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GPAT
Exam 1
114
Pathology
Graduate
02/29/2012

Additional Pathology Flashcards

 


 

Cards

Term
Define hypertrophy and discern between hormonal and compensatory types.
Definition
Increase in the size of cells. Hormonal is caused by hormones (like in the uterus during pregnancy), compensatory is caused by an increase in the demand of the tissue types of interest (as in the heart during hypertension)
Term
Define hyperplasia
Definition
Increase in the number of cells. This usually increases the volume of the organ where the cells reside.
Term
Define squamus metaplasia
Definition
Metaplasia is when a cell turns into another type. An example is when cells of the lungs change from gladular to squamus to prevent them from being damaged when exposed to cigarette smoke.
Term
Define dysplasia
Definition
This is like an early neoplasm. The cells freak out and change their shape or organize themselves differently.
Term
define anoikis
Definition
A special type of cell death where cells die after becoming detatched from their matrix. This prevents metastasis.
Term
define necrosis
Definition
Cells dying from degradative enzymes. Always pathologic. During this process it will swell, then its lysozomes will rupture causing digestion and membrane blebbing.
Term
What is hydropic swelling?
Definition
A symptom of acute cell injury that may be caused by infetions, ischemia, heat or toxins that causes blebs, chromatin clumping. Most of this is caused by lots of Na in the cell which causes influx of water.
Term
What are the 5 types of necrosis?
Definition
1. Coagulative (proteolysis stops and it dies in its own waste), 2. Liquefactive (accelerated lysis of adjacent cells), 3. Fat (chalky areas in fat), 4. Caseous (tuberculosis), 5. Fibrinoid (in Blood vessels)
Term
How does apoptosis progress initially?
Definition
Cells shrink and detatch, DNA is fragmented, cell surface blebs and apoptotic bodies form.
Term
Microscopically, what distinguishes necrosis from apoptosis?
Definition
In necrosis you will see a significant swelling of the cell unlike apoptosis. Apoptotic bodies would come from apoptotic cells. Also, the necrotic cells would break apart themselves and later be scavenged, whereas the apoptotic bodies would be phagocytized.
Term
What are occurs in apoptosis after apoptotic bodies form?
Definition
Healthy cells will phagocytize them, they will be degraded in the lysozomes.
Term
You build a perfect cell but insert a cytoplasmic protein that neutralizes cytochrome C. What effect may this have on apoptosis rates?
Definition
This would decrease apoptotic rates since the cytochrome C help to form the apoptosome.
Term
What would happen to cell death if you increased the translation of functional p53 and simultaneously exposed the cell to UV rays causing Thymidine dimers?
Definition
You would increase the cell death rate. P53 recognizes errors in DNA and initiates apoptotic responses.
Term
Autophagy. What is it?
Definition
The cell will lyse its own organelles. It is a mechanism of programmed cell death distinct from apoptosis. You want this when you won't be able to have phagocytes digest apoptotic cells.
Term
What distinguishes entosis from apoptosis?
Definition
The cell will first be internalized into another cell not by phagocytosis but by cell invasion. This occurs in epithelial cells frequently. The cell won't be dead at the time it is internalized and the process is reversible.
Term
What are the three types of calcification?
Definition
Dystrophic (usually in necrotic or messed up tissues), metastatic (calcium salts in normal tissue, because high Ca in serum), calcium stones (CaCO3, in gallbladder, kidney (ouch!))
Term
What causes aging?
Definition
It is a mixture of genetic and environmental factors including REACTIVE OXYGEN SPECIES, DNA repair defects, abnormal cell signalling, inability to make new cells (telomeres) and proteasome malfunctions
Term
You invent a telomere polymerase (TPOL) that makes telomeres really long. How will this affect the amount of divisions you'll get from TPOL active cells?
Definition
You will have increased number of generations. Cancer cells, for example have lots of telomerase.
Term
What do antibodies do?
Definition
They can neutralize toxoids and bacteria. They can also opsonize and function in the complement cascade.
Term
What percentage of White blood cells do lymphocytes compose?
