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What is the most important factor resulting in thrombosis?
Reduction in speed of blood flow.
Cardiac failure is a result of stenosis of which valve in the heart?
- Mitral valve stenosis: narrowing of the left AV valve.
- = more blood accumulates in the left aorta = decreased speed of blood leaving the heart = thrombulous.
- Ball-valve thrombus: a thrombi in circulation (thromboembolite) gets stuck in the atria, blocking the AV valve.
True or false: polycythemia results in decreased blood viscosity.
- False: polycythemia results in increased blood viscosity.
- A/k/a: erythremia = overproduction of RBC's.
- 7-8 million in 1 square mm of blood (vs the normal 5 million).
Is blood flow slower in veins or arteries?
- Veins: lower blood pressure = slower rate.
- Veins are dependent upon muscular contractions to get the blood back to the heart.
What are the 3 risk factors for thrombosis?
- 1. Physical inactivity.
- 2. Varicose veins.
- 3. Blood hypercoagulation.
Sequelae of thrombosis:
- 1. Resolution: dissolving of a thrombus = most benign.
- 2. Organization: elimination of blood clot & tissue debris via pahgocytosis = replaced by CT.
- 3. Recanalization: formation of canals through a thrombus (angiogenesis).
- 4. Propagation: enlargement of thrombus in the veins, occurring near the branching of veins, (most commonly in the legs).
- 5. Infarction: an area of necrosis due to hypoxia.
What type of necrosis occurs in the heart?
Strokes = liquefactive necrosis: replaced with neural glia = area of gliosis.
- Coagulative necrosis: preserves the size & shape of the necrotic tissue, allowing for healing to occur.
- The necrotic tissue is replaces with CT.
Which step in the sequelae of thombosis is responsible for returning functioning back to normal?
- Dissolving of a thrombus activates the fibrinolytic anticoagulation system (plasminogen -> plasmin) to take care of the thrmobus.
What is the most common cause of infarction?
- Myocardial infarction - coagulative necrosis.
- Ischemic stroke (brain infarct) = liquefactive necrosis.
- Stroke + myocardial infarct = most common cause of death in the U.S.
Name 2 examples of vasculitis.
- 1. Temporal arteritis ("giant cell arteritis," "horton's disease").
- 2. Polymyalgia rheumatica: dramatic pain in the upper & lower extremities, commonly associated with Horton's Disease.
Horton's Disease generally involves which 6 arteries?
- 1. Superficial temporal artery.
- 2. Cerebral artery.
- 3. Opthalmic artery.
- 4. Vertebral artery.
- 5. Arch of aorta.
- 6. Thoracic aorta.
- The most common type of vasculitis.
- Chronic granulomatous inflammation of the vascular wall.
- =headaches & blindness in the elderly.
Where do fat emboli usually wind up?
- In the lungs, causing minor respiratory problems.
- Fat embolus: fat gets into the venous system via fractured bones releasing yellow marrow.
Define air lock.
Air lock: following an air embolus, compressible air does not leave the heart upon contraction, also reducing the flow of blood leaving the heart.
*Rest patient on their RIGHT side*
Which type of hernia protrudes through the esophageal hiatus of the diaphragm?
- Paraesophageal hernia.
- = diaphragm may pinch veins to the stomach thus preventing blood flow = gangrenous necrosis.
What is another name for sheeham syndrome?
Post-partum syndrome: after delivery leads to anterior pituitary infarct.
True or false: the liver is most vulnerable to hypoxia.
False: the brain & myocaridum are most vulnerable... the liver is not vulnerable.
Why are the lungs well protected from infarction?
- 1. Clot retraction: reduction in size of the thrombus.
- 2. Double blood supply to the lungs: supplied from the pulmonary system & the independent bronchial arteries.
- 3. Fibrinolytic activity.
Which vitamin maintains membrane conduction of neuron cells & axons?
- Thiamin (Vitamin B1).
- Think (th1am1n).
What are the 3 diseases associated with B1 deficiency?
- 1. Dry beriberi, peripheral polyneuropathy: symmetrical loss of peripheral NS myelenation = wrist drop, foot frop, & first toe drop.
- 2. Wet beriberi, cardiovascular syndrome: peripheral vasodialation (loss of sympathetic vasoconstriction).
- 3. Wernicke Korsakoff syndrome: Opthalmoplegia, apathy, listlessness, disorientation... Korasakoff’s psychosis, retrograde amnesia, confabulation.
