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First Aid > Pathology Day 2 > Flashcards

Pathology Day 2 Flashcards

1
Q

In what stage of wound healing do you see clot formation?

A

Inflammatory (up to 3 days after wound)

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2
Q

What are the time periods for the 3 stages of wound healing?

A
  1. Inflammatory = 0 days - 3 days
  2. Proliferative = 3 days - weeks
  3. 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+

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3
Q

In what stage of wound healing do you see angiogenesis?

A

Proliferative (granulation tissue= angiogenesis and fibroblasts)

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4
Q

In what stage of wound healing do you see wound contraction?

A

Proliferative (the myofibroblasts in the granulation tissue pull it in)

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5
Q

In what stage of wound healing do you see clot dissolution?

A

Proliferative (clot formation = inflammatory)

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6
Q

In what stage of healing do you see type 1 collagen?

A

Remodeling (type 3 is replaced by type 1, with the help of collagenase and zinc)

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7
Q

Why does vitamin C deficiency cause delayed wound healing?

A

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

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8
Q

Why does zinc deficiency cause poor wound healing?

A

Collagenase (removes type 3 collagen to be replaced with type 1) needs zinc as a cofactor

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9
Q

What are the 8 infectious diseases that cause granulomas?

A
  1. Bartonella henselae (cat scratch disease)
  2. Francisella tularensis
  3. Listeria monocytogenesis (infantiseptica)
  4. M. leprae (Leprosy/Hansen disease)
  5. M. tuberculosis
  6. Treponema pallidum (syphilis… tertiary only)
  7. Schistosomiasis
  8. Fungal infections
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10
Q

What vessel polyangiitis disease cause granulomas? How is each diagnosed?

A
  1. Wegeners (Granulomatosis with polyangiitis) – bloody nose, cough, urine
    * *C-ANCA**
  2. Churg-Strauss (Eosinophilic granulomatosis with polyangiitis) - asthma, neuropathy
    * *P-ANCA**
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11
Q

What stain do we use for TB?

A

AFB

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12
Q

What stain do we use for fungi?

A

silver

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13
Q

Which abdominal problem causes granulomas?

A

Crohn’s disease

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14
Q

How are granulomas maintained?

A

Th1 -> IFN gamma -> macrophages -> TNFalpha

*memory: T-I-Me To make a granuloma (Th1, iiiiinterferon, mmmmacrophages, tttttnf)

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15
Q

Before starting anti-TNF alpha therapy for ankylosing spondylitis, what other disease must you check for?

A

Tuberculosis, because anti-TNFalpha drugs can cause sequestering granulomas to break down, leading to disseminated TB

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16
Q

Transudate vs. exudate: Which is protein rich?

A

exudate

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17
Q

Transudate vs. exudate: Which is cellular?

A

exudate

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18
Q

What is the cutoff for a specific gravity value of transudate vs. exudate?

A

1.020 (exudate is higher, transudate is lower)

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19
Q

What 3 processes cause exudate?

A
  1. Inflammation
  2. Malignancy
  3. Lymphatic obstruction
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20
Q

What 3 processes cause transudate?

A
  1. Heart failure (increased hydrostatic pressure)
  2. Cirrhosis (decreased oncotic pressure)
  3. Sodium retention
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21
Q

What is the physiologic reason why ESR indicates inflammation?

A

Products of inflammation, like fibrinogen, coat RBCs and cause them to aggregate, which makes them heavier, so they will have a higher ESR

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22
Q

Does PREGNANCY cause a high or low ESR?

A

high

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23
Q

Does SICKLE CELL cause a high or low ESR?

A

Low (sickled cells don’t fall as fast, they have like little parachutes)

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24
Q

Does POLYCYTHEMIA cause a high or low ESR?

A

Low (dilutes out aggregation factors)

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25
Q

Does HEART FAILURE cause a high or low ESR?

A

Low

*memory: Think of everything failing including your fragment stuff

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26
Q

Does CANCER cause a high or low ESR?

