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Which idiopathic disease results in ossification of the ALL?
Diffuse Idiopathic Skeletal Hyoerostosis (DISH).
Name 2 examples of congenital etiologies.
- 1. Toxoplasmosis.
- 2. Fetal alcohol syndrome.
Name 3 examples of acquired etiology.
- 1. Emphysema.
- 2. Herpes.
- 3. Brain abscess.
Name 3 examples of genetic etiologies.
- 1. Huntington's Chorea: genetic damage of the motor (basal ganglia) and cerebral cortex, after 30 years of normal life.
- 2. Down Syndrome (trisomy 21).
- 3. Cystic fibrosis.
What is the term used to describe a subjective finding?
Symptom: pain, headaches, dizziness, heartburn, stomachache.
What is the term used to describe an objective finding?
Sign: temperature, BP, pitting edema... findings will be the same.
The term used to describe the combination of signs & symptoms associated with a particular disease is...
Which syndrome is characterized by vasoconstriction of peripheral arteries of the fingers?
Primary Raunaud's Syndrome... white, blue, red.
Which syndrome is characterized by autoimmune damage to EXOcrine glands?
- Sjogren's Syndrome: results in dryness of mucous membranes, thus weakening the body's first line of defense. Eye, mouth, and joint pain.
- Manifestation of RA & SLE... Also includes joint pain.
What type of disease is confined to one region of the body?
What type of local disease has damage limited to distant sites within a diseased organ?
What type of local disease has damage distributed uniformly within the organ?
A disease is considered systemic if it involves...
Other organs & systems (metastasized).
What are the 3 types of cell injury?
- 1. Deficiency.
- 2. Intoxication.
- 3. Trauma.
Which type of cellular injury results from a lack of substance necessary to the cell?
Which nutrient deficiency results from a lack of a specific components in food?
Primary nutrient deficiency.
Name 3 examples of primary nutrient deficiencies.
- 1. Pellagra: lack of VB3 = skin inflammation.
- 2. Scurvy: lack of VC.
- 3. Beriberi: lack of VB1.
Which nutrient deficiency results from the inability to absorb necessary substances from food?
Secondary nutrient deficiency.
Name one example of a secondary nutrient deficiency.
Pernicous anemia: lack of RBC's in the blood, due to inablility for VB12 absorption.
As a result of cellular injury, which defect results in the improper production of enzymes thus affecting cellular metabolism?
Which type of cellular injury interferes with cellular function as a direct result of exposure to poisons, toxins, or other substances?
What are the 2 terms used to describe the sources of toxins for the body?
- Endogenous & exogenous.
- Endogenous: from outside the body.
- Exogenous: from inside the body.
Name 3 sources of endogenous toxins.
- 1. From infection: food contamination with toxins secreted by bacteria... Botulism, salmonellosis, e-coli.
- 2. Chemical: CC14, alcohol.
- 3. Overdose: via medications or vitamins.
Name 3 examples of endogenous toxins.
- 1. Genetic: via accumulation of normal metabolites, or the activation of an alternative pathway.
- 2. Ionizing radiation: produces free radicals, affecting cellular structure, thus function (DNA, proteins, membrane lipids).
- 3. Accumulation of metabolic by-products.
Name an example of an endogenous genetic toxin.
- Alkaptonuria: homogentisic acid builds up in the cartilage.
- Homogentisic acid: an intermediate by product of phynlalanine metabolism which builds up in cartilage when enzymes are not present to convert it to the next metabolite in the pathway.
- REMEMBER: Alkaptonuria is the only disease characterized by calcification of the IVD's!
Which condition is characterized by a build up of homogentistic acid in the IVD cartilage?
- Ochronosis of the vertebral column.
- Patient's urine becomes black after being in oxygen for 40 minutes.
- Patient may also present with blue ears.
In regards to alkaptonuria, which enzyme is missing to change phyenlalanine into tyrosine?
Phenylketonuria... so phenylalanine is converted to ketones which builds up in the blood, as phenylpyruvic acid, causing brain damage. These children cannot talk or walk.
Name 1 disease resulting from an accumulation of metabolic by-products.
Gout: results from hyperuricemia, due to the inability for the kidneys to remove uric acid.
