Pathology Exam 1

one cell type replaced by another cell type

What is metaplasia?

disordered maturation of cells, premalignant stage

what is dysplasia?

hypertrophy of the heart leading to ischemia, necrosis, and heart failure

What is the result of persistent hypertension?

Hypertrophy

Growth factor stimulation, neuroendocrine stimulation, and ion channel flux are all examples of biochemical mechanisms that cause/support ______________.

Resistance training, elF2

IGF-1 is an important growth factor that mediates hypertrophy due to _______________. __________ is an important initiation factor in this process.

Hypertrophy

A 60 year old man is hypertensive for 10 years (BP 160/98 mm Hg) Which cellular change will be observed in his cardiac muscle?

steatosis (fatty liver disease), reversible

Selective hypertrophy is seen in _______________ (due to accumulation of fat in hepatocytes). It is an example of a _______________ cell injury.

SER

More enzymes must be made to detoxify the drugs

People treated with barbiturates may have hypertrophy occur in which subcellular organelle or their hepatocytes? Why does this occur?

Hyperplasia

Bone marrow cells from an organ donor are cultured in vitro at 37°C in the presence of recombinant erythropoietin. A large colony of erythrocytes is formed. This colony, committed to the erythrocyte pathway of differentiation, represents an example of which physiological adaption?

Erythroid

__________________ hyperplasia is typically seen in people living at high altitude.

Hyperplasia

Hormonal causes (increase in estrogen at puberty leading to increased number of endometrial and uterine stromal cells), persistent injury, chronic inflammation and increased functional demand are all examples of things that can lead to ______________.

Physiological

Increases in size of breast tissue during pregnancy, increases in thickness of the endometrium during the menstrual cycle and liver growth after partial resection are all examples of ___________________ hypertrophy/hyperplasia.

Pathological

Growth of adrenal glands due to production of adrenocorticotropic hormone by a pituitary adenoma, proliferation of endometrium due to prolonged estrogen stimulus, prostatic hyperplasia, and myocardial hypertrophy are all examples of _______________ hypertrophy/hyperplasia.

Prostate

Hydronephrosis (kidney failure due to urine retention) can result form pathological hypertrophy of which organ/gland?

Yes

Is metaplasia reversible?

physiological

Is squamous metaplasia of the endocervix at puberty physiological or pathological?

Malignant transformation

Metaplasia can be the first step in developing a ____________.

H. Pylori infections

Gastric Intestinal Metaplasia is a result of chronic injury caused by ___________________.

smoking

Metaplasia of the laryngeal respiratory epithelium is a common side effect of ____________.

Metaplasia of the esophageal epithelium (squamous to columnar)

Result of dysphagia and persistent heartburn

What is Barrett's esophagus and what is it the result of?

mild = only a few abnormal cells

moderate = abnormal cells occupy about 50% of the thickness of the surface lining of the cervix

What is the difference between mild (CIN I) and moderate (CIN II) cervical dysplasia?

Coarse chromatin, prominent nucleoli, nuclear-cytoplasmic ratio of 1:1 instead of 1:4 or 1:6

What are the prominent features of an anaplastic cell?

Menopause

Physiologic atrophy occurs during ____________ in women.

Physiologic

Shrinkage of brain tissue due to aging is an example of ___________ atrophy.

atrophy

Decreased workload, denervation, diminished blood supply, inadequate nutrition, pressure by tumor or by any space occupying lesions are all examples of things that can contribute to pathological ____________.

increased, decreased

Atrophy may be caused due to ______________ protein synthesis or ______________ protein degradation.

ubiquitin-proteasome

Via what pathway are cellular proteins degraded?

neurodegenerative

Mutations in the ubiquitination pathway are the primary cause of what type of diseases?

parkinson's (neurodegenerative diseases in general)

Lewy bodies are found in which disease(s)?

True

T/F Necrosis is always pathological

Toxins, infections, physical injury, and serum deficit injury (TIPS)

What are the causes of cell injury?

