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96 Cards in this Set

  • Front
  • Back
Cardiac hypertrophy

- is usually due to...?
- what are the other cell types that only undergo hypertrophy and not hyperplasia?
cardiac hypertrophy is due to the heart's need to pump more strongly.

Skeletal muscle and nerves are
the other tissues considered permanent and do not exhibit hyperplasia

may be physiologic or pathologic
Steatosis, aka, _____________

- are due to ...
Fatty change

due to Abnormal metabolism : Fatty livers can be seen in usually alcoholics because it leads to alteration of F.A. metabolism in the liver. Leads to presence of fat vacuoles in the liver cells.
Anthracosis is ....
carbon pigment deposition, a form of pigment accumulation, and can be seen commonly in the lung
Lipofuscin granules is...
a normal biologic process commonly thought of as a "wear and tear" pigment. Tend to see these in old people. Usually have no functional consequence. It is a form of pigment accumulation.
Hemochromatosis / hemosidorosis is..
excessive iron deposition in organ tissue
Kernicterus is damage to ___ due to ______.
damage to CNS due to hyperbilirubinemia.

Due to unconjugated bilirubin crossing the immature blood brain barrier in the premi baby. Bright yellow pigment that affects usually basal ganglia.
Contrast Dystrophic calcification
and Metastatic calcification.
Dystrophic calcification: Typically found in areas of tissue necrosis or stressed tissues (inflamed and irritated) for a long time. Initiated by cell membrane damage. Ex. calcification of aortic valve cusps

Metastatic Calcification: occurs in normal tissues in setting of hypercalcemia and can occur widely throughout body
Atherosclerosis is...
plaque like material that forms in the vessels, thus interfering with blood flow. Is a common cause of ischemia, or tissue hypoxia.

7.18 9AM
Thromboembolism is....
thrombus, or clot travels to the lung and impedes blood flow. Is a common cuase of ischemia, or tissue hypoxia.

7.18 9AM
T or F:
Ischemia injures tissues faster than hypoxia.
True
Three patterns of nuclear changes can occur with regards to necrosis:
karyolysis pyknosis, karyorrhexis. Describe each.
Karyolysis : fading of the nucleus, due to deoxyribonyclease activity
Pyknosis: nuclear shrinkage and increased basophilia (increased blue staining) due to DNA condensation
Karyorrhexis: fragmentaiton and eventual disappearance of pyknotic nucleus
Infarction in the brain produces what kind of necrosis?
Liquefactive necrosis. All other organ infarcts are usually coagulative though.
Gangrene usually refers to ischemic necrosis typically of a limb. What is dry gangrene and wet gangrene?
Dry refers to coagulative necrosis. Wet refers to if it is compllicated by a bacterial infection, then it also undergoes liquiefactive necrosis.
What type of necrosis is usually associated with TB infection?
Caseous necrosis. Usually surrounded by granuloma.
What type of necrosis is associated with acute pancreatitis?
Fat necrosis
Compare necrosis and apoptosis across:
A. cell membrane integrity
B. pathalogic versus physiologic
C. incurs an inflammatory response or not
Necrosis: membrane breaks down, always pathalogic and always incurs an inflammatory response.

Apoptosis: membrane integrity maintained, can be either pathalogic or physiologic, no inflammation occurs
LAD-1 , or leukocyte adhesion deficiency, is caused by defect of .... and leads to....
LAD-1 is caused by LFA-1 and Mac-1 (both integrins) subunit defects and results in having recurrent bacterial infections and impaired wound healing.

7.18 10AM
LAD-2, or leukocyte adhesion deficiency, is caused by absence of .... and defect in .....
absence of sialyl-Lewis X and defect in E- and P- selectin (additional adhesion molecules) sugar epitopes

7.18 10AM
Chediak-Higashi Syndrome is caused by defect of _________ function.
leukocyte function; specifically defect of chemotaxis / phagocytosis due to impaired microtubule assembly
Chronic Granulomatous Disease is caused by defect of leukocyte function. How so specifically?
It is a defect of microbicidal activity. It is a deficiency of NADPH oxidase that generates superoxide which means no oxygen-dependent killing mechanism. Thus, recurrent bacterial infections occur.
There are two types of chemical mediators of inflammation:
plasma-derived and cell-derived.

What is each's origin?
Give examples of what is in each category.
Plasma-derived mediators are from the liver. Cell-derived are from leukocytes themselves.

