Pathology: inflammation Flashcards
1
Q
True or false: apoptosis requires ATP
A
True
2
Q
Apoptosis via the intrinsic pathway and extrinsic pathway both lead to activation of what proteins?
A
Caspases
3
Q
What is nuclear shrinkage seen in apoptosis?
A
Pyknosis
4
Q
What is the nuclear fragmentation seen in apoptosis?
A
Karyorrhexis
5
Q
What happens to the cytoplasm of cells undergoing apoptosis?
A
Deep eosinophilia
6
Q
DNA laddering, seen in apoptosis, is caused by what (name the process used, and the enzyme)?
A
Radiation, causing endonucleases to cleave DNA
7
Q
BAX is pro or anti apoptotic?
A
Pro
8
Q
Bcl-2 is pro or anti apoptotic?
A
Anti
9
Q
What is the chemical released from mitochondria that cause apoptosis?
A
Cytochrome C
10
Q
How does Bcl-2 prevent cytochrome 2 release?
A
Binds and inhibits Apaf-1
11
Q
What is the MOA of the intrinsic pathway of apoptosis?
A
Changes in regulating fators
12
Q
What are the two routes of the extrinsic pathway of apoptosis?
A
- Ligand receptor (FasL binds to Fas)
- CTL release of perforin/granzyme
13
Q
What is the the route of apoptosis that the thymus undergoes?
A
Fas +FasL
14
Q
What happens in the apoptotic pathway when Fas binds FasL?
A
Forms a death domain (FADD)
15
Q
Defective Fas-Fasl interaction is the basis for what types of disorders?
A
Autoimmune disorders
16
Q
What types of tissues undergo coagulative necrosis?
A
Tissues supplied by end arteries (heart, liver, kidneys) with cell walls
17
Q
What types of tissues undergo liquefactive necrosis?
A
Brain, abscesses–areas with high fat content
18
Q
What types of infections cause caseous necrosis? (3)
A
TB
Systemic fungal infections
Nocardia
19
Q
What causes the dark blue stain of fatty necrosis?
A
Ca deposits
20
Q
What are the histological characteristics of fibrinoid necrosis?
A
Amorphous and pink on H&E
21
Q
What are the two types of gangrenous necrosis?
A
Wet (Infection)
Dry (ischemic coagulative)
22
Q
Reversible with O2, or irreversible: ATP depletion
A
Reversible
23
Q
Reversible with O2, or irreversible: nuclear pyknosis, karyorrhexis, or karyolysis
A
Irreversible
24
Q
Reversible with O2, or irreversible: cellular/mito swelling
A
Reversible
25
Reversible with O2, or irreversible: nuclear chromatin clumping
Reversible
26
Reversible with O2, or irreversible: Lysosomal rupture
Irreversible
27
Reversible with O2, or irreversible: Mitochondrial permeability
Irreversible
28
Reversible with O2, or irreversible: cellular fatty changes
Reversible
29
Reversible with O2, or irreversible: ribosomal/polysomal detachment
Reversible
30
Reversible with O2, or irreversible:membrane blebbing
Reversible
31
What is the most susceptible part of the brain to necrosis?
ACA/MCA/PCA boundary areas
32
What is the most susceptible area of the heart to necrosis?
Subendocardium
33
What is the most susceptible area of the kidney to necrosis?
Straight segment of the proximal tubule
34
What is the most susceptible area of the liver to necrosis?
Central vein
35
What is the most susceptible area of the colon to necrosis?
Splenic flexure
36
Reperfusion injury is caused by what? What type of infarcts (red or white)
Free radicals
| Red
37
Pale infarcts occur in what types of tissue?
Solid tissues with single blood supply
38
What is the first sign of shock?
Tachycardia
39
What is distributive shock?
a medical condition in which abnormal distribution of blood flow in the smallest blood vessels results in inadequate supply of blood to the body's tissues and organs
40
What happens to total pulmonary resistance, cardiac output, and venous return in distributive shock?
