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Step 11.16.12
Pathology I
Question | Answer |
---|---|
Is ATP required for apoptosis? Does apoptosis cause inflammation? | requires ATP, no inflammtion |
What is the intersection of both the intrinsic and extrinsic apoptotic pathways? | both pathways end in the activation of cytosolic caspases |
What histological features characterize apoptosis? | cell shrinkage, nuclear shrinkage, basophilia (pyknosis), membrane blebbing, karryohexis, kayolysis, formation of apototic bodies |
What is the intrinsic apoptotic pathway? | incr Bax (proapototic) decr BCl-2 (anti apoptotic) leading to Cyt C release and activation of cytosolic caspases |
When is the intrinsic apoptotic pathway active? | embryogenesis, hormone induction, atrophy, result of inurous stimuli like hypoxia or toxins |
What are the 2 extrinsic pathways of apoptosis? | 1. ligand receptor interactions (Fas binds to Fas[CD95] 2. Immune cell (Tc releases perforin and granzyme) |
What is necrosis and what histological features are seen? | enzymatic degradation and protein denaturation of cell. inflmmatory process and intracellular components extravasate |
What organs can undergo coagulative necrosis? | heart, liver, kidney |
What organs can undergo liquefactive necrosis? | brain, bacterial absesses, pleural effusion |
What are some examples of casseuous necrosis? | TB, systemic fungi |
What are some examples of fatty necrosis? | pancreas (saponification) |
What types of organs undergo fibrinoid necrosis? | blood vessels |
What are the 2 types of gangrenous necrosis and where do they happen? | dry (iscemic coagulative) or wet (w bacteria) common in limbs and GI tract |
What are some examples of cell injuries which are reversible with O2? | 1. decr ATP synth 2. cellular swelling (this is due to Na/K+ pump 3. nuclear chromatin clumping 4. decr glycogen 5. fatty change 6. ribosomal detatchment (decr protein synthesis) |
What are some examples of cell injury that are irreversible? | 1. nuclear pyknosis, karyolysis, karyohexxis 2. Ca2+ influx and caspase activation 3. damage to the plasma membrane 4. lysosomal rupture 5. mitochondrial permeability |
What watershed areas are most vulnerable to hypoxia? | splenic flexure, ACA/MCA |
What part of the heart is most vulnerable to hypoxia? | subendocardial tissue |
What part of the kidney is most vulnerable to hypoxia? | proximal tubule (cortex) and thick asending limb ( medulla) |
What area of the liver is most vulnerable to hypoxia? | area around the central vein |
When and where do red ( hemorrhagic) infarcts occur? | loose tissue with collaterals like liver, lungs, or intestine or following reperfusion. The injury is from free radical damage |
What are pale infarcts and when and where do they occur? | in solid tissues with a single blood supply such as heart, kidneys, spleen |
What is seen in hypovolemic/cardiogenic shock? | low output failure, incr TPR, low CO, cold, clammy patient |
What is seen in spetic shock? | high output failure. see decr TPR, dilated arteriole, high venous return, hot patient |
What are 6 major causes of atrophy? What is it? | reduction in size or number of cells. 1. decr hormones ( uterus/vagina) 2. decr innervation (motor neuron damage 3. decr blood flow 4. decr nutrients 5. incr pressure ( nephrolithiasis 6. occlusion of secretory ducts (CF) |
What are the 4 hallmarks of inflammation? | 1.rubor 2. dolor 3. calor 4. tumor 5. function laesa (loss of function) |
What causes fluid exudation in inflammation? | incr vascular permeability, vasodilation, endothelial injury |
What causes fibrosis in inflammation? | fibroblast emigration and proliferation. deposition of ECM |
What is granulation tissue? | highly vascularized, fibrotic tissue |
What is an absess? | fibrosis surrounding pus |
What is a fistula? | abnormal communication |
What is scarring? | collagen deposition resulting in altered structure and function |
What is the onset, duration, and what cells are invovled in acute inflammation? | rapid onset, lasts minutes to days. neutrophils, eosinophils, Ab mediated |
What cells mediate chronic inflammation and what are some associted sx? | mononuclear cell mediated, characterized by persistent destruction and repair. associated with blood vessel proliferation and repair |
