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Pathology Flashcards

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1
Q

what pathways does apoptosis have

A

intrinsic and extrinsic pathways

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2
Q

general occurrences during apoptosis (4)

A
  1. eosniphilic cytoplasm
  2. cell shrinkage
  3. karyorrhexis (nuclear fragmentation)
  4. apoptotic bodies
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3
Q

what happens in karyorrhexis?

A

endonucleases cleave at internucleosomal regions into 180bp fragments

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4
Q

what does radiation therapy do to cells

A

free radicals and dsDNA breakage –> apoptosis of tumors and surrounding tissue

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5
Q

when does intrinsic pathway apoptosis occur? (3)

A
  1. regulating factor taken away from proliferating cells
  2. after injurious stimuli
  3. anti/pro apoptotic factor ratio
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6
Q

examples of intrinsic pathway apoptosis (4)

A
  1. removal of IL-2 after completed immuno reaction
  2. radiation, toxins, hypoxia
  3. BAX and BAK (pro-apoptotic)
  4. Apaf-1 (pro-apoptotic)
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7
Q

pro-apoptotic factors (3)

A

BAX
BAK
Apaf-1

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8
Q

anti-apoptotic facotrs (1)

A
  1. Bcl-2
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9
Q

What does Bcl-2 do

A

binds to Apaf-1 and inhibits it so that it cannot release cytochrome C

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10
Q

too much bcl-2?

A

too little apaf-1 and you get tumorgenesis (ex follicular lymphoma)

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11
Q

what mechanism is extrinsic pathway apoptosis?

A
  1. ligand receptor

FasL to Fas (CD95)

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12
Q

CD95?

A

Fas

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13
Q

thymus negative selection is what pathway of apoptosis

A

extrinsic pathway

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14
Q

necrosis definitino

A

enzymation degradation and protein denaturation 2/2 exogenous injury

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15
Q

where does coagulative necrosis occur (3)

A

tissue supplied by end-arteries

  1. heart
  2. liver
  3. kidney
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16
Q

order of what happens in coagulative necrosis

A
  1. proteins degrade first

2. enzymatic degradation

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17
Q

where does liquefactive necrosis occur and when

A

occurs in CNS 2/2 high fat content

brain bacterial abscess

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18
Q

order of what happens in liquefactive necrosis

A
  1. enzymatic degradation from lysosomal release

2. Then protein degradation

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19
Q

when does caseous necrosis occur (3)

A
  1. TB
  2. systemic fungi
  3. nocardia

acid fast?

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20
Q

where does fatty necrosis occur (2)

A
  1. pancreas

2. breast

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21
Q

pancreatitis leads to what?

A

saponification

fatty necrosis

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22
Q

what does fatty necrosis look like on staining

A

calcium deposits appear dark blue

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23
Q

what does fibrinoid necrosis look like on stain

A

amorphous and pink on H&E

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24
Q

where can you see fibrinoid necrosis? (2)

