Pathology Day 2 Flashcards
In what stage of wound healing do you see clot formation?
Inflammatory (up to 3 days after wound)
What are the time periods for the 3 stages of wound healing?
- Inflammatory = 0 days - 3 days
- Proliferative = 3 days - weeks
- Remodeling = 1 week - 6 months
*memory: If you take a week (7 days) and split it in half, you get the layout…. 0-3, 3-7, and 7+
In what stage of wound healing do you see angiogenesis?
Proliferative (granulation tissue= angiogenesis and fibroblasts)
In what stage of wound healing do you see wound contraction?
Proliferative (the myofibroblasts in the granulation tissue pull it in)
In what stage of wound healing do you see clot dissolution?
Proliferative (clot formation = inflammatory)
In what stage of healing do you see type 1 collagen?
Remodeling (type 3 is replaced by type 1, with the help of collagenase and zinc)
Why does vitamin C deficiency cause delayed wound healing?
Because vitamin C is a co-factor for the hydroxylation of proline and lysine residues on pro-collagen, so that the alpha triple helix can be made –> no hydroxylation = looser triple helix
Why does zinc deficiency cause poor wound healing?
Collagenase (removes type 3 collagen to be replaced with type 1) needs zinc as a cofactor
What are the 8 infectious diseases that cause granulomas?
- Bartonella henselae (cat scratch disease)
- Francisella tularensis
- Listeria monocytogenesis (infantiseptica)
- M. leprae (Leprosy/Hansen disease)
- M. tuberculosis
- Treponema pallidum (syphilis… tertiary only)
- Schistosomiasis
- Fungal infections
What vessel polyangiitis disease cause granulomas? How is each diagnosed?
- Wegeners (Granulomatosis with polyangiitis) – bloody nose, cough, urine
* *C-ANCA** - Churg-Strauss (Eosinophilic granulomatosis with polyangiitis) - asthma, neuropathy
* *P-ANCA**
What stain do we use for TB?
AFB
What stain do we use for fungi?
silver
Which abdominal problem causes granulomas?
Crohn’s disease
How are granulomas maintained?
Th1 -> IFN gamma -> macrophages -> TNFalpha
*memory: T-I-Me To make a granuloma (Th1, iiiiinterferon, mmmmacrophages, tttttnf)
Before starting anti-TNF alpha therapy for ankylosing spondylitis, what other disease must you check for?
Tuberculosis, because anti-TNFalpha drugs can cause sequestering granulomas to break down, leading to disseminated TB
Transudate vs. exudate: Which is protein rich?
exudate
Transudate vs. exudate: Which is cellular?
exudate
What is the cutoff for a specific gravity value of transudate vs. exudate?
1.020 (exudate is higher, transudate is lower)
What 3 processes cause exudate?
- Inflammation
- Malignancy
- Lymphatic obstruction
What 3 processes cause transudate?
- Heart failure (increased hydrostatic pressure)
- Cirrhosis (decreased oncotic pressure)
- Sodium retention
What is the physiologic reason why ESR indicates inflammation?
Products of inflammation, like fibrinogen, coat RBCs and cause them to aggregate, which makes them heavier, so they will have a higher ESR
Does PREGNANCY cause a high or low ESR?
high
Does SICKLE CELL cause a high or low ESR?
Low (sickled cells don’t fall as fast, they have like little parachutes)
Does POLYCYTHEMIA cause a high or low ESR?
Low (dilutes out aggregation factors)
Does HEART FAILURE cause a high or low ESR?
Low
*memory: Think of everything failing including your fragment stuff
Does CANCER cause a high or low ESR?
High
What shape does amyloid like to take on?
Beta pleated sheet
What causes AL amyloid?
Multiple myeloma (Ig light chains)
What causes AA amyloid?
Chronic inflammation (RA, IBD, spondyloarthritis, infection) – serum amyloid A accumulation
What causes dialysis-related amyloid?