Which type of cellular injury results in a loss of structural integrity?
- Ex). Direct contact, hypothermia, hyperthermia, mechanical pressure, & microorganisms.
What is an example of both traumatic cell injury and an endogenous toxin?
Name 3 examples of mechanical pressure.
- 1. Tumor.
- 2. Aneurysm.
- 3. High intensity sound.
Name the 4 types of reversible changes.
- 1. Hydropic change.
- 2. Steatosis.
- 3. Residual bodies.
- 4. Hyalinization.
Following cellular injury, the cell is unable to produce enough ATP, resulting in cloudy swelling. What type of change is this?
- Hydropic change.
- Also known as Hydropic Degeneration, or Cloudy Degeneration.
Which reversible (functional) change results in the accumulation of triacylglycerides?
- Steatosis (fatty change): results in the cellular contents being moved to the periphery of the cell.
- Alcoholism results in a fatty liver.
- Can also happen in the kidneys, skeletal muscle, and heart.
- Cause by mechanical trauma.
What are the 5 causes of steatosis?
- 1. Intoxication.
- 2. Hypoxia (anoxia).
- 3. Protein deficiency.
- 4. Obesity.
- 5. Diabetes.
Which reversible functional change results in lipofuscin granules?
Residual bodies: fragments of bacteria or cellular organelles found in an injured cell.
What are lipofuscin (lipocrone) granules?
- Indigestible aging pigments also known as brown atrophy.
- (They are traces of damaged cellular membranes).
Which pathology occurs in males & results in damage to the liver & pancreas?
Hemochromatosis: due to too much iron in the body.
True or false: Wilson's Disease is a result of too much iron in the body?
- False: Wilson's Disease (Hepatolenticular Degeneration): endogenous pigment accumulation of copper.
- Affects the liver first, followed by the brain.
Which reversible change results in an accumulation of glass like proteins?
Hyalinization (hyaline change).
Name the 4 examples of intracellular hyaline changes.
- 1. Reabsorption droplets: in the proximal tubules of the kidneys, causes proteinuria.
- 2. Dutcher bodies: intraNUCLEAR inclusions.
- 3. Russell bodies: intraCYTOPLASMIC inclusions of immunoglobulins in patients with Lymphoplasmacytic Lymphoma.
- 4. Mallory bodies: intracytoplasmic inclusions that accumulate in the hepatocytes in alcoholics.
True or false: russell bodies are intracytoplasmic inclusions.
Which disease is associated with russell bodies?
- Lymphoplamactyic Lymphoma (Waldenstron Macroglobulinemia).
- Huge production of antibodies (proteins) due to the B-cell lymphoma... remember that B-cells create antibodies.
- Results in hyperviscosity syndrome.
Dutcher & Russell bodies are found in patients that have which 2 diseases?
Lymphoplasmacytic lymphoma or multiple myeloma.
Name 2 examples of extracellular hyaline changes.
- 1. Hyalinization in arterioles.
- 2. Amyloidosis.
What disease is characterized by inadequate neurological stimulation?
Poliomyelitis: no neuronal stimulation to muscles due to viral damage on the ant. horn of the spinal cord.
What is the most important sign of irreversible cell damage?
Destruction of the nucleus.
Which irreversible change results in a dense nucleus?
Pyknosis: the nucleus shrinks and becomes too dense.
Which irreversible change results in fragmentation of the nucleus?
Karorrhexis: fragmentation of nucleus.
Which irreversible change results in melting of the nucleus?
Karyolysis: melting of the nucleus.
Which type of necrosis preserves a basic outline allowing the tissue to avoid damage?
- Coagulative necrosis.
- Ex) myocardial infarction.
Which type of necrosis typically occurs in nervous tissue?
- Liquefactive necrosis: complete digestion of the dead cells, transforming the tissue into a liquid viscous mass.
- Nervous tissue because of little or no collagen fibers.
Which type of necrosis has the appearance of melted cheese?
Casous Necrosis: amorphous granular debris composed of fragmented, coagulated cells, and the granulomatous reaction border.
What are 2 examples of caseous necrosis?
Which necrosis develops only with syphillis?
Gummatous necrosis: if not an answer choice, pick liquefactive.
Which type of necrosis is described by a severe glassy or waxy necrosis of skeletal muscles?