A

High

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27
Q

What shape does amyloid like to take on?

A

Beta pleated sheet

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28
Q

What causes AL amyloid?

A

Multiple myeloma (Ig light chains)

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29
Q

What causes AA amyloid?

A

Chronic inflammation (RA, IBD, spondyloarthritis, infection) – serum amyloid A accumulation

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30
Q

What causes dialysis-related amyloid?

A

Fibrils of beta2-microglobulins

*memory: you want 2B dialysis free

NOTE: Can present as carpal tunnel

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31
Q

What causes heritable amyloid?

A

transthyretin gene mutation

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32
Q

What causes senile/age-related amyloidosis?

A

transthyretin

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33
Q

Which form of amyloid is often asymptomatic?

A

Senile/age-related (present in 25% of people over 80 yrs old)

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34
Q

What cause amyloid deposition in Alzheimer disease?

A

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)

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35
Q

What type of amyloid is seen in type 2 diabetics?

A

Amylin deposition -> Islet amyloid polypeptide (IAPP)

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36
Q

What is lipofuscin?

A

A “wear and tear” pigment associated with normal aging. Formed by oxidation and polymerization of autophagocytosed roganellar membranes

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37
Q

What is the difference between dysplasia and carcinoma in situ?

A

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)

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38
Q

What is P-glycoprotein? What disease is it associated with?

A

A multi drug resistance protein (MDR1) classically seen in adrenal cell carcinoma that pumps out chemotherapeutic agents, so allows cancer cells to resist chemotherapy

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39
Q

What is the difference between metaplasia and dysplasia?

A 
metaplasia = replaced by another MATURE cell type
dysplasia = replaced by immature cells
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40
Q

What is anaplasia?

A

Loss of cell differentiation; reverting to immature. May see big cells with single large nucleus or several nuclei.

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41
Q

Is neoplasia = malignant?

A

No, you can get benign neoplasia. Neoplasia is just an excessive clonal proliferation.

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42
Q

What is desmoplasia?

A

Fibrous tissue formation in response to a neoplasm (ex: linitis plastica in diffuse stomach cancer)

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43
Q

How do most carcinomas spread?

A

lymphatics

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44
Q

How do most sarcomas spread?

A

blood

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45
Q

What mediates cachexia?

A

TNF-alpha (cachexia, fever, granulomas)

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46
Q

Which carcinomas are STRANGE in that they like to spread via blood instead of lymphatics?

A
  1. Renal cell carcinoma (renal vein)
  2. Hepatocellular carcinoma (hepatic vein)
  3. Choriocarcinoma
  4. Follicular thyroid carcinoma

*memory: Folliculary thyroid Flows to the blood

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47
Q

Where does ovarian cancer like to seed?

A

omentum (omental caking)

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48
Q

What is acanthuses nigricans associated with?

A
  1. Insulin resistance

2. Malignancy

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49
Q

What does Barrett esophagus predispose to?

A

Adenocarcinoma (NOT squamous!)

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50
Q

Wht does chronic atrophic gastritis predispose to?

A

Gastric adenocarcinoma (Can be a T-cell atrophic gastritis that causes B12 deficiency, or can be an H-pylori gastritis)

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51
Q

What disease predisposes you to colonic adenocarcinoma?

A

Ulcerative colitis

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52
Q

What is the precursor to SCC of the skin?

A

Actinic keratosis

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53
Q

What does dermatomyositis and polymyositis predispose to?

A

Genitourinary malignancy

Note: Btoh do symmetric progressive proximal muscle weakness
derma = CD4, rash
(poly = CD8)

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54
Q

What is the precursor to malignant melanoma?

A

Dysplastic nevus

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55
Q

What does Paget disease of the bone predispose you to?

A

Osteosarcoma + fibrosarcoma

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56
Q

What does Plummer-Vinson syndrome predispose you to?

A

SCC of the esophagus

PVS = dysphagia, iron-deficiency anemia, esophageal webs, beefy red tongue

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57
Q

What are the clinical signs of tuberous sclerosis?