What is the term used to describe retrograde amnesia, the inability to accept new information, & non-stop talking (confabulation)?
Beriberi is associated with a deficiency of which vitamin?
Dry Beriberi is associated with which pathological condition?
Wernicke-Koraskoff Syndrome is associated with deficiency of which vitamin?
Which vitamin is also known as riboflavin?
Ariboflavinosis is characterized by what 4 symptoms?
- Ariboflavinosis: lack of B2.
- 1. Cheilosis (chelitis): cracks in corner of mouth which get infected.
- 2. Glossitis: inflammation of tongue.
- 3. Superficial interstitial keratitis: scar tissue in the corneas.
- 4. Dermatitis: rash on cheeks, behind the ears, around the naso-labial folds, scrotum, & vulva.
True or false: vitamin B2 is associated with diseases of the nervous system.
False: B2 & B6 are not associated with diseases of the nervous system.
Name 3 a/k/a's for Vitamin B3.
- 1. Niacin.
- 2. Nicotinic acid.
- 3. Nicotinamide.
B3 is synthesized in small amounts by the human body. True or false?
Name 3 functions of Niacin.
- 1. Vasodialation.
- 2. Prevention of LDL production in the liver (sometimes used to atherosclerosis).
- 3. Antioxidant.
Which disease is also known as the "4 D's?"
*May show symptoms as VB2 deficiency.
- Pellegra: lack of B3 (niacin) = rough/dry skin.
- 1. Dermatitis: rough red skin... Cassal’s necklace.
- 2. Diarrhea: resulting in atrophy of columnar epithelial cells, submucosal inflammation, ulcerations.
- 3. Dementia: affects grey matter cerebral cells resulting in weakness, dizziness, headache, & depression.
- 4. Death.
Which vitamin is associated with Pellagra?
What is the major function of Pyrodoxine?
- Pyrodoxine (B6): metabolism of epithelial cells.
- Made of pyrodoxine, pyridoxal, & pyridoxamine.
- If you heat the food, B6 undergoes destruction.
Which patients are at risk for developing a B6 deficiency?
- 1. Alcoholics.
- 2. Pregnant women.
- 3. Medicated patients... TB, birth control pills, Wilson's Disease, Systemic Sclerosis.
Which drug interferes with the functions of both B3 & B6?
Izoniazid: medication used to treat TB.
Name the 8 pathologies associated with B6 deficiencies.
- 1. Cheilosis: corners of mouth turn white (also seen with B2).
- 2. Glossitis: (also seen with B2&3).
- 3. Brain growth impairment.
- 4. Seborrheic dermatitis: wet scales in hair.
- 5. Peripheral polyneuropathy: (also seen w/ B1&12).
- 6. Convulsive seizures in infants.
- 7. Promotion of oxalate kidney stones: decreased epithelial cell metabolism results in a nidus (network of organic material).
- 8. Hypochromic anemia: less hemoglobin in RBC's.
Cheilosis & glossitis result from deficiency of which 2 vitamins?
- 1. B2 (riboflavin).
- 2. B6 (pyrodoxine).
Name 2 a/k/a's for Vitamin B12.
- Vitamin B12: Cyan, Cobalamin.
- B12 is bound to proteins.
Is B12 absorbed into the body via an intrinsic or extrinsic factor?
- Intrinsic factor (of Cassel): B12 is picked up in the duodenum via the intrinsic factor.
- Intrinsic factor is produced by parietal cells in the stomach wall, flows into duodenum, SI, then the ileum… the ileum has receptors for the intrinsic factor, allowing release into the blood flow.
What are 6 predisposing factors for a B12 deficiency?
- 1. Malabsorption.
- 2. Vegetarians.
- 3. Chronic gastritis.
- 4. Following gastrectomy.
- 5. Regional enteriris.
- 6. Tropical sprue.
Name 3 ways a B12 deficiency can occur.
- 1. Blocking antibodies: prohibits intrinsic factor from binding to B12 or blocks the intrinsic factor from binding to receptors in the ileum... Type II hypersensitivity reaction... Autoimmune.
- 2. Different antibodies: blocks binding of intrinsic factor & B12... Type II hypersensitivity reaction.
- 3. Chronic autoimmune gastritis: inflammation of the stomach wall, selectively killing PARIETAL cells of the stomach... no intrinsic factor can produce this.
Name 2 a/k/a's for Pernicious Anemia.
- Pernicious anemia: one of the two megaloblastic anemias, interfering with hematopoiesis.
