Inflammation and Cell Injury
| Question | Answer |
|---|
| Cytochrome c is activated because of what imbalance in the intrinsic pathway? | bcl-2 (anti-apoptotic – prevent cyt c leak) is decreased, BAX (anti-bcl-2 is increased) |
| Caspases are activated are the end products of pathways beginning how? | intrinsic – bax > bcl-2….extrinsic – perforin/granzyme OR fasR (CD95) |
| What are the types of necrosis (6)? | coagulation pale (dry gang), coagulation hemorrhagic, liquefactive (wet gang here too), caseous, fatty, fibrinoid |
| Describe a cell that has been degraded without inflammation. | cell shrinkage, nuclear shrinkage, basophilia (pyknosis), blebbing memrane, pynotic nuclear fragmentation (karyorrhexis), nuclear fading (karyolysis), apoptotic bodies |
| What are the types of gangrenous necrosis? | wet and dry |
| Blood vessels undergo what kind of necrosis? | fibrinoid |
| What parts of cell injury are reversible with oxygen? | swelling, low ATP, ribosomal dislocation, fatty change, chromatin clumping, low glycogen |
| How is blood supply related to infarct pathology? | collaterals = red (GI, lung, liver)…single = pale (kidney, heart, spleen) |
| Nephrolithiasis can cause in the end what kind of cell change? | atrophy |
| Cystic fibrosis can cause in the end what kind of cell change? | atrophy (mucous occlusion) |
| What leukocytes are acute? | eosinophils and neutrophils |
| What are the adhesion proteins used by neutrophils to extravasate in chronological order? | lewis-sialyl…LFA-1…PECAM-1 |
| What are the adhesion proteins used by endothelial cells to promote extravasation in chronological order? | E-selectin, P-selectin…ICAM-1….PECAM-1 |
| What are the leukocyte migration factors? | C5a, IL-8, LTB-4, Kallikrein |
| A defect in ICAM-1 binding to ___ will cause what symptoms? | recurrent pyogenous infections, delayed umbilical separation…LFA-1….LAD-1 |
| Steps of leukocyte extravasation? | rolling, adhesion, diapedesis, migration |
| Free radicals will damage cells how? | peroxidation of lipid membrane, DNA break, protein modification |
| What are the seven diseases of free radical injury? | reperfusion, iron poison, copper poison, retinopathy of prematurity, bronchopulmonary dysplasia, CCl4 to liver fatty change, acetaminophen |
| Nitric oxide can cause free radical injury! | nice |
| The extrinsic clotting cascade is connected to leukocyte extravasation how? | Kallikrein is activated by factor XIIa |
| What are the 8 granulommatous diseases? | TB, sarcoid, syphilis, fungus, leprosy, crohns, cat scratch fever, berylliosis |
| The maintainance of a granulomma ____ is released by ____ which is activated by ___ released by ___? | TNFalpha – Macrophage --- IFN-gamma by Th1 |
| Specific gravity 1.011 of extracellular fluid, why? | high capillary pressure, low capillary oncotic, high Na…transudate |
| Specific gravity 1.021 of extracellular fluid, why? | inflammation or lymphatic obstruction |
| Causes of decreased ESR? | sickle cell, polycythemia, CHF |
| Cuases of increased ESR? | infections, inflammation, cancer, pregnancy,SLE |
| Mechanism of iron toxicity? | converts H2O2 to free radicals causing peroxidation of membrane lipid causing apoptosis |
| Gastric bleeding is an acute sign of ___ toxicity which can lead to what chronically? | iron, metabolic acidosis and GI scarring |
| Congo red stain shows what in amyloidosis? | apple-green birefringence |
| Types of amyloidosis and proteins associated with each (7)? | Primary (AL), Secondary (AA), senile cardiac (AF), DM-2 (AE), Medullary carcinoma of thyroid (A-CAL), alzheimers (beta-amyloid), Dialysis Associated (microglobulin B2) MHC class 1 |
| AA is derived from what in what? | Serum amyloid-associated protein (chronic inflammatory disease)…. secondary |