Plasma-derived: complement, kinin, coagulation factors
Cell-derived: preformed, sequestered and released when needed such as histamine by mast cells, or prostaglandin via cyclooxygenase
Plasma protein systems (complement system, kinin system, clotting system) are all linked by activation of ______________.
Factor XII
Arachidonic acid metabolites are produced by two pathways: cyclooxygenase makes __________ and lipooxygenase makes ____________. What does each cause?
Prostaglandins --> vasodilation and prolong edema

Leukotrienes --> increased vascular permeability, vasoconstriction and/or bronchospasm
What does nitric oxide do?
Made by endothelial cells and macrophages, NO promotes vascular smooth muscle relaxation and vasodilation
Systemic effects of inflammation include fever, acute-phase protein production, and leukocytosis. What are the last two? Name other effects.
Acute-phase proteins are made by the liver and help fix complement. They include CRP, fibrinogen, and serum amyloid protein. Leukocytosis is when WBC count rises super high especially with bacterial infections.

Other effects: increased pulse and bp, shivering, chills, sleepiness, malaise
Differentiate healing versus regeneration.
Healing is a tissue response to a wound, an inflammatory process, or cell necrosis and involves regeneration and scar formation. Regeneration is the replacement of injured cells by cells of the same type.
Regarding regeneration, in tissues capable of regeneration, requires a.................. ; if this is absent, healing by scar occurs
in tissues capable of regeneration, requires an intact connective tissue scaffold; if this is absent, healing by scar occurs
The most important regulator of cell growth and differentiation (healing) is ........
prodding resting cells (G0) to enter the cell cycle
List some
A. quiescent cells
B. labile cells
C. permanent cells
A. quiescent = stable cells. usually little to no rate of division. Includes liver, kidney, pancreas, endothelium, fibroblasts.
B. labile = always dividing. think of the rapidly dying, high turnover areas: epithelial cells of skin, oral cavity, exocrine ducts, GI tract, endometrium and bone marrow cells
C. nerves, heart, skeletal muscle
True or False:
In humans, compensatory hyperplasia reconstitutes functional mass, not original architecture.
True

Entire lobes of the liver are not replaced after partial hepatectomy
What are the four parts of the ECM and what do they do?
Collagen - confers tensile strength due to crosslinked structure
Elastin - gives recoil to tissues such as vessel walls, uterus, skin
Proteoglycans and hyaluronan - hydrated gels that confer resilience and lubrication to joints
Adhesive glycoproteins and integrins - link components of ECM to each other
Angiogenesis occurs by two ways...
vessels derive from endothelial cell precursors (angioblasts) or by budding from pre-existing vessels.