Definition
25% (80% of which are T cells)
Term
Phagocytes can kill cells by
Definition
ROS, swallowing, cytokines
Term
What are some differences between CD 4 and 8 cells
Definition
4= helper, 8= suppressor. 4 will promote antibody and inflammation. These are type Th1, but 8 cells inhibit immune response and are type Th2
Term
What to CTL cells do?
Definition
Target tumurs and virally infected cells. They will cause apoptosis. They do not recognize cells from antigen, but other means.
Term
how do vaccines help us?
Definition
Vaccines will expose us to integral parts of an organism. We will catalogue these agents as harmful and we will be able to combat insults of the same variety much quicker
Term
What are the two grand errors in immunity
Definition
1 Our immune system doesn't recognize or clear foreign insults. 2. When our immune system considers our own cells foreign and starts attacking the hosts own cells.
Term
Anemia, splenomegaly (big spleen), fatigue, weakness caused by and attack on your own red blood cells is what?
Definition
Autoimmune hemolytic anemia
Term
An autoimmune infection on lungs and kidneys causing coughing of blood is what?
Definition
Goodpasture syndrome
Term
What is the organ affected in Grave's disease?
Definition
The tyroid. This would cause hyperthyroidism. This could cause increased heart rate, weight loss and nervousness
Term
antibodies attacking the Beta cells in the pancrease causing reduction in insulin is which autoimmune disease?
Definition
Diabetes mellitus (type 1). This also causes thirst and frequent yrination.
Term
Scleroderma. What is it?
Definition
Lots of collagen deposited in the skin. This can cause edema, ishema of fingers amongst other things.
Term
Which organs are affected by SLE (lupus)
Definition
The joints, kidneys, skin, lungs, heart brain, or blood cells. This can cause anemia and other issues with lack of function of the affected organs. The tell-tale sign is the malar rash which looks like a butterfly on the face.
Term
What may occur that will cause us to develop an autoimmune disease?
Definition
A foreign substance that causes an immune reaction is similar in composition to self proteins, altered self substance (by a virus, drug, sunlight) or a substance in the body that is not normally seen by the immune cells that is suddenly released into the bloodstream.
Term
Which factors cause sjogren's?
Definition
Lacrimal and salivary glands gland is infiltrated by lymphocytes, which will cause atrophy in these glands leading to less tears and saliva.
Term
Why does HiV need a host? Which cells do they hijack?
Definition
Because it is an RNA virus (a retrovirus), and needs the host cells to use the host's DNA with REVERSE TRANSCRIPTASE to replicate ourselves. In this way, it integrates it's gemone with our own. It uses our CD4 cells becaues these have a receptor on them that HIV uses to get inside.
Term
When will symptoms of Aids begin?
Definition
After latent phase, when the rate of destruction of CD4 cells rises above the rate of CD4 replication
Term
CD4 counts that are important to aids are 500 and 200 per ml. What do each of these signify?
Definition
500=HIV is defined at this amount. 200=level where HIV related infections will ensue
Term
What is the karposi sarcoma?
Definition
HIV related blood vessel cancer that causes purple lesion on the skin.
Term
Which of these isn't a classic infection associated with HIV: Candidiasis, Mycobacterium Avium, Rickettsia or TB?
Definition
Rickettsia
Term
Which isn't a symptom of candidiasis: Thrush, xerostomia, angular chelitis or erythematous?
Definition
Xerostomia
Term
What is inflammation and what five insults is it usually aimed at?
Definition
Body's attempt to get rid of noxious stimuli or injury
Microbial, mechanical, chemical, foreign materials, neoplasia
Term
What are the two major concepts that differentiate acute inflammation from chronic inflammation?
Definition
Duration of inflammation
Nature of response
Term
Describe the time period and particular reaction that can occur with acute inflammation.
Definition
Usually onset is abrupt and short duration, associated with sudden injuries
Exudative reaction = fluid, serum proteins, and leukocytes arrive from vasculature
Term
Can acute inflammation become chronic inflammation?
Definition
YES
Term
You were silly in Sim Lab and you've cut yourself with your handpiece. Now you've got some acute inflammation; what are ALL the possible outcomes of this??