Zenker's necrosis: especially with typhoid fever.
Necrosis of adipose tissue, characterized by formation of small quantities of calcium soaps describes which type of necrosis?
Steatonecrosis (fat necrosis): associated with pancreonecrosis.
Which type of necrosis is associated with immune problems?
- Fibroid necrosis: autoimmune... occurs in walls of blood vessels.
- Aschoff nodes in heart muscle following rheumatic fever.
Which type of necrosis is characterized by the presence of noxious products?
- Gangrenous necrosis.
- Anaerobic bacterial metabolism.
Which type of gangrene is very similar to coagulative necrosis?
Dry gangrene: coagulation is sustained.
Which type of necrosis is characterized by phagoctic cells breaking down necrotic debris, producing liquefaction?
- Wet gangrene.
- Polyarteritis nodosa: wet gangrene of the blood vessel lining, due to auto immune disease.
Which type of calcification may be associated with hypercalcemia?
- Metastatic calcification.
- Increased secretion of parathyroid hormones.
- Destruction of bone.
- Paget's Disease: accelerated turnover.
- Vitamin D related disorder & Sarcoidosis.
- Renal failure.
Which type of necrosis results in deposition of calcium into necrotic tissue?
- Dystrophic calcification.
- Calcifies Gohn's Focus.
Mestastatic calcification is characterized by increased secretion of parathyroid hormones, destruction of bone, Vit D disorders, & what else?
True or false? Ischemia means lack of oxygen supply to tissue?
False: BLOOD supply.
Which organs are most susceptible to ischemia?
- 1. Brain.
- 2. Heart.
- 3. Kidneys.
- 4. Spleen.
- 5. Lung.
Ionizing radiation is susceptible to tissue with a low mitosis rate. True or false?
False: HIGH mitosis rate.
Which tissues are most susceptible to ionizing radiation?
Bone marrow, hair follicles, reproductive cells, & membranes of the GI-Tract.
Are viruses intra or extraceullar?
Where does inflammation take place?
- In the capillary & the post capillary venule.
- Also the only place where there is an exchange between intersitial fluid & blood.
If the skin is cut, the vessels immediately dialate. True or false?
- False: vasoCONSTRICTion.
- ...Quickly followed by dilation to inflame the area (hyperemia).
Exudate is composed of what?
Following damage to vessels, there is a disruption of axial blood flow. The RBC's clump together & migrate towards the center, which makes the WBC's move to the periphery. What is this called?
When there is damage, the endothelial cells become sticky & adhere the leukocytes to the endotheial cell surface. What is this process called?
What is the name of the process when leukocytes crawl through a gap between the endothelial cells?
- Leukocyte emeigration.
- Takes place ONLY @ the post. cap. venules.
What is the mildest form of inflammation?
- Serous inflammation: only fluid is allowed to escape to the interstitial tissue.
- Ex) Second degree burn.
What is an example of fibrinous inflammation?
Pericarditis: will cause bruits.
Which type of inflammation results in pus formation?
Suppurative (purulent) inflammation: acute type of exudative inflammation where WBC's liquefactive enzymes.
Diapedesis is the active escape of RBC's from the vessels. True or false?
False: PASSIVE escape.
Name the 3 examples of PolyMorphoNuclear cells/ Granulocytes.
- 1. Neutrophils: acute bacterial infection.
- 2. Eosinophils: parasitic infection, allergic reactions.
- 3. Basophils: inflammation.
Name the 2 examples of mononuclear cells/ agranulocytes.
- 1. Monocytes (Macrophages): chronic bacterial infection.
- 2. Lymphocytes: viral infection.
Which 2 types of cells participate in leukocyte emigration?
- 1. Neutrophils: lasts hours @ site of inflammation... maximum @ 24 hours after injury.
- 2. Monocytes/macrophages: lasts months to years @ site of inflammation.
Without neutrophils, people have no immune responses. True or false?
Which 3 cells are capable of phagocytosis?
- 1. Macrophages
- 2. Eosinophils.
- 3. Neutrophils.
Name the 2 mechanisms for phagocytosis.
- 1. Oxygen-independent mechanism: uses enzymes.
- 2. Oxygen-dependent mechanism: uses free radicals.