Lower TPR
Increased CO
Increased venous return
41
What happens to the pulmonary capillary wedge pressure in distributive shock? cardiogenic shock? Hypovolemic shock?
```
Distributive = decreased
Cardiogenic = increased
Hypovolemic = decreased
```
42
Vasodilation or vasoconstriction: Distributive shock and hypovolemic/cardiogenic (match correctly)
Vasodilation in distributive
| Vasoconstriction for cardiogenic/hypovolemic
43
Which type of shock in which BP can be restored using IVF: cardiogenic or distributive
Cardiogenic/hypovolemic
44
An increased or decreased in endogenous hormones will cause atrophy?
Decrease
45
An increased or decreased in exogenous hormones will cause atrophy?
Increase
46
An increase or decrease in metabolic demand will cause atrophy?
Decrease
47
An increase or decrease in pressure (generally) will cause atrophy?
Increased (e.g. nephrolithiasis)
48
What are the cardinal signs of inflammation?
```
Rubor (redness)
Dolor (pain)
Calor (heat)
Tumor (edema)
Functio laesa (function loss)
```
49
What are the first WBCs that are seen in acute inflammation?
PMNs
50
What are the WBCs that are seen in chronic inflammation?
Mononuclear cells and fibroblasts
51
What is in a granuloma?
Nodular collections of epithelioid macrophages and giant cells
52
What is the hallmark cell that can be found in chronic inflammation?
Giant cells
53
What are the possible outcomes of chronic inflammation?
Scarring, amyloidosis
54
What is chromatolysis? What are the three hallmarks of it?
Neuron body cell changes after injury.
1. Round cellular swelling
2. Displacement of nucleus to the periphery
3. Dispersion of Nissl substance
55
What is dystrophic calcification? Is it associated with hypercalcemia?
Ca deposition in tissues secondary to necrosis
| NOT directly associated with hypercalcemia
56
What is metastatic calcification? Is it associated with hypercalcemia?
Widespread Ca deposition secondary to hypercalcemia
57
Which tissues are most affected by metastatic calcification?
Kidneys
Lungs
Gastric mucosa
58
Extravasation predominantly occurs where?
At postcapillary venules
59
What are the four steps of extravasation?
1. margination/rolling
2. Tight binding
3. Diapedesis
4. Migration
60
What are the two signaling proteins that allow for margination and rolling of PMNs?
E-selectin
| P-selectin
61
What are the two signalling proteins that allow for tight binding to occur?
ICAM1 (CD54)
| VCAM1 (CD106)
62
What is the one signalling molecule that allows for leukocyte diapedesis?
PECAM-1 (CD31)
63
What are the family of molecules that guide leukocytes to their destination after they have crossed the blood vessel border?
Chemotactic products
64
What are the three ways in which free radicals damage cells? (hint: three different classes of polymers)
Lipid peroxidation
Protein modification
DNA breakage
65
Which vitamins are antioxidants?
A
C
E
66
What is inhalation injury?
Damage to lungs/bronchi d/t inhalation of combustion byproducts
67
What are the two pathological types of scars?
Hypertrophic
| Keloids
68
Which has a higher amount of collagen synthesis: keloid scars, or hypertrophic scars?
Keloid
69
Which type of scarring: hypertrophic or keloid) has parallel arrangement of collagen? Which has disorganized?
```
Hypertrophic = parallel
Keloid = disorganized
```
70
How frequently do hypertrophic scars recur after resection? Keloids?
```
Hypertrophic = infrequently
Keloid = Frequently
```
71
What is the effect of PDGF? What cells secrete it?
Induces vascular remodeling
| Secreted by macrophages and platelets
72
What is the role of FGF in wound healing?
Stimulates all aspects of angiogenesis
73
What is the role of EGF in healing?
Stimulates cell growth via Y kinases
74
What is the role of TGF-beta in wound healing?