What is a granuloma and what type of inflammation is it associated with? | chronic inflammation. nodular collections of epitheloid macrophages and giant cells |
What receptors on the vasculature/stroma and the leukocyte mediate rolling? | Vasculature/stroma: E selectin, P selectin Leuk: sialyl LewisX |
What receptors on the vasculature/stroma and the leukocyte mediate tight binding? | VAsculature/stroma: ICAM-1 Leukocyte: LFA-1 ("integrin") |
What receptors on the vasculature/stroma and the leukocyte mediate diapedesis (exit of BV)? | Vasc/stroma: PECAM-1 Leuk: PECAM-1 |
What receptors on the vasculature/stroma and the leukocyte mediate migration (travel of leukocyte to area of injury or infection)? | Vasc/stroma: bacterial products ,CILK: C5a, IL-8, LTB4, Kallikrein |
What is the order of leukocyte extravasation from the BV? | rolling-->tight binding-->diapedesis-->migration--->phagocytosis |
How do free radicals damage cells? | via membrane lipid peroxidation, protein modification, DNA breakage |
What types of things can cause free radical injury? | radiation exposure, metabolism of drugs (phase I), redox reaction, nitric oxide, transition metals, leukocyte oxidative burst |
what things can help eliminate free radicals? | catalase, superoxide dismutase, glutathione peroxidase, spontaneous decay, antioxidants ( vit A,C,E) |
What are 6 pathologies associated with free radical injury? | 1. retinopathy of prematurity 2. bronchopulmonary dysplasia 3. CCI4 leading to liver necrosis (fatty change) 4. acetaminophen 5. iron overload 6. reperfusion after anoxia (superoxide), especially after thrombolytic therapy |
What are the mediators of the inflammatory phase of wound healing? | platelets, neutrophils, macrophages |
Wbhat are the major characteristics od the inflmmatory phase of wound healing? | clot formation, icr vessel permeability, neutrophilmigration, macrophages clear debris 2 days later |
What are the mediators of the proliferative phase of wound healing and when does it occur? | 2-3 days after wound. fibroblasts, myofibroblasts, endothelial cells, keratinocytes |
What are the major characteristics of the proliferative phase of wound healing? | deposition of granulation tissue and collagen, angiogenesis, epithelial cell proliferation, dissolution of clot and wound contraction by myofibroblasts |
What are the mediators of the remodeling phase of wound healing and when does it happen? | 1 week after wound. mediated by fibroblasts |
What are the major characteristics of the remodeling phase of wound healing? | type III collagen is replaced by Type I collagen, increased tensile strength of tissue |
What are 8 causes of granullomatous disease? | 1. M tb 2. Fungi (histo) 3. treptonema pallidum (syphilis) 4. M. leprae (leprosy) 5. Bartonella hensale 6. sarcoidosis 7. Crohn's disease 8. Berylliosis |
What is the process of granuloma formation? | TH1's secrete gamma INf which activatews macrophages to secrete TNF-alpha which maintains the granuloma. The granulloma make be broken with anti TNF drugs but this leads to disseminated disease |
What are the characterisitcs of a transudate? | hypocellular, protein pooor, Specific G <1.012 |
What causes a transudate? | incr hydrostatic P, decr oncotic P, Na+ retention |
What are the characteristics of an exudate? | cellular, protein rich, specific gravity > 1.02 |
What causes an exudate? | lymphatic obstruction or inflammation |
What is the mech and use of the Eryhtrocyte sedimentation rate (ESR)? | fibrinogen, a product of inflammation, causes RBCs to aggregate. RBCs fall at a faster rate when they are aggregated |
What types of things would cause and incr ESR? | things that cause inflammation: infections, temporal arteritis, cancer, pregnancy, SLE |
What types of things could cause a decr ESR and what is the mechansim of each? | sickle cell (sltered shape), polycythemia (toomany), CHF (unknown) |
What is the mechanism of iron poisoning in children? | cell death due to peroxidation of membrane lipids |
What are the major Sx of iron poisoning? | acute: gastric bleeding chronic: metabolic acidosis, scarring leading to GI obstruction |
What is seen in the microscope in amyloidosis and what does affected tissue look like? | See Beta pleated sheet demonstrable by apple gree birefringence of Congo-red stain under polarized light. affected tissue has a waxy appearance |
