Pathoma Chapter 2D

Question 1

Sjogren syndrome is characterized by what lab tests?

Answer 1

ANA and anti-ribonucleoprotein antibodies (anti-SS-A/Ro and anti-SS-B/La)

Question 2

Sjogren syndrome is often associated with?

Answer 2

other autoimmune diseases, especially rheumatoid arthritis

Question 3

Sjogren syndrome results in increased risk for?

Answer 3

B-cell (marginal zone) lymphoma, which presents as unilateral enlargement of the parotid gland late in disease course

Question 4

Scleroderma is

Answer 4

Autoimmune tissue damage with activation of fibroblasts and deposition of collagen (fibrosis)

Question 5

Scleroderma is divided into?

Answer 5

diffuse and localized types

Question 6

Diffuse type of scleroderma exhibits?

Answer 6

skin and early visceral involvement.

Question 7

Scleroderma involves

Answer 7

Almost any organ can be involved; esophagus is commonly affected, resulting in disordered motility (dysphagia for solids and liquids).

Question 8

Scleroderma is characterized by what lab tests?

Answer 8

ANA and anti-DNA topoisomerase I (Scl-70) antibody

Question 9

Scleroderma localized type exhibits?

Answer 9

local skin and late visceral involvement.

Question 10

What is CREST syndrome?

Answer 10

For localized type scleroderma: Calcinosis/anti-Centroniere antibodies, Raynaud phenomenon. Esophageal dysmotility, Sclerodactyly, and Telangiectasias of the skin.

Question 11

What is mixed connective tissue disease?

Answer 11

autoimmune-mediated tissue damage with mixed features of SLE, systemic sclerosis, and polymyositis

Question 12

What is mixed connective tissue disease characterized by?

Answer 12

serum antibodies against U1 ribonucleoprotein

Question 13

When is healing initiated?

Answer 13

when inflammation begins.

Question 14

Wound healing occurs via?

Answer 14

a combination of regeneration and repair

Question 15

In wound healing regeneration occurs via?

Answer 15

Replacement of damaged tissue with native tissue; dependent on regenerative capacity of tissue

Question 16

Tissues are divided into three types based on?

Answer 16

regenerative capacity: labile, stable, and permanent.

Question 17

Labile tissues

Answer 17

possess stem cells that continuously cycle to regenerate the tissue.

Question 18

Examples of Labile tisues

Answer 18

1. Small and large bowel (stem cells in mucosal crypts) 2. Skin (stem cells in basal layer) 3. Bone marrow (hematopoietic stem cells)

Question 19

Stable tissues are

Answer 19

comprised of cells that are quiescent G0, but can reenter the cell cycle to regenerate tissue when necessary.

Question 20

What is a classic example of regeneration?

Answer 20

In the liver by compensatory hyperplasia after partial resection. Each hepatocyte produces additional cells and then reenters quiescence.

Question 21

Permanent tissues

Answer 21

lack significant regenerative potential (myocardium, skeletal muscle, and neurons).

Question 22

Repair

Answer 22

Replacement of damaged tissue with fibrous scar, Occurs when regenerative stem cells are lost (e.g., deep skin cut) or when a tissue lacks regenerative capacity (e.g., healing after a myocardial infarction

Question 23

Granulation tissue

Answer 23

Its formation is the initial phase of repair

Question 24

In the initial phase of repair what does the fibroblasts do?

Answer 24

deposit type III collagen

Question 25

In the initial phase of repair what does the capillaries do?

Answer 25

provide nutrients

Question 26

Granulation tissue consists of?

Answer 26

fibroblasts (deposit type III collagen), capillaries (provide nutrients), and myofibroblasts (contract wound)

Question 27

Granulation tissue eventually results in?

Answer 27

scar formation, in which type 111 collagen is replaced with type 1 collagen

Question 28

Type III collagen is

Answer 28

pliable and present in granulation tissue, embryonic tissue, uterus, and keloids.

Question 29

Type I collagen

Answer 29

has high tensile strength and is present in skin, bone, tendons, and most organs,

Question 30

Collagenase

Answer 30

removes type 111 collagen and requires zinc as a cofactor.

Question 31

Tissue regeneration and repair is mediated by?

Answer 31

paracrine signaling via growth factors (e.g macrophages secrete growth factors that target fibroblasts)

Question 32

What results in gene expression and cellular growth?

Answer 32

Interaction of growth factors with receptors (e.g.. epidermal growth factor with growth factor receptor)

Question 33

Examples of mediators of tissue repair and regeneration

Answer 33

TGF-alpha, TGF-beta, platelet, fibroblast growth factor, VEGF

Question 34

TGF-alpha

Answer 34

epithelial and fibroblast growth factor

Question 35

TGF-beta

Answer 35

important fibroblast growth factor; also inhibits inflammation

Question 36

Platelet-derived growth factor

Answer 36

growth factor for endothelium, smooth muscle, and fibroblasts

Question 37

Fibroblast growth factor

Answer 37

important for angiogenesis; also mediates skeletal development

Question 38

Vascular endothelial growth factor (VEGF)

Answer 38

important for angiogenesis

Question 39

Cutaneous healing occurs via

Answer 39

primary or secondary intention.

Question 40

Primary intention

Answer 40

Wound edges are brought together (e.g., suturing of a surgical incision); leads to minimal scar formation

Question 41

Secondary intention

Answer 41

Edges are not approximated. Granulation tissue fills the defect; myofibroblasts then contract the wound, forming a scar.

Question 42

Delayed wound healing occurs in

Answer 42

1. Infection (most common cause; S aureus is the most common offender)

Question 43

Vitamin C is

Answer 43

an important cofactor in the hydroxylation of proline and lysine procollagen residues; hydroxylation is necessary for eventual collagen cross-linking.

Question 44

What is necessary for the formation of stable collagen?

Answer 44

Copper is a cofactor forlysyl oxidase, which cross-links lysine and hydroxy lysine to form stable collagen.

Question 45

What is a cofactor for collagenase?

Answer 45

Zinc which replaces the type III collagen of granulation tissue with stronger type I collagen

Question 46

What are some causes for delayed wound healing?

Answer 46

foreign body, ischemia, diabetes, and malnutrition,

Question 47

Dehiscence is

Answer 47

rupture of a wound; most commonly seen after abdominal surgery

Question 48

Hypertrophic scar is

Answer 48

excess production of scar tissue that is localized to the wound

Question 49

Keloid is

Answer 49

excess production of scar tissue that is out of proportion to the wound

Question 50

Keloid is characterized by

Answer 50

excess type III collagen

Question 51

Keloid genetic predisposition

Answer 51

more common in African Americans

Question 52

Keloid classically affects what areas of the body?

Answer 52

earlobes, face, and upper extremities