- 1. Malignant Anemia.
- 2. B12 Deficient Anemia.
How does B12 play into pathology of the CNS?
- Lack of B12 = demylenation of the posterior & lateral tracts of the spinal cord.
- B12 maintinas the membranes of the nervous system.
- Deficiency = demyelenation of the posterior & lateral tracts.
- Results in ataxia in lower extremities initially.
Cobalamin deficiency leads to pathology of which 2 systems of the body?
- 1. Nervous system.
- 2. Hematpoietic system.: macrocytosis, rigid cell membranes, hypersegmented neutrophils.
B12 promotes the reduction of folic acid (folate, B9) into tetrahydropholate.
THP promotes hematopoiesis.
*Note that B9 (folic acid) plays a role in the development of the neural tube in the embryo.
- monofolate → reductase → tetrahydropholate (THF) → DNA.
- **Vitamin B12: can restore THF so it’s active again.
- (Methotrexate: inhibits reductase for treatment of cancer, Hodgkin’s disease, etc).
- (folate → dihydrofolate→ tetrahydrofolate ↔ methylene-THF → methyl-THF).
Deficiency of which 2 vitamins can lead to megaloblastic anemia?
- 1. B12 deficiency.
- 2. B9 (folic acid) deficiency.
: production of RBC’s with very ridged membranes... RBC’s are much larger & they are unable to bend to fit through capillaries.
- Boudeinyi WTF moment: …WBC’s are also involved…
- …hypersegmented neutrophils: too many lobes.-cells are immature & undergo death earlier.
- -pancitopenia: ……..*glossitis, chelossis (cheilitis)…
Name 4 functions of Vitamin C (ascorbic acid).
- 1. Hydroxylation of procollagen (proline into hydroxyproline).
- 2. Stimulation of protein formation.
- 3. Provides strength for collagen fibers (via hydroxyproline).
- 4. Antioxidant (free radical scavenger along with selenium & vitamin E).
Name 3 results from ascorbic acid deficiency.
- 1. Scurvy.
- 2. Skeletal changes.
- 3. Decreased wound healing: delayed wound healing because it takes a longer time to build the necessary connective tissue.
Impairment of wound healing is associated with the deficiency of which vitamin?
Which pathology is characterized by bone abnormalities in children, leg bowing (genu varus), hemorrhages, improper healing, loss of teeth/gingivitis, death of pupils, & an inward depression of the sternum of babies, subperiostal hematoma, & hemarthrosis?
Development of subperiosteal hematomas are a manifestation of which vitamin deficiency?
Vitamin C (ascorbic acid): scurvy.
Vitamin C deficiency results in impaired function of which substance?
- Retinol (Vit A) = rhodopsin.
- Thiamine (B1) = myelin.
- Vit K = prothrombin.
Which vitamin actively participates in collagen synthesis (through the synthesis of its precursor, procollagen)?
Ascorbic acid (vitamin C).
Skeletal changes in scurvy are associated with disturbance of which process?
Formation of osteoid matrix.
Vitamin A consists of retinol, retinal, & reinoic acid, thus making it fat insoluble. True or false?
False: vitamin A is fat soluble.
90% of Vitamin A is stored in the liver. This gives humans enough storage for how long?
- 6 months.
- Vitamin A is stored in the liver is Retinol.
Which food is Provitamin A abundantly found in?
Carrots via beta-carotene (a carotenoid).
The synthetic substance 'Retenoid' has a close chemical formula to Vitamin A & is used to treat which pathology?
- Psoriasis: the proretenoid activity serves as an anti-inflammatory medication.
- However, Retenoids are actually very dangerous medications.
What are the 3 main functions of Vitamin A?
- 1. Maintaining normal vision in reduced light.
- 2. Differentiation of specialized epithelial cells: via retinoic acid.
- 3. Enhances immunity to infections.
Which component of Vitamin A is responsible for maintaining normal vision in reduced light?
- Retinal: used as a material for rhodopsin synthesis in the rods of the eye.
- Rhodopsin: most light sensitive light pigment.
Which component of Vitamin A is responsible for potentiating the differentiation of specialized epithelial cells in the human body?
Retenoic acid: potentiates the differentiation of specialized epithelial cells (mainly mucus-secreting cells).
Name 3 manifestations of Vitamin A deficiencies.
- 1. Poor night vision.
- 2. Squamous cell metaplasia: the replacement of normal epithelial cells with kereatinizing epithelia which cannot preform normally.
