Pathology - First Aid / Pathoma

Question 1

Apoptosis

Answer 1

Programmed cell death. ATP required.
No inflammation.

Intrinsic: mitochondrial pathway (due to cell injury, DNA damage, or decreased hormonal stimulation) leads to inactivation of Bcl2

Extrinsic: rs ligand pathway

• FAS ligand binds FAS death rs (CD 95) on target cells which activates caspases
• TNF binds TNF rs on target cell and activates caspases

Cytotoxic CD8+ T cell mediaited pathway:
Perforins secreted and create holds in membrane through which granzymes enter to activate caspases.

Question 2

Proapopotic proteins

Answer 2

BAX
BAK
Apaf-1

Question 3

Anti-apoptotic proteins

Answer 3

Bcl-2

ex. follicular lymphoma w/ t(14;18) and overly expressed Bcl-2 which inhbits Apaf-1

Question 4

Types of Necrosis

Answer 4

Coagulative.
Liquefactive.
Gangrenous (dry and wet).
Caseous.
Fat (saponification/dystrophic calcification seen)
Fibrinoid.

Question 5

Reversible cell injury Characteristics

Answer 5

Cell/mitochondrial swelling - loss of microvilli and membrane blebbing.
Swelling of RER - dissociation of ribosomes and decreased protein synthesis.
Fatty change.

ATP depletion.
Glycogen decreased.

Question 6

Irreversible cell injury Characteristic

Answer 6

Nuclear pyknosis, karyorrhexis, karyolysis.
Hallmark of irreversible injury is : any type membrane damage.
-PM damage
-mitochondiral membrane damage
-lysosomal membrane damage

Question 7

Chromatolysis

Answer 7

Process involving neuronal cell body following axonal injury (first aid 225)

Question 8

Leukocyte extravasation

Answer 8

1. Margination and Rolling
2. Adhesion/Tight binding
3. Transmigration/Diapedesis @ post-cap venule
4. Migration/Chemotaxis
5. Phagocytosis
6. Destruction of phagocytosed material

*first aid 227

Question 9

How does Free Radical Injury arise?

Answer 9

Ionizing radiation.
Inflammation (ex. WBC NADPH oxidase).
Metals.
Drugs and chemicals (P450 etc).

Question 10

How to Eliminate Free Radicals?

Answer 10

Antioxidants (glutathione; Vitamins ACE)
Metal Carrier Proteins (transferrin, ceruloplasmin)
Scavenging enzymes (Superoxide dismutase, catalase, glutathione peroxidase)

Question 11

Two tissue mediators that stimulate angiogenesis…

Answer 11

FGF. “fibroblast growth factor”

VEGF. “vascular endothelial growth factor”

Question 12

Phases of wound healing

Answer 12

Inflammatory
Proliferative
Remodeling

Question 13

Primary amyloidosis

Answer 13

Systemic deposition of AL amyloid.
Derived from Ig light chain
Associated with plasma cell dsycrasias (ex. multiple myeloma)

Question 14

Secondary amyloidosis

Answer 14

Systemic deposition of AA amyloid which is derived from the acute phase reactant SAA

Chronic inflammatory states.
Familial Mediterranean fever (FMF).

Question 15

Classic findings of Systemic Amyloidosis

Answer 15

Diverse involvement since almost any tissue can be involved:
Nephrotic syndrome (kidney is mc involved).
Restrictive cardiomyopathy or arrhythmia.
Tongue enlargement, malabsorption, hepatosplenomegaly.

• Amyloid can’t be removed - organs must be transplanted
• Diagnose via tissue biopsy (ex. abdominal fat pad or rectum) - congo red stain/apple green biorefringence

Question 16

Localized Amyloidosis

Answer 16

Senile cardiac amyloidosis.
Familial amyloid cardiomyopathy.
T2DM.
Alzheimer disease.
Dialysis-associated amyloidosis.
Medullary carcinoma of the thyroid.

Question 17

What’s a benign/malignant name for neoplasm of connective tissue?

Answer 17

Fibroma.

Fibrosarcoma.

Question 18

Carcinomas spread via…

Answer 18

Lymphatics.

Exceptions:
Renal cell carcinoma 
Hepatocellular carcinoma
Follicular carcinoma of the thyroid
Choriocarcinoma

Question 19

Diseases assoc. w/neoplasms: Acanthosis nigricans

Answer 19

rare paraneoplastic indicator of visceral malignancy

but more commonly assoc. with insulin resistance

Question 20

Diseases assoc. w/neoplasms: Barrett esophagus

Answer 20

Esophageal ADC

Question 21

Diseases assoc. w/neoplasms: Chronic atrophic gastritis, postsurgical gastric remnants

Answer 21

Gastric carcinoma

Question 22

Tuberous Sclerosis

Answer 22

Rare multisystem genetic disease that causes benign tumors to grow in the brain and on other vital organs such as the kidneys, heart, eyes, lungs, and skin.
A combination of symptoms may include seizures, intellectual disability, developmental delay, behavioral problems, skin abnormalities, and lung and kidney disease.
TSC is caused by a mutation of either of two genes, TSC1 and TSC2, which code for tumor growth suppressor proteins hamartin and tuberin, respectively.
Ex. A child presents w/mental retardation, seizures, and facial angiofibromas. What 3 tumors is this child at risk for?
Often manifests w/multiple hamartomatous (benign) tumors including giant cell astrocytoma, renal angiomyolipoma, and cardiac rhabdomyomas; the tumors may become malignant

Question 23

Plummer-Vinson syndrome

Answer 23

AKA Paterson–Brown–Kelly syndrome or sideropenic dysphagia.
Rare disease characterized by difficulty in swallowing, iron deficiency anemia, glossitis, cheilosis and esophageal webs. Treatment with iron supplementation and mechanical widening of the esophagus generally provides an excellent outcome.
Nowadays, extremely rare. Generally occurs in postmenopausal women.
Increased risk of squamous cell carcinomas of the esophagus and pharynx