Test 1

Question 1

Vitamins necessary for healing

Answer 1

Vitamin C (cofactor for hydroxylation reactions ie crosslinking of collagen)
Zinc (cofactor for metalloenzymes ie collagenases)
Copper (cofactor for lysyl oxidase ie cross-linking of lysine and hydroxylysine)

Question 2

Keloid

Answer 2

Accumulation of exuberant amount of collagen –> raised scar beyond wound boundaries. More common in African-Americans.

Question 3

Upregulation of P- and E- selectins and where P-selectin is released from.

Answer 3

P-selectin: histamine (Weibel-Palade body)

E-selectin: TNF-a and IL-1

Question 4

Consequence of low NADPD in infection and why

Answer 4

Low NADPH means that H2O2 can’t be generated in lysosome bugs are not digested. H2O2 is converted to OH and OCl radicals, which are in turn converted to HOCl (bleach) by MPO (myeloperoxidase)

Question 5

M1 v M2 macrophages

Answer 5

M1 - chronic inflammation. Assoc. with pro-inflammatory cytokines which lead to an increase in hepatic defense proteins (less albumin), increased hepcidin (anemia), and increased platelet and monocyte growth factors.

M2 - anti-inflammatory promoting tissue repair and fibrosis.

Question 6

Granulomas have what kind of cells?

Answer 6

Necrotizing mass surrounded by giant cells, a cuff of CD4+ T cells, and proliferating fibroblasts. TMMI.

Question 7

Acute phase reactants

Answer 7

Hepatic adjustments for inflammation.

High fibrinogen, ceruloplasmin, complement components, hepcidin, and growth factors.

Decreased albumin.

Question 8

C-reactive protein

Answer 8

Levels closely linked to IL-6 levels, proxy for the level of inflammation in patients.

Question 9

The basement membrane consists of…

Answer 9

Type IV collagen, laminin, proteoglycans

Question 10

The interstitial matrix consists of…

Answer 10

Fibrillar collagen, elastin, proteoglycan, hyaluronan, and adhesive glycoproteins.

Question 11

Angiogenesis requires what growth factors?

Answer 11

VEGF, FGF, PDGF, TGF-beta

Question 12

Migration and proliferation of fibroblasts require what growth factors?

Answer 12

PDGF, FGF, TGF-beta

Question 13

Trichrome stain for what cellular components?

Answer 13

Transformation of Collagen III (immature collagen) to Collagen I (mature collagen) in the healing process

Question 14

Hyperemia

Answer 14

Arteriolar dilation leads to increased blood flow. Results from sympathetic discharge or chemical mediators. Ex - sites of inflammation, exercising skeletal muscle.

Question 15

Virchow’s Triad

Answer 15

Endothelial injury (most important), abnormal blood flow, hypercoagulable state.

Three factors influencing the formation of a thrombus.

Question 16

Which way do venous thrombosis propagate?

Answer 16

Towards the heart.

Question 17

White (Pale) vs Red infarction

Answer 17

White: arterial occlusions, solid organ with end arterial circulation (heart, spleen, liver, kidney)

Red: venous occlusion, tissue with dual circulation (lung, small intestine), and re-establishment of flow in white infarctions (re-perfusion).

Question 18

What are the three types of shock?

Answer 18

Cardiogenic - decreased cardiac output as a result of an MI, ventricular rupture, arrhythmia, or cardiac tamponade (fluid in the pericardium)

Hypovolemic - decreased C.O. secondary to decreased blood/plasma volume. Hemorrhage, fluid loss (vomiting, diarrhea, burns)

Septic - arteriolar vasodilation and venous pooling resulting from systemic immune response to infection (usu. gram positive bacteria)

Question 19

Parenchyma

Answer 19

The neoplastic cells.

Question 20

Stroma

Answer 20

The connective tissue, blood vessels, immune system cells that are supporting the growth of the neoplasm.

Question 21

Tumor names

Answer 21

Mesenchyme origin -
Benign = –oma Malignant = –sarcoma
Epithelium origin -
Benign = –oma Malignant = –carcinoma

Question 22

RAS protein

Answer 22

Oncogene - Active when bound to GTP, and upon hydrolysis to GDP turns off. When mutated, constitutively active and stimulating downstream promoters of proliferation. Dominant mutation.

Question 23

RB (“retinoblastoma”)

Answer 23

Tumor suppressor gene - When hyperphosphorylated, releases E2F to transcribe S-phase cyclins. Recessive mutation (need both genes to be hit in order to develop into cancer).

Retinoblastoma histology - you see “Flexner-Wintersteiner rosettes” and numerous mitotic figures.

Question 24

p53

Answer 24

Tumor suppressor gene. Normally involved in responding to DNA damage, puts the cell into quiescence (temporary), senescence (permanent), or signals for apoptosis.

Li-Fraumeni syndrome - inherit 1 defective p53 –>25x higher chance of cancer by age 5.

Question 25

Intrinsic/Mitochondrial apoptosis pathway

Answer 25

Bax/Bak punch a hole in the mitochondria, allowing cytochrome C to leak into the cytoplasm. This converts pro-caspase 9 to caspase 9 and leads to apoptosis.

Bax/Bak are inhibiting from dimerizing by Bcl-2/Bcl-XL (

Question 26

Extrinsic Apoptotic Pathway

Answer 26

Fas receptor bound by FasL, this leads to a conversion of pro-caspase 8 to caspase 8, starting to caspase cascade and leading to apoptosis.

Question 27

Thrombospondin-1 (TSP-1)

Answer 27

Inhibits angiogenesis

Question 28

Xeroderma pigmentosum

Answer 28

Defects in DNA repair resulting in an increased risk for skin cancer.

Question 29

Microbial oncogenesis

Answer 29

RNA viruses - HTLV-1

DNA viruses - HPV, Epstein-Barr virus, Hep B and C

Bacteria - helicobacter pylori

Question 30

Cachexia

Answer 30

Loss of body fat and lean body mass. Weakness, anorexia, anemia.

Question 31

HE Stain

Answer 31

Hematoxylin and eosin stain -

H is a basic stain that stains acids blue (nuclei)
E is an acidic stain that stains proteins pink (cytoplasm)

Question 32

PAS Stain

Answer 32

Periodic acid-Schiff - stains fungi and glycogen magenta and the rest light pink.

Question 33

GMS stain

Answer 33

Grocott methenamine silver - stains fungi black and everything else green

Question 34

Acid fast stain

Answer 34

Stains mycobacteria, actinomyces red, everything else blue

Question 35

Immunohistochemical stain

Answer 35

stains target brown/red, everything else blue.