| AL is derived from what in what? | Light chain Ig (MM)….Primary |
| AF is derived from what in what? | transthyretin…senile cardiac |
| AE is derived from what in what? | amylin….diabetes-mellitis type 2 |
| A-CAL is derived from what in what? | calcitonin….medullary thyroid carcinoma |
| beta-amyloid is derived from what in what? | amyloid precursor protein (APP), alzheimers |
| Beta-2 microglobulin is derived from what in what? | MHC I….. dialysis-associated |
| Total resistance is decreased in what kind of shock? | septic…high venous retunr |
| Total resistance is increased in what kind of shock? | cardiogenic/hypovolemic |
| memorize |
General Neoplasia
| Question | Answer |
|---|
| Describe metaplastic cells. | high N/C ratio...clumped chromatin |
| How does CIS go to invasive carcinoma?C(carcinoma in situ) | hyalinases and collagenases |
| What receptors are changed in metastatic cells? | (cadherin), laminin, integrin |
| What are the irreversible plasias? | neoplasia, anaplasia, desmoplasia (normal near cancer to fibrous) |
| What are the reversible plasias? | dysplasia, metplasia, hyperplasia |
| How do you stage? | Tumor size Node Metastasis |
| More prognostic, generally, stage or grade? | stage |
| What is a malignant blood vessel tumor? Benign? | angiosarcoma....hemangioma |
| Malignant bone? Benign? | osteosarcoma....osteoma |
| What are the types of epithelial tumors, both benign and malignant? | papilloma, adenoma.....adenocarcinoma, papillary carcinoma |
| What is a smooth muscle tumor called? | leiomyosarcoma...leimyoma |
| What is a skeletal muscle tumor called? | rhabdomyosarcoma....rhabdomyoma |
| What are the benign and malignant multiple cell type tumors called? | ((mature teratoma - femal)....immature teratoma female AND teratoma male |
| Sarcoma means | mesenchymal cancer |
| Small cell carcinoma can cause what syndromes? | cushings (ACTH/rp), SIADH, lambert-eaton |
| intracranial neoplasms can cause what syndromes? | SIADH |
| Squamous cell lung carcinoma can release ____ causing ____? | PTH-rp, TGF-beta, TNF, IL-1… hypercalcemia |
| Renal cell carcinoma can release ___ causing ___? | PTH-rp, TGF-beta, TNF, IL-1… hypercalcemia…AND Epo –polycythemia |
| Breast Carcinoma can release ____ causing ___? | PTH-rp, TGF-beta, TNF, IL-1… hypercalcemia |
| Hemangioblastoma can release ____ causing ___? | Epo –polycythemia |
| HCC can release ____ causing ___? | Epo –polycythemia |
| Pheochromocytoma can release ____ causing ___? | Epo –polycythemia |
| Thymoma can release ___ causing ___? | eaton lambert OR myasthenia… |
| Leukemias can release ____ causing ___? | uric acid (turnover) causing gout, urate nephropathy |
| Lymphomas can release ___ causing ___? | uric acid (turnover) causing gout, urate nephropathy...watch for folate deficiency as well |
| What can cause psammoma bodies? | papillary thyroid, serous cystadneocarcenoma (ovary), meningioma, mesothelioma |
| Top two causes of death in US? | heart disease > cancer |
| Mets to brain | lung , breast, melanoma, RCC, GI
(lbs kg) |
| Where are brain mets? | well circumscribed at gray white junction |
| Mets to liver? | colon > stomach > pancreas > breast > lung
(lbs pc) |
| Mets to bone? | prostate, thyroid, testes, breast, lung, kidney |
| memorize |
Disease Conditions associated With Neoplasms
| Question | Answer |
|---|
| Down syndrome cancer | ALL AML |
| XP | melanoma, basal cell, squamous cell carcinomas of skin |
| Albinism | melanoma, basal cell, squamous cell carcinomas of skin |
| Chronic atrophic gastritis | gastric adenocarcinoma |
| pernicious anemia | gastric adenocarcinoma |
| post-surgical gastric remnants? | gastric adenocarcinoma |
| tuberous sclerosis | cardiac rhabdomyoma, astrocytoma, angiomyoplipoma (kdiney) |
| actinic keratosis | SCC skin |
| barrett’s esophagus | esophageal adenocarcinoma |
