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1st Aid: Path

QuestionAnswer
Which apoptotic pathway is utilized for tissue remodeling during embryogenesis? Intrinsic Pathway
The extrinsic apoptotic pathway requires what ligand receptor interaction? How do immune cells like cytotoxic T-cells activate the extrinsic pathway? Fas ligand-Fas (CD95); T cells release perforin and granzyme B
An increase in BAX in a cell promotes what process? intrinsic apoptosis. An increase in mitochondria permeability releases cytochrome c and activation of caspases
Contrast Necrosis and Apoptosis Necrosis involves degradation and denaturation of a cell from exogenous injury stimulating the inflammatory process. Apoptosis is controlled cell death without inflammation. It involves cell/nucleus shrinkage, basophilia, and phagocytosis
Three phases of cell death distinguishable on histo in chronological order? pyknosis, karyorrhexis, karyolysis
6 types of necrosis? Coagulative, Liquefactive, Caseous, Fatty/saponification, Fibrinoid, Gangrenous (wet or dry)
Describe reversible cell injury? (reversible with O2) Cell with decreased ATP synthesis, cellular swelling, chromatin clumping, decreased glycogen, fatty change, ribosomal detachment
Describe Irreversible cell injury? Nucler pyknosis, karylolysis, karyorhexis; Ca2+ influx (caspase activation); Plasma membrane damage, lysosomal rupture, mitochondrial permeability
Anatomical locations most susceptible to ischemia? Brain (ACA/MCA/PCA); Heart (endocardium); Kidney (medulla); Liver (Zone III around central vein); Colon (splenic flexure and rectum)
Hypoxic ischemic encephalopathy affects what areas of the brain? pyramidal cells of hippocampus and Purkinje cells
White infarcts occur in what organs? Why? Kidney, Heart, spleen, Brain; Arterial insuffeciency with only one blood supply.
Red infarcts occur in what organs? Why? Testicles, Lungs, Brain, Liver, GI tract; Venous insufficiency with dual blood supply.
What kind of shock is occuring with increased TPR, Low cardiac output, and patient is cold? Hypovolemic/cardiogenic
What kind of shock is occuring in a hot patient with decreased TPR, dilated arterioles and high venous return? Septic Shock
Five general characteristics of inflammation? Rubor (redness), dolor (pain), calor (heat), tumor (swelling), functio laesa (loss of function)
4 steps of neutrophil extravasation during inflammation? Rolling; Tight Binding; Diapedesis; Migration
Surface receptors facilitating rolling of neutrophil during extravasation? E-selectin and P-selectin(stroma) - Sialyl-Lewis (leukocyte)
Surface receptors facilitating tight binding of neutrophils during extravasation? ICAM-1 (stroma) - LFA-I integrin (leukocyte)
Surface Receptor facilitating Diapedesis of neutrophil during extravasation? PECAM-1 (stroma and leukocyte)
What are some initiators of free radical injury? (6) Radiation exposure, metabolism of drugs, redox reactions, nitric oxide, transition metals, and leukocyte oxidative burst
Three phases of wound healing and relative timing? Inflammatory (immediate), Proliferative (2-3 days post wound), Remodeling (1 wk after wound)
What are the mediators of the proliferative phase of wound healing? Remodeling phase? fibroblasts, myofibroblasts, endothelial cells, keratinocytes; Fibroblasts
Granulomas are formed by activated macrophages (y-interferon from Th1 cells) secreting TNFa. Name 10 granulomatous diseases? TB, Fungal diseases (histoplasmosis, coccidiomycosis), Syphilis, Leprosy, Bartonella henselae (cat scrath dz), sarcoidosis, crohn's dz, Churg-Strauss, Berlliosis/Silicosis, Granulomatosis with polyangitis (Wegener's)
Transudate or Exudate? Fluid is cellular with specific gravity >1.020. Exudate
Inflammation and lymphatic obstruction can lead to accumulation of an exudate or transudate? Exudate
Transudate or Exudate? Accumulated fluid has a specific gravity of <1.012. It was caused by increase in hydrostatic pressure in vessels Transudate