A

vessels

  1. vasculitidies (HSP, churg-strauss)
  2. malignant HTN
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25
types of gangrenous necrosis
1. dry | 2. wet
26
when is there dry gangrenous necrosis
ischemic coagulative
27
when is there wet gangrenous necrosis
infection
28
common locations for gangrenous necrosis (2)
1. limbs | 2. GI tract
29
Examples of causes of atrophy (7)
1. low endogenous hormones (post-menopause ovaries) 2. high exogenous hormones (thyroid, steroids) 3. low innervation (MN damage) 4. low blood flow/nutrients 5. low metabolic demand (paralysis) 6. high pressure (nephrolithiasis) 7. occlussion of secretory ducts (CF)
30
Examples of reversible cell injury (7)
1. ATP depletion 2. cellular/mito swelling 2/2 ATPase dysfunction 3. ribosome detachment 2/2 swelling 4. MB blebbibg 2/2 swelling 5. nuclear chromatin clumping 6. low glycogen 7. fatty change
31
Examples of irreversible cell injury (4)
1. nuclear pyknosis, karyorrhexis, karyolysis 2. plasma MB damage 3. lysosomal rupture 4. mitochondrial permeability/vacuolization
32
Examples of damage from ROS (6)
1. retinopathy of prematurity 2. bronchopulmonary dysplasia 3. CCl4 --> liver necrosis and fatty change 4. Acetaminophen o/d 5. Fe overload 6. Reperfusion injury esp after thrombolytic therapy
33
ischemia susceptible region of heart
subendocardium (LV)
34
ischemia susceptible region of kidney (2)
1. straight segment of proximal tubule (medulla) | 2. thick ascending limb (medulla)
35
ischemia susceptible region of liver
area around central vein (zone III)
36
ischemia susceptible region of colon (2)
1. splenic flexure | 2. rectum
37
chromatolysis ... what is it?
attempt at increasing protein synthesis following axonal damage
38
what do you see in chromatolysis? (3)
1. round cellular swelling 2. displacement of nucleus to periphery 3. dispersion of RER throughout cytoplasm
39
what does nissl substance stain?
RER
40
red infarct from what
hemorrhagic
41
where does red infarct occur? (3)
loose tissue with multiple blood supplies 1. liver 2. lungs 3. intestines Red = Reperfusion
42
pale infarct where (3)
solid tissue with single blood supply 1. heart 2. kidney 3. spleen
43
distributive shock - TPR - CO/venous return - PCWP
low TPR high CO/venous return low PCWP
44
what does distributive look like?
warm dry skin 2/2 vasodilation need to use pressors b/c unresponsive to fluids 2/2 vasodilation
45
Cardiogenic shock - TPR - CO/venous return - PCWP
high TPR low CO/venous return elevated PCWP
46
Hypovolemic shock - TPR - CO/venous return - PCWP
high TPR low CO/venous return decreased PCWP
47
treating cardiogenic/hypovolemic shock
responds to fluids
48
Acute cellular inflammatory response - onset time - duration time
- seconds-minutes | - lasts minutes to days
49
Acute cellular inflammatory response - involved cells - what happens
- neutrophils, eosinophil, Ab-mediated | - resolution, abscess formation, progression to chronic inflammation
50
Chronic cellular inflammatory response - cells involved - what happens
- mononuclear cells and fibroblasts for persistent destruction and repair - granuloma (nodular collection of epithelioid macrophage and giant cells) - scarring and amyloidosis
51
what is it that leads to increased ESR in inflammation
fibrinogen coats RBCs and causes them to aggregate
52
high ESR states (5)
1. most anemias 2. infection 3. cancer (MM) 4. pregnancy 5. autoimmune d/o
53
low ESR states (3)
1. sickle cell (shape lowers ESR) 2. polycythemia (dilute) 3. CHF (unknown reason)
54
4 steps of leukocyte extravasation
1. margination and rolling 2. tight-binding 3. diapedesis 4. migration through interstitium
55
factors involved in leukocyte margination and rolling | - cellular to endothelial interaction
cellular to endothelial reaction: - Sialyl-Lewis ...P-selectin - Sialyl-Lewis ...E-selectin - L-selectin ... GlyCAM-1 and CD34