Both involve basement membrane degradation and endothelial cell migration.
What are the sequence of events in wound healing?
1. Formation of blood clot . Stops bleeding, acts as scaffold for migrating cells (neutrophils within first 24 hours)
2. Formation of granulation tissue. New small blood vessels develop, and fibroblasts proliferate
3. Cell proliferation and collagen deposition. Macrophages replace neutrophils by 96 hours
Macrophages clear extracellular debris, fibrin, foreign material, promote angiogenesis and ECM deposition
4. Scar formation
5. Wound contraction
Aberrations of inflammation and repair include:
- inadequate formation of granulation tissue or scar formation (wound dehiscence, ulceration)
- excessive formation of components of repair process (keloid, fibromatosis)
- wound contracture
What is edema? Anasarca?
Edema is the accumulation of abnormal amounts of fluid in interstitial spaces or body cavities.
Anasarca is severe and generalized edema with marked swelling of subcutaneous tissue. Usually associated with renal failure.
Which is good to drain as treatment: transudate or exudate?
Draining exudate helps the healing process. Do not drain transudate because it will recur and could possibly cause hypovolemic condition for patient.
Name some mechanisms of edema.
(ex. increased hydrostatic pressure, esp of backup on venous side)
- loss or decreased synthesis of plasma proteins due to renal or hepatic disease
- increased vascular permeability due to inflammation
- impaired lymphatic drainage due to tumor or infection
- salt and water retention due to kidney and cardiac disease
What can white/yellow (not green and dark yellow) sputum being coughed up by a patient indicate?
Fluid droplets in trachea/ bronchi. Due to increased hydrostatic pressure. Treatment: diuretic to reduce body fluid, dijdoxin to stimulate heart.
Cirrhotic liver can occur due to commonly two things. What?
alcoholism or hepatitis. See light colored scar on surface of liver and nodules. Nodules are not connected well to the biliary system and circulation system. Thus, the cirrhotic liver becomes a very high pressure high resistance portion of the body for the blood to flow through. Thus, fluid that does go here can leak out of the liver and into the surface of the abdomen.
What is ascites and what causes it?
Ascites is due to portal hypertension. Usually due to liver disease. Ascites fluid has protein in it. Generally is not infected though it could become infected. Portal system is trying to go through the liver but can’t because of high resistance liver there. (Remember 75% of the blood the liver recieves is from the portal vein delivering blood from the GI tract. The pressure causes the fluid to build up via the secondary circulation of the common hepatic artery and hepatic artery proper. The distended vessels you can see through the skin is called caput medusa (varicosities) appear on the stomach. Splenomegaly is also caused by portal hypertension.
What is hyperemia? How does this contrast to congestion?
Hyperemia is an active process with increased blood flow into capillaries (as in exercise/infection/blushing).
Congestion is a passive process (impaired venous drainage); can be coincident with edema.
Hallmark of ___________ is a lot of RBCs in vessels and along alveolar walls.
pulmonary congestion
What are heart failure cells? What are they indicative of? Where are they found?
There was a lot of back pressure in this patient. A lot of fluid but also RBCs that leaked out. Patient survived that and macrophages came and gobbled up the RBCs. When the macrophages eat RBCs up, there is a lot of hemosiderin seen upon autopsy. These are called “heart failure cells” and are found in the lung’s alveoli.
True or False:
Hemostasis aims to maintain the fluidity of the blood by allowing the rapid formation of a solid plug to close a defect in a vascular channel.
True
What is thrombosis?
A pathalogic process that denotes the formation of a clotted mass of blood within a non-interrupted vascular system.
Compare and contrast hemostasis and thrombosis. What are the three factors that the two are dependent upon?
hemostasis is a physiological process and thrombosis is a pathalogic process. Hemostasis aims to plug a defect in a vascular channel. Thrombosis is when a clotted mass occurs in a noncompromised channel. The three things are: vascular endothelium, platelets and coagulation system.
With regards to hemostasis and thrombosis, endothelial cells have antithrombotic properties and prothrombotic properties. Name em. (~3 each)
Antithrombotic: antiplatelet effects, anticoagulatn properties (heparin and thrombomodulin), fibrinolytic properties (plasminogen activators)

Prothrombotic: adherence of platelets to subendothelial collagen, syntehsis of von illebrand's factor (VWF), synthesis of tissue factor (TF) thus activating extrinsic clotting pathway.
What is primary hemostasis and secondary hemostasis?
Refers to the hemostasis process. Primary hemostasis is when platelets form a plug to seal vasculature. Secondary hemostasis is the TF (tissue factor) initiating the coagulation cascade to form a more stable plug with cross-linked fibrin.
Laboratory assessments of hemostasis include: platelet count, aPTT/ PTT (intrinsic pathway) monitors [ coumadin / heparin ] , PT/INR (extrinsic pathway) monitors [ coumadin / heparin.
aPTT / PTT monitors heparin.

PT / INR monitors coumadin.
Anticoagulants involves proteins C and S that inactivate factors of the coagulation system. If you are deficient in Proteins C and S, what happens?
You have problems with clot breakdown. (Completely lacking these is incompatible with life.)
What are some predisposing factors to thrombosis?
Endothelial injury (be it mechanical, chemical or infections), alterations to normal blood flow (stasis of blood flow, vascular changes), hypercoagulability states
Contrast arterial thrombi to venous thrombi with regards to:
A. where it occurs
B. physical findings (signs)
A. arterial thrombi occur commonly in coronary, cerebral and femoral arteries
venous thrombi: commonly occurs in veins of lower extremities
B. arterial thrombi is occlusive with regards to blood flow so you get a pale, cold
venous thrombi is usually edemitous
What do lines of zahn indicate in a histological slide?
These alternating lines represent successive waves of clotting that has occurred and indicates that there was a clot there at one point antemortem.
What is a risk factor for having a fat embolus?
When you have a bone fracture or break, you get some fat leakage. This can also occur with necrosis of the bone marrow.
What are some clinical manifestations of shock?
* Hypotension --> weak pulse, tachycardia, faster breathing
* oliguria or anuria
What is the main test for assessing shock?
looking at amount of lactic acid
Iscemic encephalopathy, subendocardial hemorrhages and necrosis, acute tubular necrosis, patchy hemorrhages and necrosis in the GI tract, fatty change or central hemorrhagic necrosis in liver are all morphological features of ________.
Shock
_______ is due to systemic release of endotoxins for gram negative bacterial cell walls and LPS. Cytokine cascade of alpha TNF, IL-1, IL-6 and IL-8 occurs.
septic shock
What is the mechanism of septic shock?