A

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

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58
Q

What cancers does AIDS predispose to? Immunodeficiency in general?

A

AIDS: Lymphoma, Kaposi
Immunodef: Lymphoma, Melanoma, RCC

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59
Q

What does hashimoto’s thyroiditis predispose to?

A

Lymphoma

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60
Q

What does SLE predispose to?

61
Q

What cancer does Down syndrome predispose to?

A

ALL

*memory: we ALL fall DOWN

62
Q

What cancers are involved in Li-Fraumeni syndrome? What mutation is it associated with?

A

Sarcoma, breast, leukemia, adrenal gland

p53 mutation

63
Q

What cancers does radiation predispose to?

A

Leukemia, sarcoma, papillary thyroid, breast

64
Q

What gene product and tumor is associated with BCR-ABL?

A

Tyrosine Kinase
CML, ALL

*memory: Ty-ro-sine is 3 syllables, and ALL CaMeLs have 3 humps (lets pretend they do)

65
Q

What gene product and tumor is associated with BCL-2?

A

Apaf-1 (no apoptosis)
Follicular lymphoma, undifferentiated lymphoma

*memory: BCL-2 takes care of YOU (its anti-apoptic) and your Feelings (Follicular)

66
Q

What gene product and tumor is associated with BRAF?

A

Serine/threonine kinase
Melanoma, Non-hodgkin Lymphoma

*memory: Sir Brave (Serine, BRAF) is tall, dark (Melanoma) and over 21 (Non-hodgkin)

67
Q

What gene product and tumor is associated with c-kit?

A

Cytokine receptor
GIST (gastrointestinal stromal tumor)

*memory: C-kid, its a Cytokine, you get the GIST

68
Q

What gene product and tumor is associated with c-myc?

A

Transcription factor
Burkitt Lymphoma

*memory: microphones (myc) in a factory (transcription factor)
AND
*memory: kids seem-like (c-myc) they are booking it (Burkitt) from ages 11 to 14 (t11;14)

69
Q

What gene product and tumor is associated with HER2/neu?

A

Tyrosine kinase
Breast, ovarian, gastric

*memory: women have breasts, ovaries, and big tummies

Same as erbB2

70
Q

What gene product and tumor is associated with erbB2?

A

Tyrosine kinase
Breast, ovarian, gastric

*memory: women have breasts, ovaries, and big tummies

Same as HER2/neu

71
Q

What gene product and tumor is associated with L-myc?

A

Transcription factor
Lung tumor

  • memory: microphones in a factory (myc stuff will always be transcription factors)
  • memory: LLLLL myc for LLLLung
72
Q

What gene product and tumor is associated with N-myc?

A

Transcription factor
Neuroblastoma

  • memory: microphones in a factory (myc = transcription factor stuff)
  • memory: NNNNN my for NNNNueroblastoma
73
Q

What gene product and tumor is associated with RAS?

A

GTPase
Colon, lung, pancreatic cancer

*memory: It’s a RACE (ras) to Get To the toP (GTPase), so you jump from colon -> pancreas -> lung

74
Q

What gene product and tumor is associated with RET?

A

Tyrosine kinase
Men 2A, Men 2B, medullary thyroid cancer

*memory: from the endocrine section! Men like to WRECK (RET) things

75
Q

What are the tumors associated with MEN1?

A

Parathyroid
Pancreas (ZE, VIPoma, insulinoma)
Pituitary

*memory: Theres always that ONE MAN that wants to be your pa-pa-pi

76
Q

What are the tumors associated with MEN 2A?

A

Medullary thyroid carcinoma
Parathyroid
Pheochromocytoma

*memory: Men love to go TO A (2A) MEDiocre PoRn Film

77
Q

What are the tumors associated with MEN 2B?