56
factors involved in leukocyte tight-bonding - cellular to endothelial interaction
- CD11/18 integrins (LFA-1, Mac-1) ... ICAM-1 (CD54) | - VLA-4 integrin ... VCAM-1 (CD106)
57
factors involved in leukocyte diapedesis - cellular to endothelial interaection
- PECAM-1 (CD31) ... PECAM -1 (CD31)
58
factors involved in leukocyte migration -cellular to endothelial interaction
- various things ... chemotaxis mediated through C5a, IL-8, kalligkrein, Plt-activating factor
59
examples of exudate causing stuff (4)
1. lymphatic obstruction 2. inflammation 3. infection 4. maligancy
60
examples of transudate causing stuff (3)
1. CHF (hydrostatic pressure) 2. cirrhosis (decresaed oncotic pressure) 3. Na retention
61
what's the specific gravity number differentiating exudate and transudate
1.012
62
phases of wound healing (3) when do they occur
1. inflammatory (immediate) 2. proliferative (2-3 days) 3. remodeling (1 week later)
63
what does EGF do in wound healing
stimulates cell growth via TyrKin Rec
64
TGF-beta does what in wound healing (3)
angiogenesis fibrosis cell cylce arrest
65
PDGF does what in wound healign (3)
1. vascular remodeling 2. SMC migration 3. stimulate fibroblast growth for collagen synthesis
66
cells involved in inflammatory wound healing (3)
1. platelets 2. neutrophils 3. macrophages (a little later just to clean up) clotters and eaters
67
cells involved in proliferative wound healing (5)
1. fibroblasts 2. myofibroblasts 3. endothelial cells 4. keratinocytes 5. macrophages the rebuilders, supporters, and clean up
68
cells in remodeling wound healing
fibroblasts
69
what collagen stuff happening in wound healing
collagen III replaced by collagen I --> increases tensile strength of tissue
70
pathogenesis of granulomatous disease
TH1 cells secrete IFN-g --> activates macrophages --> they release TNF-alpha --> induces and maintains granuloma formation
71
examples of granulomatous diseases (13)
1. TB 2. Sarcoidosis 3. Crohn 4. Fungal 5. myco leprae 6. Syphilis 7. Wegener granulomatosis 8. Churg-Strauss 9. Bartonella (cat scratch) 10. Berrylliosis 11. Listeria monocytogenes 12. Francisella tularensis 13. schistosomiasis
72
types of calcification (2)
1. dsytrophic | 2. mestastatic
73
dystrophic calcification caused by what
local deposits 2/2 necrosis
74
calcium state in dystrophic calcification
usually normocalcemic | not a/w hyper-Ca
75
metastatic calcification caused by what
diffuse deposits 2/2 hypercalcemia OR | high calcium-phosphate product
76
states of hypercalcemia (3)
1. primary hyperparathyroidism 2. sarcoidosis 3. hypervitamoniosis D
77
states of high calcium-phosphate product (4)
1. CRF 2. secodnary hyperparathyoriodism 3. long-term dialysis 4. warfarin
78
where is calcium usually in metastatic calcification? - what environments - examples
alklaloid environments ``` interstitial tissue of: 1. kidneys 2. lungs 3. gastric mucosa b/c they lose acid quickly ```
79
how does Fe poisoning kill?
peroxidation of cell MB lipids --> cell death
80
what stains show amyloidosis
congo red stain
81
what does congo red stain look like in polarized light
apple green birefringence
82
what is primary amyloidosis ?
AL | deposits of light chains
83
causes of primary amyloidosis (AL)?
1. plasma cell d/o | 2. MM
84
what does primary amyloidosis cause? (6)
1. nephrotic syndrome 2. restrictive cardiomyopathy 3. arrhyhtmia 4. easy bruising 5. hepatomegaly 6. neuropathy
85
what is secondary amyloidosis?
AA | chronic conditions with fibrils made of serum Amyloid A
86
where can you see secondary amyloidosis (4)
1. RA 2. IBD 3. Spondyloarthropathy 4. protracted infection
87
what is P-glycoprotein
MDR-1 | the channel that pumps out toxins from the cell to keep it alive
88
reversible plasias (3)
hyperplasia metaplasia dysplasia