What is the protein and what is it derived from in Bence Jones amyloidosis? What disease is it seen? | AL protein derived from Ig Light chains (multiple myeloma) |
What is the protein and where is it derived from in Secondary amyloidosis? What is a common setting | AA protein derived from serum amyloid associted protein (chronic inflammatory disease) |
What is the protein and from what is it derived in Senile cardiac amyloidosis? | Protein: transthyretin from AF |
What is the protein and from what is it derived in DM type II amyloidosis? | amylin protein derived from AE |
What is the protein and from what is it derived in medullary carcinoma of the thyroid? | A-CAL protein derived from calcitonin |
What is the protein and from what is it derived in Alzheimer's disease amyloidosis? | Beta amyloid protein derived from amyloid precursor protein (APP) |
What is the protein and from what is it derived in dialysis associted amyloidosis? | Beta 2 microglobulin derived from MHC class I proteins |
What are some major hallmarks of cancer? | evasion of apoptosis, self sufficiency in growth signals, insensitivty to anti growth signals, sustained angiogenesis, limitless replicative potential, tissue invasion and metastasis |
What is hyperplasia and dysplasia? | hyperplasia: cells have increased in number Dysplasia: abnormal proliferation of cells with loss of size, shape and orientation |
What is seen in carcinoma in situ? | neoplastic cells have not invaded basement membrane, high N/C ratio and clumped chromatin, neoplastic cells encompass the entire thickness |
What is seen in an invasive carcinoma? | cells have invaded the basement membrane using collagenases and hydrolases ( metalloproteases), can metastasize if they reach a BV or LV |
What metastasis and what is the seed and soil theory of metastasis? | Met: spread to distant organ, seed= tumor embolus, soil=target organ= liver, lungs, bone, brain |
What is the order of neoplasm growth? | normal-->hyperplasia-->carcinoma in situ-->invasive carcinoma-->metastatic carcinoma |
What is metaplasia? | one adult cell is replaced by another. often secondary to irritation or environmental exposure (squamous metaplasia in trachea and bronchi in smokers) |
Are hyperplasia, dysplasia, and metaplasia reversible? | yes |
What is anaplasia? | abnormal cells that lack differentiation, resemble primitive cells of the same tissue. often equated with undifferentiated malignant neoplasms |
What is a neoplasia? | clonal proliferation of cells that is uncontrolled and excessive. neoplasia can be benign or malignant |
What is desmoplasia? | fibrous tissue fromation in response to a neoplasm |
Are neoplasia, anaplasia, and desmoplasia reversible? | NO |
What is a tumor grade? | degree of cellular differentiation based on histiological appearance of tumor. I-IV based on number of mitoses per field. character of tumor |
What is a tumor stage? | degree of localization/spread based on site and size of primary lesion, spread to LN, metastases, spread of tumor in a specific pt |
Which has more prognostic value stage or grade? | stage |
What is the TNM staging system? | T= tumor size N= none involvement M= metastases (most important prognostic factor) |
What are 2 benign tumors of epithelium? | adenoma, papilloma |
What are 2 malignant tumors of epithelium? | adenocarcinoma, papillary carcinoma |
What are 2 malignant tumors of blood cells? | leukemia, lymphoma |
What are the benign and malignant tumors of blood vessels? | B:hemangioma M:angiosarcoma |
What are the benign and malignant tumors of SMM? | B:leiomyoma M: leiomyosarcoma |
What are the benign and malignant tumors of SM? | B: rhabdomyoma M: Rhabdomyosarcoma |
What are the benign and malignant tumors of connective tissue? | B: fibroma M: fibrosarcoma |
What are the benign and malignant tumors of bone? | B: osteoma M: osteosarcoma |
What are the benign and malignant tumors of fat? | B: lipoma M: liposarcoma |
What are the benign and malignant tumors of greater that one type? | B: women. mature tetroma M: men. immature tetroma and mature tetroma |
What is the difference between carcinoma and sarcoma? | carcinoma= epithelial sarcoma= mesenchymal origin |
What are the characteristics of a benign tumor? | usually well differentiated, slow growing, well demarcated, no metastases |
What are the characterisitcs of a malignant tumor? | may be poorly differentiated, erratic growth, locally invasive/diffuse, may metastasize |