What is the name of the natural anti-biotic used with oxygen-independent phagocytosis?
Name 3 substances which the oxygen-dependent mechanisms uses.
- 1. Superoxide anion.
- 2. Hypocholrite anion.
- 3. Hyrogen peroxide.
Name the genetic disease in which phagocytic cells are unable to produce free radicals, resulting in death by 2 years of age.
Chronic Granulomatous Disease of Children: unable to produce oxygenated free radicals. Microbes are unable to be torn down, and the body forms a granuloma to try to contain them. The child is unable to kill off diseases.
What is the name of a genetic disease in which degranulation cannot occur, resulting in inability to digest foreign substances?
Chediak-Highashi Syndrome: dismotility of phagocytes, resulting in inability to prevent degranulation.
Which type of cell initiates inflammation?
Name the 4 cell derived mediators of inflammation.
- 1. Histamine.
- 2. Arachidonic acid.
- 3. Serotonin: very similar to histamine.
- 4. Substance P: neuropeptide, increased permeability of vessels.
Name the 4 functions of the vasoactive amine, histamine.
- 1. Vasodialation.
- 2. Increased permeability of blood vessels.
- 3. Bronchospasm.
- 4. Increased mucous production.
From which pathway are thromboxanes & prostoglandins produced?
From which pathway are leukotrienes formed?
Which substance is responsible for vasodilation & increased permeability?
Which substance is responsible for chemotaxis, vasoconstriction, & increased permeability?
Which substance is responsible for vasoconstriction & platelet aggregation?
Which cell is the major source of histamine in the body?
What cell is the major source for serotonin?
Platelets: serotonin is very similar to histamine.
Which clotting factor is responsible for activating 4 different cascades as a result of injury?
Clotting factor XII (Hageman Factor).
Which 4 cascades does the Hageman Factor activate?
- 1. Coagulation cascade: pvrevents blood loss.
- 2. Fibrinolytic cascade: prevents coagulation from spreading over body.
- 3. Complement cascade: immunity.
- 4. Kinin cascade: inflammation.
What is the name of the independent mediator of inflammation?
Antibody: plasma derived, but not associated with any of the cascades.
What is characterized by more than 5,000-9,000 WBC's in 1 cubic mm of blood?
Neutrophillia indicates what 3 things?
Neutrophillia: >65% neutrophils, indicative of bacterial infection, appendicitis, colitis.
Lymphocytosis is indicative of what?
Eosinophillia is indicative of what?
Allergic reaction or parasites.
Monocytosis is indicative of what?
Chronic baterial infection.
With acute inflammation there is a lot of exudate (swelling). Which 2 cells are present?
- 1. Neutrophils.
- 2. Macrophages.
How much exudate is present with chronic inflammation? Which cells are present?
- Very little exudate.
- Lympocytes & monocytes (macrophages) are present.
Which type of reaction is associated with Chronic Granulomatous Inflammation?
- Delayed type 4 hyersensitivity reaction.
- TB & leprosy.
- Granuloma (formed by macrophages) prevents spreading.
- Regeneration: healing process in which tissue is replaced from parenchyma.
- Function will be regained.
Define repair (Fibroplasia, Fibrosis).
- Repair: healing process when the fibroblasts lay down fibrous CT, resulting in a scar.
- Restores strength & structural integrity.
- Function is lost.
- Occurs when regeneration cannot occur.
Labile tissues are characterized by rapid shifting cell, which divide continually to replace cells that are constantly being deleted by normal processes. Name some examples of labile tissues.
Blood cells, spermatozoa, ova, epithelia, endothelial cells.
What kind of tissues generally stop dividing after adolescence?
Stable (quiescient) tissues.
Permanent tissues loose all mitotic activity soon after birth, never to regain it. Name some examples.
Muscle tissue, cartilage, neurons.
Formation of collagen fibers from fibroblasts describes which term?
- Repair (fibrosis, fibroplasia).
- More common than regeneration.
- Fibroblasts: produce the precursors of collagen (procollagen).
What is tissue debris combined with a clot?
What it the term used to describe the breaking open of a healing wound due to increased pressure?
Dehiscence: common in the abdomen.
Keloid: irregular masses of scar tissue that protrude from the surface of the skin.