89
irreversible plasias (3)
anaplasia neoplasia desmoplasia
90
what is desmoplasia
fibrous tissue formation in response to neoplasm
91
tumor grading has to do with | - what are the numbers
differentiation and mitotic activity 1-4 from well differentiated to poorly anaplastic
92
tumor staging based on what
localization and spread
93
TNM staging involves?
tumor size node involvement mets
94
Carcinomas spread how
lymphatic spread
95
which carcinomas can spread hematogenously as well as lymphatically (4)
1. RCC via renal vein 2. HCC via hepatic vein 3. Follicular carcinoma of thyroid 4. Choriocarcinoma
96
sarcomas spread how
hematogenously
97
benign sarcomas 6)
1. hemangioma (vessels) 2. leiomyoma (SMC) 3. rhabdomyoma (striated muscle) 4. fibroma (connective tissue) 5. osteoma (bone) 6. lipoma (fat)
98
Cachexia is mediated by what (3)
1. TNF-alpha 2. IFN-gamma 3. IL-6
99
what is called cachectin?
TNF-alpha
100
what condition a/w visceral malignancy
acanthosis nigricans
101
what condition a/w squamous cell carcinoma of skin
actinic keratosis
102
what condition a/w malignant melanoma
dysplastic nevus (skin lesions)
103
xeroderma pigmentosum / albinism a/w what neoplasms (3)
1. melanoma 2. basal cell carcinoma 3. squamous cell carcinoma of skin
104
what condition a/w aggressive malignant non-Hodgkin lymphoma
AIDS
105
what condition a/w Kaposi sarcoma
AIDS
106
what condition a/w lymphomas
autoimmune (hashimoto, SLE)
107
what condition a/w malignant lymphomas?
immunodef
108
what condition a/w ALL and AML
Down syndrome
109
what condition a/w thymoma (2)
1. myasthenia gravis | 2. pure RBC aplasia
110
what condition a/w esophageal adenocarcinoma
barrett esophagus
111
what condition a/w squamous cell carcinoma of esophagus
Plummer-Vinson syndrome (low Fe)
112
what condition a/w gastric adenocarcinoma
1. chronic atrophic gastritis 2. permicious anemia 3. postsurgical gastric remnants
113
what condition a/w colonic adenocarcinoma
UC
114
what condition a/w HCC
cirrhosis
115
what neoplasm a/w polycythemia (2)
1. RCC | 2. HCC
116
what condition a/w small cell lung cancer (3)
1. Cushing 2. Lambert Eaton 3. SIADH
117
what condition a/w lung cancer
dermatomyositis
118
what condition a/w squamous cell lung cancer
hypercalcemia
119
what neoplasms a/w TS (3)
1. giant cell astrocytoma 2. renal angiomyolipoma 3. cardiac rhabdomyoma
120
what neoplasms a/w radiation exposure (4)
1. leukemia 2. sarcoma 3. papillary thyroid cancer 4. breast cancer
121
what neoplasms a/w Paget disease of bone (2)
1. secondary osteosarcoma | 2. fibrosarcoma
122
examples of oncogenes (10)
1. Bcr-abl 2. bcl-2 3. BRAF 4. c-kit 5. c-myc 6. HER2/neu 7. L-myc 8. N-myc 9. Ras 10 Ret
123
what does Bcr-abl code for and what condition a/w (2)
tyrosine kinase 1. CML 2. ALL
124
what does bcl-2 code for and what condition a/w (2)
anti-apoptotic mitochondrial factor 1. follicular lymphoma 2. undifferentiated lymphoma
125
what does BRAF code for | and what condition a/w
serine/threonine kinase melanoma
126
what does c-kit code for and what condition a/w
cytokine receptor for stem cell factor GI stromal tumor (GIST)
127
what does c-myc code for and what condition a/w
TF Burkitt lymphoma
128
what does HER2/neu code for and what condition a/w
tyrosine kinase 1. breast 2. ovarian 3. gastric carcinoma
129
what does L-myc code for and what condition a/w
TF lung
130
what does N-myc code for and what condition a/w
TF Neuroblastoma
131
what does Ras code for and what condition a/w (3)
GTPase 1. colon 2. lung 3. pancreatic
132
what does Ret code for and what condition a/w (2)
tyrosine kinase 1. MEN 2A 2. MEN 2B
133
what does BRCA1 and 2 code for and a/w (2)
DNA repair enzymes 1. breast cancer 2. ovarian cancer
134
what does CPD4/SMAD4 code for and a/w?
DPC (deleted in pancreatic cancer) pancreatic cancer
135