Fibrils of beta2-microglobulins
*memory: you want 2B dialysis free
NOTE: Can present as carpal tunnel
What causes heritable amyloid?
transthyretin gene mutation
What causes senile/age-related amyloidosis?
transthyretin
Which form of amyloid is often asymptomatic?
Senile/age-related (present in 25% of people over 80 yrs old)
What cause amyloid deposition in Alzheimer disease?
Beta-amyloid protein (cleaved from Amyloid Precursor Protein)
NOTE: This is present on chromosome 21, which is why Downs syndrome more likely to get Alz
*memory: remember to ALZo B A (beta-amyloid) Perfect Person (APP)
What type of amyloid is seen in type 2 diabetics?
Amylin deposition -> Islet amyloid polypeptide (IAPP)
What is lipofuscin?
A “wear and tear” pigment associated with normal aging. Formed by oxidation and polymerization of autophagocytosed roganellar membranes
What is the difference between dysplasia and carcinoma in situ?
Carcinoma in situ has increased N:C ratios, clumped chromatin, and takes up the whole thickness of the epithelium (whole epithelium is when CIN3 becomes CIS)
What is P-glycoprotein? What disease is it associated with?
A multi drug resistance protein (MDR1) classically seen in adrenal cell carcinoma that pumps out chemotherapeutic agents, so allows cancer cells to resist chemotherapy
What is the difference between metaplasia and dysplasia?
metaplasia = replaced by another MATURE cell type dysplasia = replaced by immature cells
What is anaplasia?
Loss of cell differentiation; reverting to immature. May see big cells with single large nucleus or several nuclei.
Is neoplasia = malignant?
No, you can get benign neoplasia. Neoplasia is just an excessive clonal proliferation.
What is desmoplasia?
Fibrous tissue formation in response to a neoplasm (ex: linitis plastica in diffuse stomach cancer)
How do most carcinomas spread?
lymphatics
How do most sarcomas spread?
blood
What mediates cachexia?
TNF-alpha (cachexia, fever, granulomas)
Which carcinomas are STRANGE in that they like to spread via blood instead of lymphatics?
- Renal cell carcinoma (renal vein)
- Hepatocellular carcinoma (hepatic vein)
- Choriocarcinoma
- Follicular thyroid carcinoma
*memory: Folliculary thyroid Flows to the blood
Where does ovarian cancer like to seed?
omentum (omental caking)
What is acanthuses nigricans associated with?
- Insulin resistance
2. Malignancy
What does Barrett esophagus predispose to?
Adenocarcinoma (NOT squamous!)
Wht does chronic atrophic gastritis predispose to?
Gastric adenocarcinoma (Can be a T-cell atrophic gastritis that causes B12 deficiency, or can be an H-pylori gastritis)
What disease predisposes you to colonic adenocarcinoma?
Ulcerative colitis
What is the precursor to SCC of the skin?
Actinic keratosis
What does dermatomyositis and polymyositis predispose to?
Genitourinary malignancy
Note: Btoh do symmetric progressive proximal muscle weakness
derma = CD4, rash
(poly = CD8)
What is the precursor to malignant melanoma?
Dysplastic nevus
What does Paget disease of the bone predispose you to?
Osteosarcoma + fibrosarcoma
What does Plummer-Vinson syndrome predispose you to?
SCC of the esophagus
PVS = dysphagia, iron-deficiency anemia, esophageal webs, beefy red tongue
What are the clinical signs of tuberous sclerosis?
HAMARTOMAS
Hamartomas Angiomyolipoma (ex: over both kidneys) Mental retardation Ash-leaf spots (white skin) Rhabdomyoma (esp. cardiac) Ts O autosomal dOminant Mitral regurg Angiofibroma (spots on skin) Seizures Shagreen patches (bumpy/fungus skin)
subependymal astrocytomas
ungual fibromas
What cancers does AIDS predispose to? Immunodeficiency in general?
AIDS: Lymphoma, Kaposi
Immunodef: Lymphoma, Melanoma, RCC
What does hashimoto’s thyroiditis predispose to?
Lymphoma