What is the term used to describe the overproduction of granulation tissue?
Proud flesh: exuberant granulations.
Platelet activation promotes blood coagulation. True or false?
Which pathway for coagulation occurs when the skin is cut?
- Extrinsic pathway: when skin, mucous membranes, or vessels are cut.
- Tissue thromboplastin (tissue factor) leads to proconvertin (VII).
Which pathway is activated if damage to endothelial cells & collagen fibers occurs?
Intrinsic pathway: activated the Hageman Factor (XII).
What percentage of blood proteins are capable of coagulation?
What are the 3 steps for the anti-coagulation system?
- 1. Hemodynamics: blood vessel washes out clotting factor.
- 2. Endothelial mediation: prostacyclin prevents blood coagulation.
- 3. Fibrinolytic system: plasmin destroys clots.
What is the term used to describe pinpoint hemorrhages?
What is the term for a small, but not the smallest hemorrhage?
Bruises are hemorrhages larger than 2cm, which are associated with which syndrome?
Bruises (Ecchymoses): associated with Cushing's Syndrome due to excessive amounts of corticosteroids in the body, resulting in brittle blood vessels.
- Thrombocytopenia: lack of platelets (thrombocytes) resulting in the formation of various hemorrhages.
- Generally petechiae or purpura.
Clotting factors are produced where? And are under the control of with which vitamin?
- Produced in liver.
- Under the control of Vitamin K.
True or False: Hemophillia is a genetic disease associated with production of clotting factors.
FALSE: non-production of clotting factors.
What is the name of the disease characterized by an autosomal dominant inheritance, which results in ecchymosis & hematomas commonly affecting the stomach & intestines.
- Von Willebrand Disease: one or more parents must have disease in order for child to get it.
- Women also have metrorrhagia: leaking of blood from the uterus, not during menses.
Classic hemophellia is due to the non-production of which clotting factor?
- Classic Hemophellia (Hemophellia A): non-production of clotting factor VIII.
- Genetic disease.
Christmas Disease results from non-production of which clotting factor?
- Christmas Disease (Hemophellia B): non-production of clotting factor IX (Christmas Factor).
- Genetic disease.
Which type of hematoma develops only in joints?
- Patient has either Hemopheilia A or B.
- Males only.
- Parents do not have the disease.
Is a blood clot the same things as a thrombus?
No. Blood clots can form outside & inside, but thrombi can only form within a blood vessel.
What are the 4 components of a thrombus?
- 1. Fibrin.
- 2. Platelets.
- 3. WBC's.
- 4. RBC's.
What are lines of zahn?
Lines of zahn: layers of fibrin with trapped blood cell layers & layers of almost pure platelets on top of each other.
Name the 2 risk factors for thrombosis.
- 1. Hemodynamic stress.
- 2. Hypertension.
Atherosclerosis affects smaller arteries. True or false?
False. Atherosclerosis affects larger arteries.
What is the normal ratio for LDL's:HDL's?
Homocysteine leads to the destruction of which layer?
Intimal layer of endothelial cells.
What is the most important factor resulting in thrombosis?
Reduction in speed of blood flow: via cardiac failure, increased blood viscosity, polycythemia.
What is the most common type of vasculitis?
- Temporal Arteritis a/k/a Giant Cell Arteritis a/k/a Horton's Disease.
- Autoimmune disease.
- Superficial temporal artery.
- Chronic granulomatous inflammation of the vascular wall.
- Cause of headaches in people over 50 years old.
All herniations are gangrenous necrosis. True or false?
True: because all herniations pinch off blood flow.
Steastosis occurs in the liver, kidneys, heart, & what other organ?
Hemochromatosis can interfere with DNA causing what?
Hepatoma (liver cancer).
A granuloma is a tumor of foreign bodies accompanied by which type of cells?
Which cells produce muscopolysaccharides in the area of the exuadte with inflammation?
Which substance is constantly being released with endothelial mediation?
Polymyalgia rheumatica is often times associated with which disease?
- Horton's Disease: dramatic pain in the proximal portions of the upper & lower extremities (shoulder griddle & pelvic joint).
- Corticosterroids are the only anti-inflammitories that will work.
Which of the following is a cell-derived vasoconstrictor?