what does DCC code for
deleted in colon colon cancer
136
what does NF1 code for and a/w ?
Neurofibormin, a RAS GTPase activating protein NF1
137
what does NF2 code for and a/w?
Merlin (schwannomin) protein NF2
138
what does p16 code for and a./w?
cyclin-dep kinase inhibitor 2A melanoma
139
what does p53 code for and a/w
TF for p21 ... blocks G1 to S most cancers Fraumeni (AR cancer syndrome): breast, leukemia, adrenal gland
140
what is PTEN and a/w?
TSG breast, prostate, endometrial
141
what does Rb do and a/w? (2)
inhibits E2F ... blocks G1 to S 1. retinoblastoma 2. osteosarcoma
142
what genes mutated in TS
TSC1
143
VHL codes what and a/w?
inhibits hypoxia inducible factor 1a (HIF-1a) VHL
144
AlkPhos used to monitor what (4)
1. mets to bone 2. liver disease 3. Paget disease of bone 4. seminoma (placental aklphos)
145
AFP used to monitor what (5)
1. HCC 2. hepatoblastoma 3. yolk sac (endodermal sinus) tumor 4. testicular cancer 5. mixed germ cell tumor
146
beta-hCG used to monitor what (3)
1. hydatiform moles 2. choriocarcinomas 3. testicular cancer
147
what do you use to monitor breast cancer?
CA-15/3 | CA-26/29
148
what do you use to monitor pancreatic adenocarcinoma
CA-19/9
149
what do you use to monitor ovarian cancer
CA-125
150
what do you use to monitor medullary thyroid carcinoma
calcitonin
151
what are some neural crest origin cancer (4)
1. melanoma 2. neural tumo 3. schwannoma 4. Langerhans cell Histiocytosis
152
what do you use to monitor neural crest origin cancers
S-100
153
what do you use to monitor hairy cell leukemia
TRAP
154
EBV can cause what cancer
1. Burkitt lymphoma 2. Hodgkin lymphoma 3. nasopharyngeal carcinoma 4. CNS lymphoma inimmunom
155
What viruses can cause HCC? (2)
1. HBV | 2. HCV
156
what virus can cause kaposi sarcoma
HHV-8
157
what causes cervical, penile, headneckthroat cancer
HPV 16,18
158
H pylori can cause what cancers (2)
1. gastric adenocarcinoma | 2. MALT lymphoma
159
adult T-cell leukemias and lymphomas can be caused by what microbe
HTLV-1
160
what microbe can cause cholangiocarcinoma
liver fluke (clonorchis sinensis)
161
what microbe can cause squamous cell bladder cancer
schisotoma haematobium
162
Aflatoxin - produced by what - causes what cancer
- aspergillus | - HCC
163
Arsenic can cause what cancers (3)
1. angiosarcoma 2. lung cancer 3. squamous cell carcinoma
164
asbestos causes what cancer 2)
1. bronchogenic carcinoma 2. meothelioma bronchogenic > meso
165
cigarette smoking causes what cancer (6)
1. transitional cell carcinoma 2. SCC and adenocarcinoma of esphageus 3. RCC 4. squamous cell CA or laynx 5. squamous and small cell CA of lung 6. adenocarcinoma of pancreas
166
nitrosamines - where found - causes what cancer
- smoked foods | - gastric cancer
167
2nd leading cause of lung cancer after smoking
Radon
168
Vinyl chloride causes what
hepatic angiosarcoma
169
what paraneoplastic syndrome a/w Hodgkin lymphoma? | - leads to
1,25-VitD --> hypercalcemia
170
what paraneoplastic syndrome a/w small cell lung carcinoma (3)
ACTH --> cushing anti-presyn CaCh --> LES Autoimmune subacute cerebellar degeneration --> dizzy, ataxia
171
what paraneoplastic syndrome a/w small cell lung CA and some intracranial neoplasms
ADH --> SIADH
172
what malignancies have EPO production as neoplastic syndrome? (6)
1. RCC 2. thymoma 3. hemangioblastoma 4. HCC 5. leiomyoma 6. pheochromocytoma
173
what malignances have PTHrP production as neoplastic syndrome (3)
1. squamous cell lung CA 2. RCC 3. breast cancer
174
psammoma bodies found where (4)
1. Papillary CA thyroid 2. Serous papillary cystadenoCA of ovary 3. Meningioma 4. Malignant mesothelioma
175
which mets go to brain (6)
1. lung 2. brain 3. GU 4. osteosarcoma 5. melanoma 6. GI
176
which mets go to liver
1. colon 2. stomach 3. pancreas
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