Endotoxins cause hypotension and DIC (disseminated intravascular coagulation)....
DIC turns on clotting when it isn't supposed to happen so you start getting little bits of occlusion in the body. Simultaneously fibrinolysis occurs rampantly. . Coagulation factors are consumed and they don’t have any more coagulation factors to stop the bleeding. DIC can also be released with endothelial injury.
What are some common screenting tests for the general asymptomatic population? (5)
Glucose , Lipid panel, PSA, Pap Smear, Occult Blood (looks for Hg in stool. is a screening for colon cancer)
Regarding common blood tests for evaluating general medical conditions, what is the difference between CBC and CMP tests?
CBC : RBCs, WBCs, platelets
CMP: good for assessing fluid balance and electrolytes (Na, K, Cl, CO2, glucse, Ca, Protein, albumin, liver function with AST, ALT, ALP, Bilirubin, and finally renal function BUN and Cr.
Part of the CMP, the AST, ALT, and ALP tests are to detect what?
AST and ALT tests detect enzymes that are normally in hepatocytes. If these are high in the blood that means there is damage to the liver.

ALP detects biliary enzymes that are normally in biliary tract (and also can come from bone)
If you suspect a patient has anemia, would you want to order a CMP or CBC to assess your suspcion?
CBC because CBC looks at RBCs, WBCs and platelets. For anemia, we want to look at RBC (cell size or chromicity), and possibly also order a reticulocyte count which gives you an idea if the bone marrow is able to produce RBCs to answer if anemia is from failure to produce RBCs or excess destruction.
What does it mean if an RBC is "microcytic"?
R is microcytic. See more space between RBCs. Cells have more of a white glow in the middle that’s bigger than in the normal RBC swab. Also these are a bit paler than the normals.

Might be indicative of anemia.
What is a possible treatment for hemochromatosis?
Phlebotomy. Ferritin levles go down, as does iron and iron saturation.
Hemochromatosis is caused by a hereditary genetic mutation in what gene?
HFE gene

(tyrosine for cysteine at aa282; aspartic acid for histidine at aa63)
Regarding HIV tests for diagnosis, screening is done by _______ and if positive is repeated. A second confirm repeat is followed by ____________.
EIA, then western blot
When is the BMP ordered?
For monitoring patients on IV therapy and/or for hos inpatients in the hospitals this is the test ordered 3x a day. Checks for electrolyte balance and hydration status.
Some people would be predisposed to have CVTs if they have a mutation specific to what codon?
Codon 506
What tumors get the suffix
A. - oma
B. -carcinoma
-C. -sarcoma
A. all benign tumors, regardless of origin (mesenchymal vs. epithelial). Epithelial tumors can be named by histological or gross features.
B. malignant tumors of epithelial origin
C. malignant tumors of mesencymal origin
Polyp vs. papilloma:
________ is benign epithelial neoplasm with finger-like projections while ______ is an extension of epithelium and stroma above mucosal surface
Papilloma has the fingerlike projections. Grossly can look like wartiness ; polyp is stalk of stroma
What is a hamartoma?
A benign term which indicates normal indigenous cells that lack appropriate architecture and structure and form a disorganized mass. Not cancerous (malignant).
What is a choristoma?
When there is an ectopic rest of normal tissue just in the "wrong" location. Commonly in the GI tract where gastric or pancreatic tissue is sitting in an abnormal location. Again, NOT cancerous (malignant).
Are hamartomas and choristomas malignant?
NO. They do NOT have cancerous potential. (Remember hamartomas are disorganized cell masses; choristomas are normal but misplaced cells.)
What is it called when on neoplastic cell line has diverged into two cell lines?
Mixed tumors.