Angiogenesis + fibrosis
75
What is the role of metalloproteinases in wound healing?
Tissue remodeling
76
Which cells are primarily involved in the remodeling phase of wound repair?
Fibroblasts
77
What are the cells that are involved in proliferative phase of wound healing?
Fibroblasts
Macrophages
Endothelial cells
Lots o' cells
78
What role do fibroblasts play in tissue remodeling?
Increases Type I collagen deposition (instead of Type III)
79
What cytokine do Th1 cells secrete to maintain a granuloma?
IFN-gamma
80
What cytokine do macrophages secrete to maintain a granuloma?
TNF-alpha
81
Why should you always test for TB prior to starting anti-TNF therapy?
TNF needed to maintain granuloma. Thus anti-TNF will cause breakdown and disseminated disease
82
Exudate or transudate: cellular
Exudate
83
Exudate or transudate: protein rich
Exudate
84
Exudate or transudate:specific gravity
Transudate
85
Exudate or transudate: cause by lymphatic obstruction
Exudate
86
Exudate or transudate: caused by inflammation/malignancy
Exudate
87
Exudate or transudate: caused by an increase in hydrostatic pressure
Transudate
88
Exudate or transudate: cause by a decrease in oncotic pressure/ Na retention
Transudate
89
Increase or decrease in ESR: Anemia
Increased
90
Increase or decrease in ESR: infections
increased
91
Increase or decrease in ESR: sickle cell disease
Decrease
92
Increase or decrease in ESR: polycythemia
Decreased (d/t RBCs diluting aggregation factors)
93
Increase or decrease in ESR: CHF
Decreased (unknown cause)
94
Increase or decrease in ESR: pregnancy
Increased
95
Increase or decrease in ESR: SLE
Increased
96
What does ESR measure?
Products of inflammation causing aggregation of RBCs
97
How does Fe lead to disease?
Peroxidation of lipids
98
What are the symptoms of acute Fe poisoning?
n/v dysentery
99
What are the symptoms of chronic Fe poisoning (as in hemochromatosis)?
Metabolic acidosis
| scarring
100
What is the treatment for acute/chronic Fe poisoning?
Chelating agents + dialysis
101
What is amyloidosis?
Abnormal aggregation of proteins into beta=pleated sheets
102
What is the cause of AL amyloidosis (which protein deposition)?
Light chain Ig deposition (e.g. in multiple myeloma)
103
What is the cause of AA amyloidosis (which protein deposition)?
FIbrils of serum Amyloid (e.g. RA, IBD)
104
What is the protein that causes dialysis related amyloidosis?
Fibrils of beta2 microglobulin in pts with ESRD
105
Dialysis pt presenting with carpal tunnel = ?
Amyloidosis
106
How is ATTR, amyloidosis acquired?
Heritable
107
Senile amyloidosis is caused by deposition of what protein?
Deposition of TTR in myocardium and other sites
108
Beta amyloid deposition in the brain = which disease?
Alzheimers
109
What is lipofuscin cause by?
Oxidation and polymerization of autophagocytosis organellar membranes
110
What does carcinoma in situ mean?
Neoplastic cells have not invaded BM
111
What are the enzymes that allow tumors to pierce the BM?
Collagenases and hydrolases
112
What is the P-glycoprotein (aka MDR1)?
Glycoprotein used to pump out toxins, including chemotherapeutic agents
113
What is metaplasia?
One adult cell is replaced by another of a different type (e.g. Barrett's esophagus)
114
True or false: metaplasia and dysplasia are reversible
True
115
What is anaplasia?
Loss of structural differentiation and function of cells, resembling primitive cells of same tissue
116
What is neoplasia?
A clonal proliferation of cells that is uncontrolled and excessive
117
What is desmoplasia?
Fibrous tissue formation in response to neoplasia
118
True or false: neoplasia, neoplasia, and desmoplasia are all irreversible
True
119
What does it mean to grade a tumor?