- 3. Measles, pneumonia, or infectious diarrhea: 30% more likely to kill a patient with a Vitamin A deficiency.
What are the 4 organs typically affected by squamous cell metaplasia?
- 1. Eye: resulting in xeropthalmia (dry eyes) resulting in bitot's spots, corneal erosion, keratomalacia, & blindness.
- 2. Urinary Tract: normal cells are sloughed off being replaced by keratinizing cells, thus forming a nidus (stone).
- 3. Repsiratory tract: resulting in an increased susceptibility for secondary pulmonary infections.
- 4. Adnexal glands: sebaceous glands resulting in follicular or papular dermatosis.
Why does squamous cell metaplasia increase vulnerability to secondary pulmonary infections?
Because normal epithelial cells have an immune function of brushing away foreigners with their villi, but keratinized epithelia have lost this function.
Which is worse, hypervitaminoses A or hypovitaminoses A?
Hypervitaminoses A: Vitamin A is not supposed to be in the body in high amounts, especially if it is synthetic.
Name 7 manifestations of hypervitaminoses A.
- 1. Increased ICP = headache, nausea/vomiting, papilledema.
- 2. Weight loss.
- 3. Bone pain & muscle pain. 4. Skin rash/dermatosis.
- 5. Nausea/vomiting.
- 6. Hyperostosis: too much bone growth (DISH: calcification/ALL).
- 7. Hepatomegaly (enlarged liver) = liver fibrosis.
Overdose of which vitamin results in hyperostosis?
- Vitamin A.
- Hyperostosis = DISH.
Which vitamin is responsible for lowering mortality rate due to infectious diseases in children?
Bitot's spots are characteristic with deficiency of which vitamin?
The deficiency of which 2 vitamins results in kidney & bladder stones?
What are the 2 a/k/a's for Vitamin E?
- 1. Tocopherol.
- 2. Alfa-tocopherol.
What 2 things does Vitamin E specialize in protecting as a free radical scavenger?
- 1. Nervous system: deficiency results in demyelenation of peripheral sensory nerves & the posterior columns.
- 2. RBC's: deficiency results in anemia in children & babies.
- May also result in impaired eye movements.
Which 2 vitamins are considered antioxidants & free radical scavengers?
- 1. Vitamin E.
- 2. Vitamin C.
- Sometimes B3 also.
Vitamin E can be regenerated by which vitamin?
Which vitamin is characterized by damage to the posterior column of the spinal cord, atrophy of DRG, demyelenation of peripheral sensory fibers, damage to the spinocerebellar tract leading to ataxia, abscence of DTR's, & loss of pain sensation?
- Vitamin E.
- DRG atrophy.
- Periphreal sensory fiber demyelenation.
- Abscence of DTR's.
- Loss of pain sensation.
Vitamin E prevents the formation of HDL's along with B3, C, A, & D. True or flase?
False: prevents the formation of LDL's.
Vitamin K plays a role in Koagulation by promoting the formation of which clotting factors in the liver?
II (prothrombin), VII, IX (Christmas), & X.
Which 2 vitamins are produced by the gut flora?
Body = K, B2/3.
- 1. Vitamin K.
- 2. B2.
- B3 is also synthesized in small amounts by the human body, via tryptophan.
How does Vitamin K play a role in calcification of bone proteins?
- Vitamin K promotes the formation of osteocalcin.
- Vitamins involved with bone formation: C, K.
Deficiency of Vitamin K may result from which 3 things?
- 1. Fat malabsorption: vitamin K is fat soluble.
- 2. Diffused liver disease.
- 3. Long term intake of antibiotics.
Vitamin K deficiencies are result in which 6 manifestations?
- 1. Hemorrhagic disease of newborns: in first week of life since the gut flora is still producing vitamin K.
- 2. Bleeding diathesis.
- 3. Hemorrhages.
- 4. Brusies (ecchymoses)/ hematomas.
- 5. Melena: black poo.
- 6. Gum bleeding.
Hemorrhagic disease of newborns is associated with deficiency of which vitamin?
Which vitamin accounts for the production of ostecalcin?
Vitamin K: osteocalcin promotes calcification of bones.
Deficiency of which vitamin results in a reduction of clotting factors synthesized in the liver?
*Look @ diagram of vitamins!*
- NS: B1, B12, E.
- Body: B2, B3, K.
- Epithelia: B6, A.
- Anemia: B9, B12.
- Free Rad's: B3, C, E.