A

Medullary thyroid carcinoma
Pheochromocytoma
Ganglioneuromas/mucosal neuromas

*memory: Men love TO BE (2B) MEDiocre Film Guests

78
Q

What single physical finding are MEN 2A and 2B associated with?

A

Marfinoid habitus

79
Q

What tumor is associated with APC?

A

Colorectal cancer

*memory: Appreciate your Colon

80
Q

What gene product and tumor is associated with BRCA1/BRCA2?

A

DNA repair
Breast and ovarian cancer

*memory: BRCA repairs DNA BReaks

81
Q

What tumor is associated with DCC?

A

colon cancer

*memory: Deleted in Colon Cancer

82
Q

What tumor is associated with DPC4/SMAD4?

A

pancreatic cancer

*memory: Deleted in Pancreatic Cancer

83
Q

What gene product is associated with MEN1?

84
Q

What gene product and tumor is associated with NF1?

A

Ras GTPase activation protein = neurofibromin = a negative regulator of Ras (because GTPase cleaves Ras to give the signal)

Neurofibromatosis type 1 —> hamartomas, pheochromocytomas, optic gliomas, neurofibromas

85
Q

What gene product and tumor is associated with NF2?

A

Merlin protein = schwannomin protein

Neurofibromatosis type 2 –> bilateral acoustic neuromas

*memory: Its elusive, like a wizard (merlin)

86
Q

What gene product and tumor is associated with p16?

A

Cyclin-dependent kinase inhibitor 2A
Melanoma

*memory: Every 16 year old Princess tans so much as to get Melanoma. She should Stop the Cycle.

87
Q

What gene product and tumor is associated with p53?

A

Blocks G1 -> S phase by being a transcription factor for p21

Li-Fraumeni syndrome (and tons of other cancers)

88
Q

What tumors are associated with PTEN?

A

Breast, prostate, endometrial

*memory: private areas you want to PreTENd don’t get cancer

89
Q

What gene product and tumor is associated with Rb?

A

Blocks G1->S phase by inhibiting E2F

Retinoblastoma, Osteosarcoma

90
Q

p53 and Rb are both loss of function or gain of function mutations?

A

loss of function (both alleles must be lost)

91
Q

What gene product and tumor is associated with TSC1?

A

Hamartin protein
Tuberous sclerosis –>
subependymal astrocytomas, ungural fibromas, rhabdomyoma, angiomyoma, angiofibroma, hamartoma

*memory: Hammer Time (hamartin for 1, tuber in for 2)

92
Q

What gene product and tumor is associated with TSC2?

A

Tuberin protein
Tuberous sclerosis

*memory: Hammer Time (hamartin for 1, tuber in for 2)

93
Q

What gene product and tumor is associated with VHL?

A

Inhibits hypoxia inducible factor 1a

VHL disease –> hemangioblastoma, pheochromocytoma, renal cell carcinoma

94
Q

What gene product and tumor is associated with WT1 and WT2?

A

Nephroblastoma (Wilm’s tumor)

95
Q

Can tumor markers be used to diagnose cancer?

A

NO! Only for screening and to monitor recurrence/response to therapy

96
Q

What is Alk Phos a marker for?

A

Mets to the bone
Mets to the liver
Paget disease of the bone
Seminoma (from the placenta?)

97
Q

What is AFP a marker for?

A

Hepatocellulcar carcinoma
Hepatoblastoma
Yolk sac tumor (from the endodermal sinus?)
Mixed germ cell tumor

Pregnancy (transient)
Neural tube defects
Abdominal wall defects

If low: Down syndrome

98
Q

Significance of high b-HCG?

A

Hydatiform mole
Choriocarcinoma
Testicular cancer
Mixed germ cell tumor

NOTE: made by syncytiotrophoblasts

99
Q

Significance of high CA 15-3?

A

Breast cancer

100
Q

Significance of high CA 27-29?

A

Breast cancer

101
Q

Significance of high 19-9?

A

Pancreatic adenocarcinoma

*memory: the number 9 looks like the letter p for pancreas

102
Q

Significance of high CA 125?