Definition
Complete resolution (heals and we're all good)
Abscess formation (gets wall off with tons of leukocytes)
Resolution with sequalae (you get a lovely battle scar)
Chronic (becomes WORSE)
Term
Describe the time period of chronic inflammation, the particular reaction associated with it, and the only way to cause resolution.
Definition
Tissue injury continues (can be weeks, months, etc.)
Proliferative reaction = fibroblasts, endothelial cells mass proliferate and chronic inflammatory cells (think macrophages) parade in
Only end with the PERSISTENT SOURCE is REMOVED
Term
Which is more important in acute inflammation: severity of injury or cause of injury?
Definition
SEVERITY OF INJURY
Term
Acute inflammation can be broken into two major event categories. Name them and give a brief description of each.
Definition
Vascular events = think increase permeability of fluids and plasma pieces and increased blood flow
Cellular Events = think calling the troops to battle (PMNs, platelets, macrophages)
Term
Walk through a basic cycle of acute inflammation as if you have just gotten a cut.
Definition
1. Bacteria/pathogens invade wound!
2. Platelets release blood-clotting factors at wound
3. Mast cells start dumping out histamine, seratonin, and bradykinin to increase blood and plasma to wound
4. Neutrophils chomp on pathogens
5. Macrophages dump cytokines for chemotaxis (see more with chronic)
6. Keep going until remove material or repair wound!
Term
The vascular response of acute inflammation is like an EMT; why is this?
Definition
It acts as a delivery system for inflammation and helps bring the life-saving materials to the wound
Term
Describe the basic components of the vascular response.
Definition
Rapid and transient vasoconstriction followed by vasodilation (hyperemia)
Increased vascular permability
System slows down in a progression to concentrate cellular supplies causing statis and leukocyte margination
Term
What are the four classic signs of acute inflammation and what is the extra special fifth one?
Definition
Redness/erythema
Heat
Swelling
Pain
**Loss of function**
Term
Vasodilation is associated with which cardinal signs of inflammation?
Definition
Redness AND heat
Term
Swelling is caused by what response?
Definition
Vascular response = exudation of fluid, plasma proteins and leukocytes
Term
Pain in acute inflammation is caused by what?
Definition
Tissue distension
Nerve ending compression
Term
What are the three systemic signs of acute inflammation?
Definition
Fever = endogenous pyrogens (injured cells OR microorganisms)
Leukocytosis = increase in WBC (neutrophils = neutrophilia)
Lymphadenopathy = swelling of lymph nodes
Term
When we say that vessels are getting 'leaky' during acute inflammation, what are we talking about?
Definition
Endothelial cells have retracted from each other and made gaps so fluid can leak from intravascular compartment into extracellular compartment
Term
In acute inflammation, the vascular response produces a 'triple response of the skin' and goes through all signs of inflammation. Name the three steps and the signs associated.
Definition
Immediate injury = vasodilation with dull redness (rubor and calor)
Wait a few seconds = vasodilation with red flare (rubor and calor)
About a minute =swelling with wheal and edema (tumor and dolor)
Term
Which cells most likely cause the red flare seen in acute inflammation?
Definition
Mast cells
Term
What is vascular stasis and why does it help in the delivery system?
Definition
Fluid loss from vessels without blood cell loss
Causes increased viscosity of blood, decreasing flow so more concentration of materials
Term
What is leukocyte margination and what happens as this occurs?
Definition
WBC stick together
Intravascular hydrostatic pressure increases, causing more fluid loss and cells to enter extravascular space
Term
Edema is swelling because fluid leaked into tissues. This escape is also called exudate. What are the two types of exudate and how are they different?
Definition
Serous exudate = thin clear fluid, usually plasma fluids (low protein and cells) in mild inflammation
Purulent exudate = suppration with nasty pus, rich in neutrophils and cell debris, plasma fluids/protein from pyogenic bacterial infections
Term
What is a fistulous?
Definition
A canal for drainage of purulent exudate that the body produces itself
Term
Did you know that having edema and nasty swelling is actually protective to your body??? What does edema do for the body?
Definition
Diluate toxins in tissues
Inactive those toxins via proteases
Give nutrients to inflammatory cells
Concentrate antibodies/complement
Have fibrinogen --> to fibrin for movement of inflammatory cells
Term
Let's review immunology! What is chemotaxis?