Degree of cellular differentiation (1= high, 4= low[bad])
120
Which has more prognostic value: stage or grade of a tumor?
Grade
121
What does it mean to stage a tumor?
Degree of localization/spread based on site and size of secondary lesion
(stage = spread)
122
What is the TNM staging system?
Tumor size
Node involvement
Metastases
123
The term carcinoma implies what?
Epithelial origin of tumor
124
The term sarcoma implies what?
Denotes mesenchymal origin of tumor
125
Most carcinoma spread (BLANK) whereas most sarcomas spread (BLANK)
Carcinomas spread lymphatically
| Sarcomas spread hematogenously
126
Adenomas come from what tissue type?
Glands
127
Malignant or benign: adenocarcinomas
Malignant
128
Malignant or benign: Hemangioma
Benign
129
Malignant or benign: leiomyoma
Bening
130
Malignant or benign: angiosarcoma
Malignant
131
Malignant or benign, and what tissue type is it from: Rhabdomyoma
Benign-- striated muscle
132
Malignant or benign, and what tissue type is it from: fibroma
Benign-- CT
133
Malignant or benign, and what tissue type is it from: fibrosarcoma
Malignant--CT
134
Malignant or benign, and what tissue type is it from: osteoma
benign--Bone
135
Malignant or benign, and what tissue type is it from: osteosarcoma
malignant--bone
136
Malignant or benign, and what tissue type is it from: liposarcoma
Malignant--fat
137
Upregulation of what enzyme in tumors prevents chromosome shortening and cell death?
Telomerase
138
What are the three major cytokines that are involved with cachexia in CA pts?
TNF-alpha
IFN-gamma
IL-6
139
Acanthosis nigricans is associated with what neoplasm?
Visceral malignancy
140
AIDS is associated with what neoplasm?
Kaposi
| Non-hodgkins lymphoma
141
Actinic keratosis is associated with what neoplasm?
Squamous cell carcinoma of the skin
142
Autoimmune diseases (e.g. SLE, hashimoto thyroiditis) is associated with what neoplasm?
Lymphoma
143
Barrett's esophagus is associated with what neoplasm?
Esophageal adenocarcinoma
144
Chronic atrophic gastritis is associated with what neoplasm?
Gastric adenocarcinoma
145
Cirrhosis is associated with what neoplasm?
Hepatocellular carcinoma
146
Cushings is associated with what neoplasm?
Small cell lung CA
147
Dermatomyositis is associated with what neoplasm?
Lung CA
148
Down syndrome is associated with what neoplasm?
ALL ("we ALL fall DOWN")
149
Dysplastic nevus is associated with what neoplasm?
Malignant melanoma
150
Hypercalcemia is associated with what neoplasm?
Squamous cell lung CA
151
Immunodeficiency states are associated with what neoplasm?
Malignant lymphomas
152
What is Eaton-lambert syndrome? What malignancy is associated with it?
Autoimmune attack of Ca channels at the neuromuscular junction
Small cell lung cancer
153
Myasthenia gravis is associated with what malignancy?
Thymoma
154
Paget's disease of the bone is associated with what malignancy?
Secondary osteosarcoma
155
Plummer-Vinson syndrome (Fe-deficiency anemia + esophageal webs + dysphagia) is associated with what malignancy?
Squamous cell carcinoma of the esophagus
156
Polycythemia is associated with what neoplasm?
Renal cell carcinoma
157
Radiation exposure is associated with what neoplasm?
Leukemia
| sarcoma
158
SIADH (syndrome of inappropriate antidiuretic hormone secretion) is associated with what neoplasm?
Small cell lung CA
159
Tuberous sclerosis is associated with what neoplasm?
Giant cell astrocytoma
160
Ulcerative colitis is associated with what neoplasm?
Colonic adenocarcinoma
161
Xeroderma pigmentosum is associated with what neoplasm?
melanoma
| Basal cell carcinoma
