smaller RBC)
What are the clinical characteristics of Hereditary Spherocytosis
Hemolytic/aplastic crisis if RBC destruction exceeds production
What is the treatment method for Hereditary Spherocytosis?
Splenectomy
Destruction of RBCs usually occur from ?
Hemolytic anemia
What are some common causes of destruction of RBC leading to hemolytic anemia?
Malaria Autoimmune hemolytic anemia Mismatched transfusion Hemolytic disease in newborn Drugs: anti-malarial, sulfa trigger lysing event in PTs w/ G6PD
Define Lymphadenopathy
What is a red flag here?
Enlarged lymph node w/out not specific cause
Slowly enlarging, persistent and non-tender- early cancer
Define Lymphadenitis
Infected lymph node
Enlarged and tender w/ possible abscess
Define Lymphangitis
What are some S/Sx that would be seen
Infection of lymph vessels
Red streaking- blood poisoning
Fever, chills, leukocytosis
What are the two forms of plycythemia?
Primary- vera, myeloproliferative disorder considered neoplastic. Hematopoietic stem cell proliferation w/out external stimuli
Secondary- over production of RBCs w/ increase stimulation by increased erythropoietin
Secondary polycythemia is usually caused by what event?
Prolonged hypoxia
What are the clinical features of polycythemia?
Splenomegaly
Red/flushed skin
Hyperviscous blood w/ easy clotting
Headache, hypertension
What is the treatment for polycythemia?
Cytotoxic drugs Therapeutic phlebotomy (blood letting)
What are some causes of leukopenia?
What are these PTs at risk for?
Cytotoxins- chem/rad PTs
Overwhelming infections
Define Leukocytosis
Normal response to inflammation/infection
Prolonged leukocytosis may represent what other disease?
Malignancy
Neutrophilia is indicative of ?
Eosinophilia is indicative of ?
Lymphocytosis is indicative of ?
Bacterial
Allergy, parasitic
Viral, chronic TB
What are 3 malignant disease of WBCs?
Leukemia
Lymphoma
Multiple Myeloma
What are the 4 types of leukemia
ALL/CLL
AML/CML
What are the two types of lymphomas?
Non-Hodgkins
Hodgkins
What is the most common form of leukemia in children, especially under the age of five?
Acute lymphoblastic leukemia
What is the pathogenesis of Acute Lymphoblastic Leukemia
Bone marrow w/ immature blast (lymphoid) cells
Malignant lymphoid cells in peripheral blood
What are the clinical features of Acute Lymphoblastic Leukemia?
Enlarged lymph nodes
Splenomegaly
Rapid- recurrent infections, malaise, bleeding into skin
How is Acute Lymphoblastic Leukemia treated?
Chemo
W/out chemo= fatal in 3-6mon
What PT population is Acute Myelogenous Leukemia common in?
Most common acute leukemia in +65y/o
Acute Myelogenous Leukemia is linked to what environmental factors?
Radiation
Benzene
What is the pathogenesis of Acute Myelogenous Leukemia?
Proliferation of myeloblasts
Blast cells take over marrow and smother normal stem cells
What are the clinical features of Acute Myelogenous Leukemia?
Enlarged spleen/nodes
What is the treatment for Acute Myelogenous Leukemia
Chemo/radiation/BMT
High recurrence rate
Chronic Meylogenous Leukemia usually infects what PTs?
Adults over 30y/o
What is the pathogenesis of Chronic Myelogenous Leukemia?
Bone marrow over run by malignant cells
Chronic Myelogenous Leukemia PTs usually have what genetic abnormality?
Philadelphia chromosome abnormality on #22
What are the clinical features for Chronic Myelogenous Leukemia?
Slow onset fatigue, infections, splenomegaly
What are the 3 phases of progression of Chronic Myelogenous Leukemia
Chronic- 2/3yrs w/ leuko/thrombocytosis
Accelerated- inc blast production in marrow
Blast Crisis- death
What is the treatment method for Chronic Myelogenous Leukemia?
Radiation w/ chemo
What is the PT population for Chronic Lymphocytic Leukemia
Older adults above 50y/o
Why is Chronic Lymphocytic Leukemia hard to diagnose?
Lymphocytes are indistinguishable from normal lymphocytes
What are the clinical features of Chronic Lymphocytic Leukemia
Slow progression of increase infections
What is the treatment method for Chronic Lymphocytic Leukemia?
No chemo
What is the pathogenesis of lymphoma?
B-cell phenotypes
What are the clinical features of lymphoma?
Painless lymph nodule
Extra nodule tumor spread
Fatigue/malaise/fever
What are the 3 subtypes of lymphoma?
Follicular- older population has slow growing tumor, least response to treatment
Diffus large B cell- most aggressive but most responsive to treatment
Burkitts- Common in Africa, endemic in kids w/ EBV
What part of the body does Burkitt’s Lymphoma effect?
Mandible, face
What is the incidence of Hodgkin’s Lymphoa?
Bi-modal peaks at 25 and 55
What are the clinical features of Hodgkin’s Lymphoma?
Large nodes- neck, mediastinum
Reed-Sternberg cells
What is the pathogenesis of Multiple Myeloma?
Malignant plasma cells proliferate in bone marrow casuing punched-out look
What are the clinical features of Multiple Myeloma?
Serum protein electrophoresis
Bence-Jones proteins
How is Multiple Myeloma treated?
Ineffective to chemo, death from renal failure
Characteristics of Idiopathic Thrombocytopenic Purpura?
Auto-Abs to platelets destroy them in spleen
Acute to children post-viral infection
Easy bleeding from gums/nose
Chronic ITP needs splenectomy
Characteristics of Thrombotic Thrombocytopenic Purpura
Abnormal clotting in small cells
Primary- Abx breaks up Von Willebrand clotting factor
Secondary- from cancer, pregnancy, HIV
Easy bleeding gums, nose, hemolytic anemia
How is TTP treated?
Plasmapheresis to remove Abs
What are the inherited Bleeding Disorders?
A- 8 disorder
B- 9 disorder
Von Willebrands Disease- autosomal dominant
Easy/ecess bleeding
Tx w/ infusion of concentrated blood-clotting factors
What medication is contraindicated in PTs with Von Willebrand’s?
Aspirin- due to inhibitory affect on platelets