Definition
Directed movement of WBCs to area of injury stimulated by factors (Like C5a and cytokines!)
Term
Let's review immunology! What is phagocytosis?
Definition
cells engulfing and ingesting foreign substances from injured site; involves neutrophils and macrophages
Term
Neutrophils are pretty awesome. What is their purpose and what is so special about them?
Definition
Hallmark of acute inflammation, first on the job!
Phagocytose nasty things
Multilobular nucleus and granular cytoplasm with lysosomes
Term
Monocytes are pivotal cells in regulating chronic inflammation. Describe them and their functions.
Definition
Part of WBCs, second line of defense!
Large, mononuclear and phagocytose nasty stuff with lysozymes
Can migrate out of bloodstream to become tissue macrophages
Term
What are the sequence of microscropic events that occur during the inflammatory response?
Definition
1.) Injury
2.) Constriction of microcirculation
3.) Dilation of small blood vessels
4.) Increase in permeability of small blood vessels
5.) Exudate leaves small blood vessels
Term
We can classify inflammatory mediators into two broad categories; what are these and what do each of these categories lead to?
Definition
Vasoactive factors (think histamine) increase vascular permeability and cause edema
Chemotactic factors (think C5a) call up inflammatory cells to cause either acute or chronic inflammation
Term
What are formylated peptides?
Definition
Peptides that have formylated Met as their first amino acid (hallmark of bacterial proteins!)
Term
When you compare vasoactive factors to direct vascular injury, what will you notice about the time period for the change in permeability?
Definition
Vasoactive factors change permeability within a hour but then go back to normal
Injury will cause slower change but will last longer (think burn victims)
Term
Let's review immunology! What is emigration?
Definition
Passage of white blood cells through endothelium/microcirculation into injured tissue
Term
In acute inflammation, neutrophils come out first to help deal with the insults. What are the steps in the process of exudation?
Definition
Margination - short vasoconstriction then vasodilation (think bradykinin, PAF)
Adhesion - stimulated by adhesion factors and cytokines
Emigration and chemotaxis- go towards stimulus!!
Phagocytosis and degranulation (oxygen dependent/independent killing)
Extracellular release of leukocyte products
Term
Chemical mediators come in a variety of flavors. Name the two big categories we can divide them into and the three subdivisions of each.
Definition
Cells = cytokines, prostaglandins, and histamine
Plasma = complement, kinins, and clotting
Term
Describe in a general sense where cell mediators are made and what each class does.
Definition
Cytokines made in cells = cause more inflammation (attract cells) and systemic effects (think fever)
Prostaglandins made in cells = cause more inflammation and pain
Histamine released from granules = cause vasodilation and increase permeability
Term
Describe in a general sense what plasma mediators do.
Definition
Complement = increase permeability, attract inflammatory cells, and attack microorganisms
Kinins = increase permeability and cause pain
Clotting = coagulation
Term
Resolution of acute inflammation depends on what factors?
Definition
Injury is limited or brief
Minimal tissue destruction
Tissue can regenerate
Term
How does resolution of acute inflammation occur?
Definition
Remove/neutralize chemical mediators
Normalize vascular permeability
Stop leukocyte emigration
Clear edema, inflammatory cells, and debris via lymphatic drainage and macrophage digesting
Term
Sometimes you get a nasty scar after you've cut yourself. Why is this and what does it involve during the acute inflammation process?
Definition
Tissue could NOT regenerate or there was tons of tissue destruction
Massive amounts of fibrinous exudates couldn't be absorbed so lots of connective tissue elements were laid down
Term
We get abscess formation when what infects us?
Definition
Pyogenic (pus-forming) bacteria or fungi
Term
What are three hallmarks of chronic inflammation?
Definition
Mononuclear cells invade! (macrophages, etc)
Tissue is destroyed (inflammatory cells do this!)
Repair via new vessel proliferation and scarring
Term
What three general situations would you expect to find chronic inflammation in?