Common in tumors of salivary glands.
What is a teratoma?
he multifaceted mixed tumors should not be confused with a teratoma, which contains recognizable mature or immature cells or tissues representative of more than one germ cell layer and sometimes all three. Teratomas originate from totipotential cells such as those normally present in the ovary and testis and sometimes abnormally present in sequestered midline embryonic rests. Such cells have the capacity to differentiate into any of the cell types found in the adult body and so, not surprisingly, may give rise to neoplasms that mimic, in a helter-skelter fashion, bits of bone, epithelium, muscle, fat, nerve, and other tissues. When all the component parts are well differentiated, it is a benign (mature) teratoma; when less well differentiated, it is an immature, potentially or overtly, malignant teratoma. A particularly common pattern is seen in the ovarian cystic teratoma (dermoid cyst), which differentiates principally along ectodermal lines to create a cystic tumor lined by skin replete with hair, sebaceous glands, and tooth structures.
What would you call:
A. a benign tumor of fat
B. a malignant tumor of cartilage
C. a malignant tumor of the bone
D. a benign tumor of the capillary
E. a malignant tumor of the capillary
A. lipoma
B. chodrosarcoma
C. osteosarcoma
D. Hemangioma
E. Angiosarcoma
What would you call:
A. a malignant tumor of smooth muscle
B. a malignant tumor of skeletal muscle
A. leiomyosarcoma (uterine fibroids or esophagus are common sites)
B. rhabdomyosarcoma (usually in large muscles like in thighs or hamstrings)
What would you call:
A.squamous cell papilloma (benign) if it were malignant?
B. renal tubular adenoma (benign) if it were malignant?
C. Liver cell adenoma / hepatoma (benigns) if it were malignant?
A. squamous cell carcinoma
B. renal cell carcinoma
C. Hepatocellular carcinoma
What would you call a benign mixed and compound tumor of divergent differentiation with one germ layer origin?

A. Mature teratoma
B. Dermoid cyst
C. Wilm's tumor
D. Pleomorphic adenoma
D. Pleomorphic adenoma

If this were malignant it'd just be "Malignant mixed tumor of salivary gland origin."
What are characteristics of dysplasia? (5)
- loss of uniformity of individual cells
- loss of architectural orientation
- pleomorphism (bizarre nuclei that have notches or are cleft shaped)
- hyperchromatic nuclei
- increased mitoses
What does it mean if a tumor is anaplastic?
Anaplasia is a feature of poorly differentiated neoplasms and it is used as the end of the spectrum to represent typically aggressive tumors.
What is the MOST reliable feature of malignancy?
A. poor demarcation
B. destroys surrounding tissue
C. invasion
C. INVASION is the most reliable feature of malignancy
Carcinogenesis occurs from accumulated mutations. What are two noteable oncogenes and what do they do?
RAS oncogene allows cells to secrete more growth factors so they can grow without anchorage.

MYC oncogene makes cells sensitive to growth factor, thereby immortalizing cells (allowing them to not undergo apoptosis).
True or False:
If tumor cells are detected in peripheral blood, that means metastasis has occurred.
Not necessarily. Not all become metastatic tumors. There are a series of steps required for metastatic spread. Mainly:
1. Invasion of ECM
2. Vascular dissemination, homing and colonization by tumor cells
Tumor cells are vulnerable in circulation so what do they do?
Often they form platelet tumor aggregates to enhance survivability and implantability.
What is a Krukenberg tumor?
Colon cancer that homes to ovary.
What types of tumors like to metastasize to bones? (hint: mnemonic)
BLT with a Kosher Pickle:

Breast, Lung, Thyroid, Kidney, Prostate
True or False:
Tumors themselves are heterogenous
True. It is the subset of clones that develop gene products for metastasis.
Grading of tumors indicates cellular differentiation. Does the Grading scale from Grade I --> Grade IV go from
A. undifferentiated --> well differentiated
B. well differentiated --> undifferentiated
B. well differentiated --> undifferentiated
Keratin pearls are found in what type of cancer and indicate what grading?
Squamous cell carcinoma; indicates well differentiated
What is cancer staging based on? (What measurements?)
3 things we look at to stage a cancer:
1. Primary tumor size (length, width, depth of tumor) T0-T4
2.Regional lymph node involvement. See if lymph nodes around it have cancer. N0-N3
3. Metastases. See if we rec’d other specimen from same pt. and see if there is a tumor in the specimen. M0-M2.
What is carcinomatosis? Why is it inoperable?
Serosa is studded with numerous little tumor blots. Inoperable because impractical to remove every single little blot.
What are clinical symptoms of neoplasia?
* Impingement of adjacent structures that can lead to pain or obstruction of vessels, ducts or bowels
* bleeding and infections as tumor erodes thru adjacent structures
* cachexia
* hormone synthesis producing syndromes
Tumor cells are not of endocrine origin but might cause hormonal changes. Hypercalcemia is common as is Cuhsing's syndrome. What causes the two?
Hypercalcemia is caused by too much "parathryoid-like hormone" being released. Usually associated with carcinomas of the breast, lung, kidney and ovary.

Cushings syndrome is due to excess release of corticotropin and is associated with small cell carcinoma of the lung.
What neoplasm causes:
A. gigantism and acromegaly
B. hypoglycemia
A. pituitary adenoma --> excess GH
B. Islet cell adenoma or carcinoma --> excess insulin