An increase in ESR can be caused by what? (5) Infection, Inflammation, Cancer, Pregnancy, SLE
A decrease in ESR can be caused by what? ((3) Sickle Cell (altered shape), Polycythemia (too many), CHF
A child is brought in to your clinic complaining of severe stomach pain and constipation. Workup reveals metabolic acidosis and GI obstruciton from chronic iron poisoning from contaminated drinking water. What is the mech by which cell death occurs? Iron poisoning causes peroxidation of membrane lipids
Abnormal aggregation of proteins on their fragments into Beta-pleated sheet structures, leading to cell damage and apoptosis. Amyloidosis
AL Amyloidosis? Deposited proteins are from Ig Light chains; plasma cell disorder, multiple myeloma; impacts multiple systems: renal, cardiac, hematologic (bruising), hepatomegaly, neuropathy
AA Amyloidosis? Secondary amylodosis with proteins from serum Amyloid A. Seen in chronic disease like RA, IBD, infections, Spondyloarthropathy
Dialysis related Amyloidosis? Fibrils composed of B2-Microglobulin in patients with ESRD and long term dialysis. Often presents as carpal tunnel syndrome and other join issues
6 types of amyloidosis? AL, AA, Dialysis, Heritable, Age-related, Organ-Specific (Alzheimer's)
How do Carcinoma in situ cells eventually invade the basement membrane to become invasive? By using collagenases and hydrolases
increase in number of cells? hyperplasia
one adult cell is replaced by another (often secondary to irritaiton or exposure)? metaplasia
Abnormal growth with loss of cellular orientation, shape, and size in comparison to normal tissue maturation? Dysplasia
Abnormal cells lacking differentiation; resemble primitive cells of same tissue; often equated with undifferentiated malignant neoplasms? Anaplasia
A clonal proliferation of cells that is uncontrolled and excessive? Neoplasia
Fibrous tissue formation in response to neoplasm desmoplasia
TUmor Grade vs Stage? Grade is degree of cellular differentiation; Stage is degree of localization/spread expresssed with T (tumor size), N (Node involvement), M (metastases)
Organs experiencing coagulative necrosis? Heart, liver, kidney
Organs experiencing liquefactive necrosis? brain, bacterial abscess, pleural effusion
What is associated with Caseous Necrosis? TB, Systemic fungi
What undergoes fibrinoid necrosis? blood vessels
What part of the heart is most suseptible to ischemia? subendocardium (Left ventricle)
What parts of the colon are most suspetable to ischemia? Spleni flexure and rectum
Enzymes that eliminate free radicals? Catalse, superoxide dismutase, glutathione peroxidase)
Urine specific gravity of 1.010? Advanced Renal Failure: Isothurea
Causes of transudate? Increased hydrostatic pressure; Decreased oncotic pressure; Na+ retention
Causes of Exudate? Lymphatic Obstruction, inflammation
symptoms of chronic iron poisoning Metabolic acidosis, scarring leading to GI obstruction
Benign epithelial tumors? Malignant? Adenoma, Papilloma; Adenocarcinoma, papillary carcinoma
Malignant tumors of the blood Leukemia, Lymphoma
Mesenchymal bengin tumor of blood vessels? Malignant? Hemangioma; Angiosarcoma
Benign tumor of smooth muscle? Malignant? Leiomyoma; Leiomyosarcoma
Benign tumor of striated muscle? Malignant? Rhabdomyoma; Rhabdomyosarcoma
What is Cachexia mediated by? TNF-a, IFN-y, IL-6
Down syndrome is associate with what neoplasms ALL, AML
Xeroderma pigmentosum and albinism is associated with what neoplasmins Melanoma, Basal cell carcinoma, and especially SCC of skin
Chronic atrophic gastritis, pernicious anemia, postsurgical gastric remnants is associated with what neoplasm? Gastic Adenocarcinoma
Tuberous sclerosis (facial angiofibroma, seizures, mental retardation) is associated with what tumors? Giant cell astrocytoma, renal angiomyolipoma and cardiac rhabdomyoma
Actinic keratosis is associated with what neoplasm? SCC of skin