Definition
Persistent infection of organisms with LOW pathogenicity causing delayed hypersensitivity (think TB)
Prolonged exposure to toxic agents (asbestos skank)
Autoimmune diseases (since body keeps making the antigens)
Term
What four cells would you expect to find in a wound that is chronically infected?
Definition
Tissue macrophages- trying to chomp on debris and spewing out cytokines
T-Lymphocytes- stimulating more macrophages
Plasma cells- making antibodies
Eosinphils- dealing with nasty parasites and allergies (IgE response!)
Term
What steps occur during macrophage activation?
Definition
1.) Chemokines are secreted by smooth muscle, monocytes, and fibroblasts (RANTES, MCP-1, MIP-1)
2.) Chemokines recruit and activate monocytes so they bind to VCAMS and ICAMS to migrate
3.) Lymphokines recruit and activate macrophages to increase their size, make them produce enzymes, and spew cytokines for local healing
Term
An activated macrophage spits out tons of IL-1 and TNF-alpha. What are some of the effects of doing this?
Definition
Acute phase = fever, increase sleep, decrease appetite, cause muscle wasting, increase acute phase proteins, cause hemodynamic effects and neutrophilia
Endothelial effects = increase leukocyte adherence, PGI synthesis, PAF, pro-coagulant activity, and decrease anti-coagulant activity
Fibroblast effects = increase proliferation, collagen synthesis, collagenase, protease, and pGE synthesis
Term
Macrophages can also cause some nasty tissue damage. How do they do it?
Definition
Toxic oxygen metabolites, proteases, neutrophil chemotactic factors, coagulation factors, amino acid metabolites, and nitric oxide
Term
What things do activated macrophages deal with to cause fibrosis?
Definition
Increase growth factors (think TGF-beta), fibrogenic cytokines, angiogenesis factors, and remodeling via collagenases
Term
What are the three systemic manifestations of chronic inflammation?
Definition
Fever- endogenous pyogens (IL-1 and TNF-alpha)
Leukocytosis- increase number of leukocytes
Acute Phase response- that feeling that you are sick (weakness, don't want to eat...) releasing C-protein and lectins from liver to start up complement
Term
What do eosinphil granules contain?
Definition
Major basic protein (MBP)- highly charged catonic protein that is deadly to parasites BUT also causes epithelial damage
Term
What are the two types of chronic inflammation?
Definition
Non-specific inflammation- mononuclear cell infiltrate and proliferate fibroblasts and new blood vessels
Granulomatous inflammation- get collections of activated macrophages
Term
What basic things can cause granulomatous inflammation?
Definition
Bacterial infection
Fungal infection
Parasitic infection
Inorganic metals/dust
Foreign body reactions
Diseases with unknown cause (think Crohn's disease)
Term
There are different flavors of granulomas. Name them and give a brief description.
Definition
Epitheloid cells- in center with long, stringy nulcei
Giant cells- macrophages have fused together and now multinucleated
Caseating- epitheloid cells in center are all irregular and amorphous
Foreign body giant cells- near foreign materials in body with nuclei scattered haphazardly
Term
What is orofacial granulomatosis and what would you possibly see clinically?
Definition
Non-specific granulomatous inflammation in orofacial tissue - diagnose via EXCLUSION
Possibly see chelitis granulomatosa (swollen lips), Melkersson-Rosenthal syndrome (swollen lips, fissured tongue, and facial palsy), or Intraoral sites with swelling, erythema, erosins, paresthesia, or pain
Term
When cells get hit with stress, they have to adapt in one of four ways. What are they?
Definition
Atrophy
Hypertrophy
Hyperplasia
Metaplasia
Term
What two processes does the body use for tissue repair?
Definition
Regeneration- use parenchymal cells
Replacement with scar- use connective tissue
Term
What are the three types of cells and which are able to renew?
Definition
Labile cells- always renewing (think epithelium)
Stable cells- can renew if needed (think hepatocytes)
Permanent cells- NO RENEW (think neurons)
Term
In tissues with stable cells, what determines whether or not the tissue with regenerate?
Definition
Depends on potential to replicate NOT actual number of stead-state mitoses
Term
What two factors influence regeneration and what responses do they modify?