- C&G: B2, B6.
- Kidneys: B6, A.
- LDL: A, B3, C, D.
- Bone: C, K.
What does PEM stand for?
- PEM: protein-energy malnutrition.
- Range of clinical syndromes characterized by inadequate dietary intake of proteins & calories to meet the body’s needs.
If a person is down to 80% of their normal body weight they have which condition?
- Marasmus: a person is down to 60% or less of their body weight.
- It is caused by lack of energy intake & protein containing foods.
- The body begins to steal protein from the somatic protein compartment (skeletal muscles).
- Results in emaciation (too thin) & growth retardation.
- The head will appear to be too large for the body.
- Serum albumin (protein carriers in blood) levels are normal, or slightly lower.
Kwashiorkor patients have higher or lower protein deprivation in relation to calories?
There is enough energy intake, but not enough protein intake.
- Higher protein deficiency.
- More common in Africa & SE Asia due to diets high in carbs & low in protein.
Which protein compartment is affected in Kwashiorkor patients?
- The visceral protein compartment.
- Results in a decreased amount of albumins in the blood, thus reducing oncotic pressure resulting in generalized edema.
Which comes first in Kwashiorkor patients, hypoalbumenia or fatty liver?
- Steps of Kwashiorkor:
- 1. Hypoalbuminemia.
- 2. Generalized edema.
- 3. Skin lesions: zones of hyperpigmentation, desqumation, hypopigmentation... flaky paint appearance.
- 4. Hair changes: loss of color, straightening, fine texture.
- 5. Fatty liver (steatosis): without proteins the liver cannot produce LDL's so FFA's build up causing fibrosis.
- 6. Apathy, listlessness, anorexia.
- 7. Defects in immunity, secondary infections.
The prognosis is worse than with marasmus.
Which disorder is caused predominately by insufficient dietary intake of calories?
Which disease is characterized by ammenorrhea, thyroid pathology, arrthmias, hypokalmeia, osteoporosis, hypoalbuminemia, constipation, & sudden death?
- Anorexia nervosa.
- Note there are significant decreases in secretion of GRH, LH, & FSH.
- Hypothyroidism = cold, listlessness, weakness, dry hair, etc.
Which disease is characterized by amenorrhea 50% of the time, normal weight & GRH levels, esophageal cancer, espohageal rupture, hypokalemia, & pulmonary aspirations?
Which type of hypersensitivty reaction is characterized by the relase of histamine & other vasoactive substances that are derived from mast cells?
- Type I Hypersensitivity Reaction: affects vascular permeability & smooth muscles in various organs.
- Associated with mast cells & basophils.
- Mast cells: basophils fixed in the tissue, subepithelial areas.
Which hypersensitivity reaction is associated with anaphalactic shock?
- Type 1 hypersensitivity reaction: anaphalactic (allergic) reaction… anaphalactic shock.
- Release of vasoactive amines & other mediators derived from the mast cells or basophils.
- Affects vascular permeability & smooth muscles in various organs.
Will the first exposure to an allergen result in a physiological reaction?
No: the first reaction results in the degranulation of the cytosome within mast cells
, thus allowing for allergic reactions in the future.
- Type I Hypersensitivity Reaction Mechanism
- Allergen goes into body --> activates CD4 & T Helper cells (TH2) --> secretion of IL-4 & 5 cytokines --> IgE antibody production & recruitment of eosinophils (& mast cells).
What are the 4 functions of histamine?
- 1. Vasodialation.
- 2. Increased vessel permeability = swelling.
- 3. Bronchospasm.
- 4. Increased mucous production.
Systemic anaphylaxis is characterized by a long onset. True or false?
False: systemic anaphylaxis has a rapid onset of 1-2 minutes.
A patient is getting a cavity filled. Unbeknownst to the doctor, they are allergic to novocaine. Name the 6 clinical manifestations which would occur rapidly. Is this reaction systemic or local?
- 1. Itching.
- 2. Hives (urticaria).
- 3. Bronchospasm.
- 4. Laryngeal edema.
- 5. Nausea/vomiting/diarrhea.
- 6. Vascular shock.
A patient comes in to your office in the spring, complaining of seasonal allergies. Which type of reaction is this? And what are the possible 5 symptoms?
- 1. Itching of the skin.
- 2. Hives (urticaria).
- 3. Hay fever.
- 4. Atopic bronchial asthma.
- 5. Rhinitis (runny nose).
Which of the following disorders is an example of Type I Hypersensivity Reactions?