Barrett's Esophagus is associated with what neoplasm? Esophageal adenocarcinoma
Plummer-vinson syndrome (dec iron) is associated with what neoplasm SCC of esophagus
Cirrhosis (alcoholi; hepaptiis B or C)is associated with what neoplasm? Hepatocellular carcinoma
Ulcerative Colitis is associated with what neoplasms Colonic adenocarcinoma
Paget's Disease of bone is associated with what neoplasm? 2ndary osteosarcoma and fibrosarcoma
Immunodeficiency states are associated with what neoplasms? Malignant lymphomas
AIDS is associated with what neoplasms? Aggressive malignant lymphomas (non-Hodgkins) and Kaposi's sarcoma
Autoimmune diseases (hashimoto's, Myasthenia gravis) is associated with what neoplams? Lymphoma
Acanthosis nigricans can be associated with what neoplasms? Visceral malignancy (stomach, lung, uterus)
Dysplastic nevus is associated with what neoplasm? Malignant melanoma
Radiation exposure is associated with what neoplasms? Leukemia, Sarcoma, Papillary thyroid cancer, and breast cancer
abl oncogene is associated with what tumor? What is gene product CML; Tyrosine kinase
C-myc oncogene is associated with what neoplasm? Gene product? Burkitt's lymphoma; Transcription factor
Bcl-2 oncogene is associated with what neoplasm? Gene product? Follicular and undifferentiated lymphomas (inhibits apoptosis); Anti-apoptotic molecule
HER2/neu (c-erbB2) oncogene is associated with what neoplasm? Gene product? Breast, ovarian, and gastric carcinomas; Tyrosine kinase
ras oncogene is associated with what neoplasm? gene product? Colon Carcinoma; GTPase
ret oncogene is associated with what neoplasm? Gene product? Multiple endocrine neoplasia (MEN) types 2A and 2B; Tyrosine Kinase
c-kit oncogene is associated with what neoplasm? Gene product? Gastrointestinal stromal tumor (GIST); Cytokine receptor
L-myc oncogene is associated with what neoplasm? Gene product? LUng tumor; Transcription Factor
N-myc oncogene is associated with what neoplasm? gene product? Neuroblastoma; Transcription factor
Describe Oncogene by principle Gain of function: increased cancer risk. Need damage to only 1 allele
Describe Tumor ruppressor genes by principal Loss of function: increased cancer risk; both alleles must be lost fo expression of disease
Rb tumor suppressor gene is associated with what tumor? gene product? Retinoblastoma, osteosarcoma; Inhibits E2F: blocks Gi--S phase
p53 gene tumor suppressor is associated with what tumor? Gene product? Most human cancers, Li-Fraumeni syndrome; Transcription factor for p21, blocks GI--S phase
BRCA1 tumor suppressor gene is associated with what tumor? Gene product? Breast and ovarian cancer; DNA repair protein
BRCA2 tumor suppressor gene is associated with what tumor? Gene product? Breast and ovarian cancer; DNA repair protein
p16 tumor suppressor gene is associated with what tumor? Melanoma
BRAF tumor suppressor gene is associated with what tumor? Gene product? Melanoma; B-raf
APC tumor suppressor gene is associated with what tumor? Colorectal cancer (associated with FAP)
WT1 tumor suppressor gene is associated with what tumor? Wilm's Tumor (nephroblastoma)
NF1 tumor suppressor gene is associated with what tumor? Gene product? Neurofibromatosis type 1; RAS GTPase activating protein (RAS-GAP)
NF2 tumor suppressor gene is associated with what tumor? Gene product? NeuroFibromatosis Type 2; Merlin (Schannomin) protein
DPC4 tumor suppressor gene is associated with what tumor? Gene product? Pancreatic Cancer; DPC (Deleted in Pancreatic Cancer)
DCC tumor suppressor gene is associated with what tumor? Gene product? Colon Cancer; DCC (Deleted in colon cancer)
PSA is elevated in? BPH and prostatitis
What tumor marker do you monitor in prostate carcinoma that is not PSA Prostatic Acid Phosphatase
What is CEA? CarcinoEmbryonic Antigen; Very nonspecific but produced by 70% of colorectal and pancreatic cancers; also produced by gastric breat and medullary thyroid carcinomas