A

Ovarian cancer

103
Q

Significance of high Calcitonin?

A

Medullary thyroid carcinoma

HINT: Watch out for this in MEN2A and Men2B. Medullary thyroid (mediocre) and film (pheochromo) are in both… parathyroid (porn) and guest (glioma) is different

104
Q

Significance of high CEA?

A

Very non-specific, but found in:
Colorectal cancer
Pancreatic cancer

*memory: Casually Estimate And guess (CEA)

And sometimes in:
Gastric
Breast
Medullary thyroid

105
Q

Significance of high chromogranin?

A

Neuroendocrine tumors (carcinoid)

106
Q

Significance of high PSA?

A

Prostate cancer
BPH
Prostatitis

107
Q

Which cancers are associated with Ebstein-Barr virus?

A

Burkitt Lymphoma
Hodgkin Lymphoma
Nasopharyngeal carcinoma (neck mass in chinese man)

If immunocompromised: Primary CNS lymphoma

*memory: you get the kissing disease if you are Dr. Burke (Burkitt), you’re young and sexy (Hodgkin), a neck slut (Nasopharyngeal), or crazy in the head (CNS lymphoma)

108
Q

Which cancers are associated with HBV and HCV?

A

Hepatocellular carcinoma

109
Q

Which cancers are associated with HHV-8? How does treatment change depending on the patient?

A

Kaposi sarcoma

If in an old man: Excise it
If in an AIDS patient: Boost immunity

110
Q

Which cancers are associated with HPV? Which types?

A

Cervical carcinoma
Penile carcinoma
Anal carcinoma
Head and neck cancer

Types: 16,18

111
Q

Which cancers are associated with H Pylori?

A 
Gastric adenocarcinoma (chronic gastritis)
MALT lymphoma
112
Q

Which cancers are associated with HTLV1?

A

Adult T cell leukemia/lymphoma

113
Q

Which cancers are associated with Liver Fluke (clonorchis sinensis)?

A

Cholangiocarcinoma

*memory: think of a little (Liver) fluke getting up into your bile ducts

114
Q

Which cancers are associated with schistosomiasis?

A

SCC of the bladder

115
Q

Which cancers are associated with Aflatoxins?

A

Hepatocellular carcinoma

116
Q

Which cancers are associated with Alkylating agents? How do alkylating agents work?

A

Leukemia/lymphoma

Attach an alkyl group to guanine in DNA

Ex: If you treated someone with Wegners granulomatosis with polyangitis with cyclophosphamide

117
Q

Which cancers are associated with Aromatic amines like 2-naphthylamine?

A

Bladder (transitional cell carcinoma)

118
Q

Which cancers are associated with Arsenic, like in cig smoke? How would you test for this?

A

Angiosarcoma of the liver
Lung cancer
Squamous cell carcinoma of the skin

119
Q

What are the carcinogens in cig smoke? Which is most important?

A 
Polycyclic Hydrocarbons *most important
Arsenic
Aromatic amines (2-naphthylamine)
120
Q

Which cancers are associated with Asbestos? Which is more likely?

A

Mesothelioma

Bronchogenic lung carcinoma **more likely

121
Q

Which pathologies are associated with CCl4?

A

Centrilobular necrosis of the liver
Fatty change in the liver

NOTE: Induced by free radicals. First cells swell, then fatty change, then necrosis.

122
Q

Which 7 cancers are associated with cig smoke?

A 
Esophageal - SCC or Adeno
Larynx - SCC
Lung - SCC or Small Cell
Kidney - RCC
Bladder - Transitional cell
Pancreas - Adeno
Cervix
123
Q

Which cancers are associated with ethanol?

A

SCC of the esophagus
Pancreatic cancer
Hepatocellular carcinoma

124
Q

Which cancers are associated with ionizing radiation?

A

Papillary thyroid carcinoma
AML
CML

*memory: PAC in that radiation

125
Q

Which cancers are associated with nitrosamines/smoked foods?