| Plummer vinson syndrome | SCC of esophagus |
| Cirrhosis | HCC |
| Hep B | HCC |
| Hep C | HCC |
| ulcerative colitis | colonic adencarcinoma |
| pagets disease of bone | osteosarcoma secondary…. fibrosarcoma |
| immunodeficiency states | malignant lymphoma |
| AIDS | kaposi sarcoma… aggressive malgnant lymphomas |
| autoimmune disease | lymphoma |
| acanthosis nigricans | viscera malignancy |
| dysplastic nevus | malignant melanoma |
| radiation exposure | sarcoma, papillary thyroid carcinoma, mixed mullerian (endometrial adeno + mesenchymal tumor) |
| memorize |
Oncogenes and products
| Question | Answer |
|---|
| CML | abl…tyrosine kinase o |
| Burkitts | c-myc….transcription factor o |
| follicular lymphoma | bcl-2,…anti-apoptotic o |
| breast, ovarian, and gastric carcinomas | erb-B2 tyrosine kinase o |
| Colon carcinoma | ras…. GTP-ase o |
| Lung tumor | L-myc …. transcription factor o |
| Neuroblastoma | N-myc ….. transcription factor o |
| MEN IIa | ret …. tyrosine kinase o |
| MEN IIB | ret …. tyrosine kinase o |
| Gastrointestinal stromal tumor | c-kit….cytokine receptor o |
| memorize |
Tumor suppresor genes, chromosomes and products
| Question | Answer |
|---|
| retinoblastoma, osteosarcoma | Rb (13q)…. block G1→S t |
| Li-fraumeni | p53 (17p)….block G1→S t |
| breast and ovarian Cancer | BRCA1 (17q)…. DNA repair protein t |
| Breast cancer only | BRCA2 (13q)….DNA repair protein t |
| Melanoma | p16 (9p) t |
| colorectal cancer (FAP) | APC (5q) t |
| Wilms tumor | WT1 (11p) t |
| Neurofibromatosis type 1 | NF1 (17q) t...neurofibromin inhibits oncogene ras |
| Neurofibromatosis type 2 | NF2 (22q) t |
| Pancreatic cancer | DPC (18q) t |
| Colon cancer | DCC (18q) t |
| memorize |
Tumor Markers
| Question | Answer |
|---|
| BPH, prostatitis (monitor response/recurrence) | PSA |
| Prostate carcinoma | PSA + prostatic acid phosphatase |
Colorectal cancer
CEA (bava) | CEA (ambiguous)
Pancreatic,colorectal,medul ca thy,breast, |
| Pancreatic cancer | CEA (ambiguous) |
| CEA can be eleveated in what . | CRC, pancreatic, gastric, breast, thyroid medullary |
| HCC | AFP |
| non-seminomatous germ cell tumor of testis | AFP |
| hydatiform mole | bHCG |
| Choriocarcinoma | bHCG |
| Gestational trophoblastic tumor | bHCG |
| ovarian | CA-125 |
| malignant epithelial tumor | CA-125 |
| Melanoma | S-100 |
| Neural tumors | S-100 |
| schwannoma | S-100 |
| obstructive biliary disease marker | ALP |
| pagets | ALP |
| metastasis to bone | ALP |
| neuroblastoma | bombesin |
| lung cancer | bombesin |
| gastric cancer | bombesin (GRP) |
| hairy cell leukemia | TRAP |
| Pancreatic adenocarcinoma | CA-19-9 |
| Thyroid medullary carcinoma | Calcitonin |
| memorize |
Oncogenic microbes
| Question | Answer |
|---|
| HTLV-1 | adult t-cell lymphoma/leukemia |
| HBV | HCC |
| HCV | HCC |
| EBV | primary CNS lymphoma, burkitts lymphoma, nasopharyngeal carcinoma |
| HPV | Cervical carcinom (16,18), penil/anal carcinoma |
| HHV-8 | kaposi’s sarcoma…body cavity fluid B-cell lymphoma |
| HIV | primary CNS lymphoma |
| H. pylori | Gastric adenocarcinoma and lymphoma |
| Schistosoma | squamous cell carcinoma of transitional epithelium |
| memorize |
Chemical Carcinogens
| Question | Answer |
|---|
| Aflataoxin | HCC |
| vinyl chloride | liver angiosarcoma |
| CCl4 | centrilobular necrosis, fatty change liver |
| nitrosamine | eophagus, stomach |
| cigarette smoke | larynx squamous, lung (squamous and small cell), kidney (renal cell carcinoma), bladder (transitional cell carcinoma) |
| Asbestos | mesothelioma and bronchogenic carcinoma |
| Arsenic | squamous cell carcinoma skin, liver angiosarcoma |
| naphthalen | transitional cell carcinoma |
| alkylating agents | leukemias |
| memorize |
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