What tumors make alpha-fetoprotein? Hepatocellular carcinomas. Nonseminomatous germ cell tumors (e.g. testis overy)
Beta-hCG is made by what tumors? Hydatidiform moles and Choriocarcinomas (gestational trophoblastic disease)
CA-125 is a tumor marker for what cancer? Ovarian Cancer
S-100 is a tumor marker for ? Melanoma, neural tumors, schwannomas
Alkaline phosphatase is a tumor marker for? Metastases to bone, liver, Paget's Dz of Bone
Bombesin is a tumor marker for? Neuroblastoma, lung and gastric cancer
TRAP is a tumor marker for? Tartrate-Resistant Acid Phosphatase: HAIRY CELL LEUKEMIA
CA-19-9 is a tumor marker for? Pancreatic Adenocarcinoma
Calcitonin is a tumor marker for? Medullary Thyroid Carcinoma
LIver fluke is associated with what cancer? Cholangiocarcinoma
H pylori is associated with what cancer? Gastric adenocarcinoma and lymphoma
Schistosoma haematobium is associated with what cancer? Blader cancer (SCC)
HPV is associated with what cancer? Cervical carcinoma (16, 18), penile/anal carcinoma, upper respiratory SCC
EBV is associated with what cancer? Burkitt's lymphoma, Hodgkins lymphoma, Nasopharngeal carcinoma, CNS lymphoma (in immunocompromised)
HTLV-1 is associated with what cancer? Adult T cell leukemia/lymphoma
Aflatoxin associated with? Hepatocellular carcinoma
Vinyl chloride is associated with what cancer? Angiosarcoma of liver
Carbon tetrachloride is associated with what cancers? Centrilobular necrosis, fatty change in liver
Nitrosamines (smoked foods) is associated with what cancer? Gastric cancer
Cigarette smoke is associated with what cancers where? Larynx (SCC); Lung (SCC/ Small cell carcinoma); Kidney (RCC); Bladder (Transitional Cell Carcinoma); Pancreas (pancreatic adenocarcinoma)
Asbestos is associated with what cancer where? Bronchogenic carcinoma>mesothelioma of the lung
Arsenic is associated with what cancers and where? Skin (SCC); Liver (Angiosarcoma)
Naphthalene dyes is associated with what cancer and where? Bladder (Transitional Cell Carcinoma)
Alkylating agents are associated with what cancer and where? Blood (Leukemia)
Paraneoplastic syndrome of Small cell lung carcinoma? Cushings syndrome (ACTH/ACTHlike peptide); SIADH (ADH); Lambert-Eaton syndrome, muscle weakness (Ab against presynaptic Ca2+ channels at NMJ)
Paraneoplastic syndrome of intracranial neoplasms SIADH (ADH)
Hypercalcemia from increased PTHrP is associated with what neoplasms Squamous cell lung carcinoma, renal cell carcinoma, Breast cancer
Hyper calcemia from increased 1, 25 (OH)2 D3 (Calcitriol) is associated with what neoplasm? Hodgkins lymphoma, Some non-Hodgkin's lymphomas
Polycythemia is a paraneoplastic syndrome of what neoplasms and what are they excreting? Erythropoietin from RCC, hemangioblastoma, HCC, Pheochromocytoma
Lambert eaton syndrome (muscle weakness)from Ab against presynaptic Ca2+ channels at NMJ can be a paraneoplastic syndrome from what cancer? Small Cell Lung Carcinoma
Psammoma bodies are laminated, concentric, calcific spherules seen in? Papillary adenocarcinoma of thyroid, Serous Papillary cystadenocarcinoma of ovary, Meningioma, Malignant mesothelioma
Highest incidences of cancers in males Prostate (32%) Lung (16%) Colon/rectum (12%)
Highest incidences of cancers in females? Breast (32%) Lugn (13%) Colon/Rectum (13%)
Highest mortality of cancers in females? Lung (32%) Breast (18%)
Highest mortality of cancers in males? Lung (33%) Prostate (13%)
Brain metastasis often come from? Lung > Breast > Genitourinary > Osteosarcoma > melanoma > GI
Mulitple, well-circumscribed tumors at gray/white matter junction Brain metastatses. 50% of brain tumors are from metastases
Liver metastases often come from? Colon >> Stomach > Pancreas
Bone Metastases often come from? Prostate, breast > Lung > thyroid, testes
The most common sites of mestastasis after regional lymph nodes? LIver and lung
Which are more frequent Primary Bone TUmors or Tumor metastases to bone? Metastases
Created by: gsei174