Atherosclerosis

Excess serum cholesterol can lead to ____________________.

calcium, degrade

Injurious agents like ischemia and toxins can lead to increases in intracellular ________________. This will lead to activation of specific enzymes which will _____________ the mitochondrial membrane.

cell injury

Dysfunction of the respiratory system, cell membrane integrity, protein synthesis process, cell cytoskeleton, and cell genetic apparatus can lead to what?

irreversible mitochondrial damage, profound membrane dysfunction

What are the main characteristics of cell injury?

increased cytosolic calcium, increase oxidative stress, and accumulation of lipid breakdown products

What are the three ways the mitochondria can become irreversibly damaged?

cytochrome c, apoptotic

When there is a leak in the mitochondrial membrane, __________________ is released. This triggers the cells _____________ mechanisms.

False, they damage DNA

T/F Free radicals do not affect cellular DNA.

transition metals like iron and copper

What produces free radicals?

CkMB and troponins I

During ischemia like myocardial infarction, what two enzymes (heart specific) would you expect to see increased in the blood?

Hydropic swelling

A cell with a large, pale cytoplasm, a normally located nucleus, and distended endoplasmic reticulum cisternae is likely to be undergoing what type of acute reversible cell injury?

ischemia

If swelling of the mitochondria is present, what is the most likely cause?

hydropic, fatty, necrosis, and apoptosis

What are the 4 morphological changes seen in cell injury?

cystic fibrosis = chloride channelopathy

myasthenia gravis = sodium channelopathy

Channelopathies are issues associated with ion channels or the subunits that regulate them. Dysfunction of which type of ion channels are associated with cystic fibrosis and myasthenia gravis?

True

T/F chaperonopathies can be either genetic or acquired.

Reversible

Cell blebs, mitochondrial swelling, and glycogen depletion are all signs of _______________ cell injury

Irreversible

Nuclear changes such as pyknosis, karyorrhexis, and karyolysis are signs of _______________ cell injury.

False, lack of inflammation is a hallmark of apoptosis

T/F inflammation is produced by apoptosis.

atrophy

Excessive apoptosis causes ____________.

Apoptosis

Cell shrinkage, chromatin condensation, cytoplasmic blebs, phagocytosis, and no inflammation are observed. Is this apoptosis or necrosis?

DNA damage, protein misfolding, and infections (especially viral)

What are the common causes of pathological apoptosis?

Apoptosis, chemotherapy induces targeted cell apoptosis

A 48-year-old woman has a malignant lymphoma involving lymph nodes in the para-aortic region. She is treated with a chemotherapeutic agent which results in the loss of individual neoplastic cells through fragmentation of individual cell nuclei and cytoplasm. Over the next 2 months, the lymphoma decreases in size, as documented on abdominal CT scans. By which mechanism has her neoplasm primarily responded to therapy?

Necrosis

An initial swelling of the cell and organelles, followed by ATP depletion and increased plasma membrane permeability, finally ending with release of macromolecules from the cell and cell death, is indicative of what type of cell injury?

leakage and denaturation of proteins and enzymatic digestion of cell organelles

Morphological changes observed in cell necrosis are the result of what associated processes?

brain = <3 mins

Heart = 1-2 hours

kidney = 2-3 hours

skin = < 24 hours

How long until brain tissue undergoes necrosis in a hypoxic situation? what about heart tissue? kidney? skin?

Coagulative

Infarction of the heart of kidneys will result in what type of necrosis?

loss of cell outline, glassy eosinophilic appearance

Coagulative necrosis can be characterized by what macroscopic tissue details?

CNS

Liquefactive necrosis is associated with infarction of (the) ____________.

Caseous

Which type of necrosis is seen in tuberculosis and fungal infection (rare)?

Caseous

Which type of necrosis is associated with friable cheese-like cellular debris?

Granuloma

A focal collection of inflammatory cells at sites of tissue infection included activated macrophages, Langerhans' giant cells and lymphocytes is known as a _______________.

Tuberculosis

Langerhans' giant cells are typically associated with what disease primarily?

Malignant hypertension

Fibrinoid necrosis is associated with what emergency condition?

Fatty

Which type of necrosis is seen with acute pancreatitis?

Fatty Necrosis

A 50-year-old chronic alcoholic presents to the emergency room with 12 hours of severe abdominal pain. The pain radiates to the back and is associated with an urge to vomit. Physical examination discloses abdominal tenderness. Laboratory studies show elevated serum amylase. What morphologic change would be expected in the peri pancreatic tissue of this patient?