A. Hemotransfusion reactions.
B. Laryngeal edema.
D. Graft rejection.
- Which of the following disorders is an example of Type I Hypersensivity Reactions?
- A. Hemotransfusion reactions: type II, complement dependent.
- B. Laryngeal edema.
- C. TB: type IV, delayed type hypersensitivity.
- D. Graft rejection: type IV, cell-mediated cytotoxicity.
Type I Hypersensitivity Reactions are associated with which class of immunoglobulins?
Type II Hypersensitivity Reactions are mediated by which 2 types of immunoglobulins?
- 1. IgG.
- 2. IgM.
- They are both directed at antigens on the body's own cells.
How many types of reactions are associated with Type II Hypersensitivity Reactions?
- 1. Complement dependent: hemotransfusion reactions, erythroblastosis fatalis, auto-immune diseases, & certain drug reactions.
- 2. Antibody-dependent cell-mediated cytotoxicity: parasites, tumors.
- 3. Antibody-mediated cellular dysfunction: Myasthenia Gravis, Hoshimoto's, Grave's Disease.
Which 4 cells are associated with antibody-dependent cell-mediated cytotoxicity?
- 1. Monocytes.
- 2. Eosinophils.
- 3. Neutrophils.
- 4. Natural killers.
Name 3 pathologies associated with Type II Antibody-Dependent Hypersensitivy Reactions.
- 1. Myasthenia Gravis.
- 2. Hoshimoto's.
- 3. Grave's Disease.
- Antibody dependent = antibody-mediated cellular dysfunction.
What is the most common subtype for Type II Hypersensitivity Reactions?
- Complement dependent: antibody attaches to the antigen & fragments into an Ab & Fc fragment.
- Opsonization stops @ C3b, & is more favorable for phagocytosis.
Name 2 pathologies associated with Type II Hypersensitivity Reactions.
- 1. Erythroblastosis fetalis.
- 2. Pernicious anemia.
What is the name of the injection given to a Mom after delivery of her first Rh+ child to prevent erythroblastosis fetalis?
- Rhogam: needs to be given after abortions as well.
- 1st pregnancy: Mom Rh-, Baby Rh+... blood mixes @ birth... Mom develops Rh+ antibodies within the first 72 hours, & her body kills the cells.
- 2nd pregnancy: Mom Rh-, Baby Rh+... blood mixes @ birth, antibodies get into baby = baby need blood transfusion.
True or false: erythroblastosis fetalis could result from a scenario when mother is Rh-, & fetus is Rh+.
Type II & Type III Hypersensitivity Reactions are very similar. How can you tell the difference?
- Type II: fixed in tissue.
- Type III: circulating in blood.
What is the a/k/a for Type III Hypersensitivity Reactions?
Immune Complex Mediated Type.
Name 2 examples of Immune Complex Mediated Type Reactions:
(Type III Hypersensitivity Reaction)
- 1. Serum sickness.
- 2. Arthus reaction: local Type III... Farmer's Lung.
Vasculitis is usually associated with which type of hypersensitivity reactions?
Type III. (Immune complex mediated type).
Sidenote on trace elements: yay!
- Iron: hypochromic, microcytic anemia.
- Iodine: hypothyroidism, goiter.
- Selenium: Keshan disease, myopathy, congestive cardiomyopathy, (also a free radical scavenger along with vitamins C & E).
- Zinc: distinctive rash, acrodermatitis enteroptahica, anorexia/diarrhea, growth retardation, hypogonadism/infertility, impaired wound healing, impaired night vision, impaired immune function, depressed mental function.
- Copper: muscle weakness, hypopigmentation, nueorological defects.
What is an a/k/a for Type IV Hypersensitivity Reaction?
- Cell Mediated = antibody independent mechanism.
- Involves CD4 & CD8 lymphocytes.
What are the 2 subdivision of Cell Mediated Hypersensitivity Reactions (Type IV)?
- 1. Delayed Type Hypersensitivity: TB, contact dermatitis.
- 2. Cell-Mediated Cytotoxicity: anti-viral, graft rejection, tumors.
Which pathology is characteristic of Delayed Type (Type IV) Hypersensitivity Reactions?
- TB (mycobacterium tuberculosis).
- CD4 (T4) T-helper cells are activated by antigens.
- T4 cells release cytokines which recruit macrophages.
- The macrophages result in a granulomatous reaction.
Describe the mechanism associated with Delayed Type (IV) Hypersensitivity Reactions.