A

Gastric cancer (intestinal type) - esp in Japan

126
Q

Which cancers are associated with Radon?

A

Lung cancer *#2 cause of lung cancer after cig smoke

127
Q

Which cancers are associated with Vinyl Chloride (an occupational thing found in PVC pipes)?

A

Angiosarcoma of the liver

*memory: ANGIE is either looking for ARSe (arsenic) or flirting with Vinny (vinyl chloride)

high yield because a definitive study was done

128
Q

Which cancers cause high 1,25-OH-D?

A

Hodgkin lymphoma

Non-hodgkin lymphoma

129
Q

Which cancers cause excess ACTH?

A

Small cell lung carcinoma

Renal cell carcinom

130
Q

Which cancers cause excess ADH?

A

Small cell lung carcinoma

Intracranial neoplasms

131
Q

Which cancers cause antibodies against presynaptic calcium channels at the NMJ (Lambert-Earton)?

A

Small cell lung carcinoma

132
Q

Which cancers cause elevated EPO?

A 
Renal cell carcinoma
Hemangioblastoma
Hepatocellular carcinoma
Leimyoma
Pheochromocytoma
133
Q

Which cancers cause elevated PTHrp?

A

Squamous cell lung carcinoma
Renal cell carcinoma
Breast cancer

134
Q

Which cancers cause psammoma bodies?

A

Papillary carcinoma of the thyroid
Serous adenocarcinoma of the ovary
Meningioma
Mesothelioma

135
Q

What are the #1,2,3 cancers by incidence?

A
  1. Prostate/Breast
  2. Lung
  3. Colon/Rectum
136
Q

What are the #1,2,3 cancers by mortality?

A
  1. Lung
  2. Prostate/Breast
  3. Colon/rectum
137
Q

What are the #1,2,3 causes of death in the US in adults?

A
  1. CV disease
  2. Cancer
  3. Stroke
138
Q

What are the #1,2,3 causes of death in the US in kids?

A
  1. Accidents
  2. Cancer
  3. Congenital
139
Q

Where do brain mets usually come from?

A

Lung > breast > prostate > melanoma > GI

*memory: Log on to Brainscape for your Paper Money Guarantee

140
Q

Where do liver mets usually come from?

A

Colon&raquo_space;> Stomach > Pancreas

*memory: Cool Colors Steal the Prize (2 C’s for super&raquo_space;)

141
Q

Where do bone mets usually come from?

A

Prostate, Breast > kidney, thyroid, lung

*memory: PBKTL (lead kettle)

142
Q

What % of brain tumors are from mets?

143
Q

What do mets to the brain usually look like?

A

Well-circumscribed (WEIRD!) tumors at the gray/white junction

144
Q

What are the 2 most common sties of mets in general?

A

Liver and Lung

*memory: Love the Liver and Lung
remember red infarcts likely in liver, lung, and intestines because good blood supply

145
Q

What % of bone tumors are mets?

A

A lot. Way more common than primary bone tumor.

146
Q

Which bone mets are blastic? (the rest are lytic)

A

Prostate mets

sometimes breast mets

147
Q

Where in the skeleton do bone mets tend to go?

A

Akial skeleton

148
Q

What tumor is associated with t(14;18)?

A

Follicular lymphoma

*memory: BCL2 takes care of YOU (antiapoptotic) but Following you (follicular) until you are an adult (18)

149
Q

What chromosome has immunoglobulin heavy chain on it? What tumors are involved with it?

A

Chromosome 14 (*memory: I Got Good looking at age 14… IgG, 14)

Burkitt lymphoma = t(8;14) (c-myc) *kids CeeM to Bookit from ages 8 to 14

Mantle cell lymphoma = t(11;14) (cyclin D1) *you start to want the D at ages 11 to 14, you put boys on a MANTLE

Follicular lymphoma = t(14;18) (Bcl2) *Bcl2 takes care of YOU by Following you around until you are an adult age 18

First Aid (7 decks)

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