Fatty free acids bind to calcium to form soaps, seen in acute pancreatitis

What is saponification and what condition is it associated with?

quickly, blood vessel disease (atherosclerosis)

Dry gangrene develops ____________ is found most commonly in patients with __________________.

bacterial, diabetes

Wet gangrene is classified as such because of the presence of a ___________ infection. It occurs often in people with _____________.

Neurodegenerative disease (Lewy bodies), kidney filtration disorders, and protein folding disorders

Protein accumulation may be the result of what types of disease/disorders?

early, hemosiderin, late

Hemosiderosis is classified as the __________ stage of ________________ accumulation whereas Hemochromatosis is the _____________ stage.

inherited

Primary hemochromatosis is __________________.

Secondary

Anemia, thalassemia, liver disease, or blood transfusion can be causes of _____________ hemochromatosis.

cirrhosis, fibrosis, bronze skin discoloration, portal hypertension, diabetes mellitus

Too much iron as a result of hereditary hemochromatosis can result in what conditions?

Copper, mutation

Wilson's disease is associated with accumulation of _________________ due to a gene _______________.

Wilson's

Kayser-Fleisher rings in the cornea are a major sign of which disease?

Wilson's

The slit lamp eye exams and 24 hour urinary copper excretion tests are used to diagnose which disease?

Decreased serum ceruloplasmin

In addition to increased free serum copper, what other marker is typically found in a Wilson disease patient's bloodwork?

decreased cellular replication, accumulation of toxic byproducts, cross linking or mutation of DNA, ageing genes, loss of cell repair mechanisms and free radical injury

What are the important mechanisms of aging?

Rapid ageing

What is Werner's syndrome?

increased vascular permeability

What is the most common characteristic of inflammation?

Rubor (redness), Color (warmth), Dolor (pain), Tumor (swelling)

bonus: loss of function

What are the 4 cardinal clinical signs of inflammation? what is the bonus 5th sign?

Exudation

Which is present in inflammation, exudation or transudation?

Bacterial infection, acute

If a patients blood panel shows high neutrophil count, what is the most likely source of their inflammation? acute or chronic?

Viral infection

If a patients blood panel shows high lymphocytes and macrophages, what is the most likely source of their inflammation?

Chronic

If a patients blood panel shows a high lymphocyte count, is their inflammation acute or chronic?

Acute

Which type of inflammation (acute or chronic) is characterized by exudative inflammation (excess fluid)?

Chronic

Which type of inflammation (acute or chronic) is characterized by severe fibrosis?

Monocytes

__________________ leave the circulation, enter tissue, and differentiate into macrophages.

parasitic infections, allergic conditions, immune disorders, and drug reactions

What are the potential causes of eosinophilia?

skin presentation, diarrhea, eosinophils in urine

How can one determine if a patient is having an allergic reaction to a drug?

Von Willebrand factor, thromboxane A2

Platelets use ____________________ to adhere to collagen and are stimulated by ___________________.

Platelets, endothelial cells

Thromboxane A2 (TXA2) and prostaglandin (PGI2) are responsible for reulgating ______________ and ________________.

increase blood flow to the site of an injury, alert products of healing to attend to the site of injury, and remove injured tissue and prepare the site for healing

What are the three major goals of inflammation?

1. Chemical mediators releases

2. Vasodilation and vascular injury lead to leakage (edema)

3. Platelets are activated to initiate clot formation and homeostasis

4. Vascular permeability increases via histamine release

5. Vascular endothelial cells contribute to clot formation

6. Microbes initiate activation of the complement cascade, recruits neutrophils

7. Neutrophils eliminate microbes and remove damaged tissue

What are the sequence of events that occur during the inflammatory response to injury

Protein loss results in reduced intravascular osmotic pressure and increases the osmotic pressure of interstitial fluid

How does edema occur in inflammation?

Lymphangitis, lymphadenitis

In addition to exudate, acute inflammation is also accompanied by __________________ and ________________.

Release of c reactive proteins, serum amyloid A and P, coagulation proteins

During acute inflammation, the liver receives IL-1, TNFalpha, IL-6, LIF and OSM. What is its response?

More WBCs

IL-6 alone will cause the bone marrow to produce what?

Prostaglandin production/fever

IL-6 and IL-1 together will produce what response?

Bradykinin and prostaglandin

What are the mediators of pain?