- CD4+ T Cells of the TH1 type
- Recruitment of macrophages
What are the 3 main functions of cell-mediated cytotoxicity reactions?
- 1. Anti-tumor activity.
- 2. Anti-viral activity.
- 3. Graft rejection.
- *also immune suppression.
Delayed-type hypersensitivity reactions are induced by sensitization of which of the following cells?
- Delayed-type hypersensitivity reactions are induced by sensitization of which of the following cells?
- A. Neutrophils.
- B. B-cells.
- C. T-helpers: type IV, delayed type hypersensitivity.
- D. T-cytotoxic: type IV, cell-mediated cytotoxicity.
Anaphalactyic: Type I.
- 1.1) Systemic: bee sting... rapid developing.
- 1.2) Local: asthma attack.
Cytotoxic: "Antibody Dependent": Type II.
Fixed in tissue.
Triggered when anti-bodies attach to the surface of individual cells.
- 2.1) Complement Dependent: most common of type II.
- i) Blood transfusion.
- ii) Erythroblastosis fetalis.
- iii) Auto-immune hemolytic reactions.
- iv) Certain drug reactions.
- 2.2) ADCM (Anti-body Dependent Cell Mediated): involves NK & MAC.
- i) Parasites.
- ii) Tumors.
- iii) Cells.
- 2.3) AMCD (Antibody-Mediated Cellular Dysfunction):
- i) MG.
- ii) Grave's Disease.
- iii) Hoshimoto's.
Immune Complex Mediated: Type III.
In blood circulation.
Glomerulonephritis, RA, Lupus, Autoimmune Diseases.
- 3.1) Local reaction:
- i) Arthus reaction: Farmer's lung.
- ii) Vasculitis.
- 3.2) Systemic reaction:
- i) Serum sickness.
Delayed Hypersensitivity "Cell Mediated": Type IV.
- 4.1) Delayed type: CD4/T4, marcrophages, granulomatous reaction.
- i) TB.
- ii) Contact dermatitis.
- 4.2) Cell-mediated cytotoxicitiy: CD8/T8, Gamma IFN.
- i) Anti-tumor.
- ii) Anti-viral.
- iii) Graft rejection.
- iv) Immune supression.
Which cell growth process occurs in response to increased demands?
- Hypertrophy: process of cell & organ enlargement that occurs in response to increased demands.
- Ex) Left ventricular hypertrophy resulting from systemic hypertension.
Which term means shrinking of the cell (or organ) due to a lack of neuronal or endocrinological stimulation?
- May also result from disease.
True or false; the term "trophy" refers to the number of cells present.
- False: trophy refers to the cell size.
- Ex) Hypertrophy: the amount of cells are the same but they are bigger than they were before which makes the whole organ larger.
Which term reefers to mitosis?
- Plasia: referring to mitosis (new cells forming).
- The formation of new cells makes the organ bigger.
Does hyperplasia involve the enlargement of cell size?
- No... Hyperplasia: the process of mitosis producing new cells, but only in quantities needed to meet a particular demand.
- Hyperplasia is still considered normal or ok.
Name 2 examples of hyperplasia.
- 1. Increased amounts of glandular tissue in the female breast during pregnancy.
- 2. Restoration of liver cells following liver resection.
Which form of cell growth is characterized by a change in the type of cell?
Metaplasia: a reversible condition in which there is replacement of normal cells by cells that aren't supposed to be there.
Name 2 examples of metaplasia.
- 1. Chronic gastritis: replacement of stomach columnar epithelial cells by intestinal type cells.
- 2. Heavy smokers: replacement of columnar bronchial epithelial cells by stratified squamous cells.
- *Squamous epithelial cells: most important predisposing factor for lung cancer.
Which form of cell growth is a precursor for neoplasm?
Which type of cell growth is characterized by a loss in uniformity of the individual cells, as well as a loss of their architectural orientation?
- Dysplasia: very close to neoplasia.
Which type of cell growth do you see both normal & abnormal cells?
What is the term used to describe the variability of cell size & shape, in contrast to regularity of the cell structure seen in normal tissue?
- Larger more darkly stained nuclei.
- Increased mitosis rates.
Which 2 forms of cell growth display signs of pleomorphism?
- 1. Neoplasia.
- 2. Dysplasia.
Name 3 characteristics of neoplsitic dysplasia.
- 1. Larger more darkly stained nuclei.
- 2. Increased mitosis rates = higher risk for cancer.