Definition
Soluble factors (growth factors)
Insoluble factors (Laminin, fibronectin, collagens)
Influence cell growth, locomotion, contractility, and differentiation
Term
What do growth factors basically do?
Definition
Cause fibroblast proliferation, collagen synthesis, and provide blood and nutrients
Term
Let's review cell bio! What is the extracellular matrix (ECM) and why is it so important?
Definition
Network of crosslinked fibrous structural proteins and interstitial ground substance (remember collagens, elastins, and proteoglycans) to provide a substrate so cells can adhere, regulates movement, growth, and differentiation of cells in it --> MUST BE INTACT TO REPAIR INJURED TISSUE
Term
Let's review cell bio! What is the basement membrane, collagen, glycoproteins, and proteoglycans?
Definition
Basement membrane- separated epithelial from endothelial and provides polarity
Collagen- give strength and support (triple helix!)
Glycoproteins- Linking ECM to cells and together (laminin, fibronectin, thrombospondins)
Proteoglycans- maintain ECM structure and permeability (bottle brush like)
Term
Let's review more cell bio! Name the five types of collagen discussed in Dr. Basile's lecture.
Definition
Type I- principle in bone, skin, tendons, mature scars
Type II- cartilage
Type III- embryonic tissues, GI, blood vessels
Type IV- ONLY basement membranes
Types V-XXII- more basement membranes
Term
Which protein is the most abundant in the basement membrane?
Definition
Laminin
Term
What are the four steps to scar formation/fibrosis?
Definition
1.) Angiogenesis- make new but leaky vessels (always see edema)
2.) Migration and proliferation of fibroblasts- GFs control and promote
3.) Deposit ECM- at first only proteoglycans then only collagen (depends on tensile strength of wound)
4.) Maturation and organization of scar- make metalloproteinases and serine proteases to regulate (originally made as zymogens)
Term
What are the changes that occur in angiogenesis?
Definition
1.) Basement membrane and ECM degradation and remodeling
2.) Cell migration
3.) Mitosis
4.) Capillary differentiation and anastomosis
Term
What are the steps in wound healing?
Definition
1.) Induction of acute inflammation (after initial injury)
2.) Parenchymal cell regeneration (if possible)
3.) Migration and proliferation of parenchyma and CT
4.) Synthesis of ECM Components
5.) Remodeling of parenchyma and ECM to restore function and increase wound strength
Term
Over the course of two weeks, describe the typical wound healing process.
Definition
Day of injury= make clot and increase fibrin, RBCS, and platlets
Day one= neutrophils come and phagocytosis happens
Day two= macrophages, lymphocytes, plasma cells, fibroblasts, and epithelial cells come
Up to a week = fibrin digestion of initial repair and inflammation complete *granulation tissue formed and epithelial proliferation and migration*
Two weeks= SCAR
Term
What are the phases of cutaneous wound healing?
Definition
1.) Injury --> increase permeability to allow inflammatory cells to invade and then vasoconstriction follows
2.) Coagulation as platelets spew fibrin in wound
3.) Platelets attract PMNs and commence inflammation
4.) After 48 hrs, macrophages replace PMNs and release GFs to make collagen
5.) After 72 hrs, proliferation to make collagen
6.) After 3 wks, slow down collagen synthesis but continue crosslinking
Term
What happens in healing by primary intention?
Definition
Clean incision with approximated ends so more epithelial regeneration over fibrosis and LESS scar tissue
Term
What happens in healing by secondary intention?
Definition
Cell or tissue loss is massive so lots of granulation tissue and scarring with wound contraction (via myofibroblasts)
Term
What happens in healing by tertiary intention?
Definition
Must wait until an infection is resolved before performing tissue repair
Term
What factors influence wound healing?
Definition
Local factors = wound type (size and location), vascular supply, infection, movement
Systemic factors = circulatory status, infection, metabolic status, malnutrition
Term
What complications can arise from wound healing?
Definition
Deficient scar formation - leads to dehiscence and incisional hernias or ulceration
Excessive scar formation
Excessive contraction
Term
What are keloids?
Definition
Firm, rubbery lesions that are usually darkly colored
Occur after trauma and may be itchy
Can be on earlobes after piercing
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