- 3. Irreversible alteration of cell growth patterns.
What is the term used to describe the uncontrolled mitosis of cells beyond normal anatomical boundaries due to the irreversible alteration of cell growth pattern?
What is an a/k/a for neoplasm?
- Neoplasia: tissue formation, involving the overgrowth of a tissue to form a neoplastic mass, of neoplasm, which is called tumor.
- Cells are abnormal.
- Polymorphic cells.
What does aplasia mean?
- Aplasia: the complete lack of organ development.
- All cells are abnormal.
Which type of cell growth results in structures that are immature & functionally deficient?
?????? : development that is inadequate, so that the resulting structure is immature & functionally deficient.
Hypoplasia: inadequate development = immature & functionally deficient.
????? : the process of cell & organ enlargement that occurs in response to increased demands.
Hypertrophy: cellular & organ enlargement due to increased demands.
????? : a loss in uniformity of the individual cells as well as a loss in their architectural orientation.
Dysplasia: loss in uniformity & architectural orientation.
????? : lack of organ development.
????? : production of new cells, but only in quantities needed to meet a particular demand.
Hyperplasia: new cells to meet a demand.
????? : change of the cell type.
????? : lack or reverse of cell differentiation.
Anaplasia: the less mature (lack of cell differentiation) the tissue organ, the more malignant the cells are.
Which of the following is NOT a characteristic of pleomorphism?
A. Increased mitosis rates.
B. Larger, more darkly stained nuclei.
C. Uniformity of cell size & shape.
D. Variability of cell size & shape.
- Which of the following is NOT a characteristic of pleomorphism?
- A. Increased mitosis rates.
- B. Larger, more darkly stained nuclei.
- C. Uniformity of cell size & shape.
- D. Variability of cell size & shape.
Pleomorphism is typical for which of the following?
A. Benign tumor.
B. Malignant tumor.
C. This is characteristic of normal cell growth.
D. None of the above.
- Pleomorphism is typical for which of the following?A. Benign tumor.
- B. Malignant tumor.
- C. This is characteristic of normal cell growth.
- D. None of the above.
Name the 2 characteristics which separate benign & malignant tumors.
- 1. Pattern of growth.
- 2. Tissue of origin.
Are benign tumors more or less pleomorphic?
- Benign tumors are less pleomorphic, meaning that their architecture looks the same as the surrounding cells.
- Slow growth.
- Orderly growth.
Which type of tumor is named according to the tissue that the tumor originated from, followed by the suffix "oma" to the end?
- Benign tumors.
- Ex) Osteoma: bone tumor.
- Ex) Adenoma: tumor from glandular tissues.
Malignant tumors are named according to what?
Their embryonic origin.
Carcinomas originate from where?
Carcinoma: from ectodermal or endodermal tissue.
Where do sarcomas originate?
- Sarcomas: from mesoderm.
- Ex) Fibrosarcoma: from fibrous connective tissue.
- Ex) Chondrosarcoma: from cartilage.
Name the 7 tissues which arise from mesoderm & are thus associated with sarcomas.
- 1. Connective tissues.
- 2. Muscles.
- 3. Skeletal system.
- 4. Circulatory system.
- 5. Lymphatic system.
- 6. Urogenital system.
- 7. Linings of the body cavities.
Which is malignant, leiomyoma or leiomyosarcoma?
Leiomyosarcoma: malignant smooth muscle tumor.
Exceptions to the tumor naming rules:
- 1. Melanoma: appears to be benign by name, but is the most malignant tumor occurring in the body.
- 2. Lymphoma: should be called lymphosarcoma.
- 3. Hepatoma: occurs in people have Hep B or C.
Which type of connective tissue is associated with neoplasm?
What is stroma comprised of?
- Connective tissue (which is made of fibers).
- If a tumor has a lot of stoma it will be soft & fleshy.
What is the term used to describe a tissue that is growing rapidly through mitosis, but the the cells are not differentiating?
- Anaplasia: the lack of cell differentiation (or even a reverse of cell differentiation).
- The more anaplastic a tissue is, the more malignant it will become.
- Does not mean a lack of cell growth through mitosis, it means a lack of cell differentiation.
Does development from more basic structures make the tumor more or less malignant?
- (If cancer starts from a very premature blood cell it will be very malignant).
What type of cancer is made up of more than 90% stroma?
- Scirrhous cancer (scirr).
- Ex) Breast adenocarcinoma: scirrous cancer of the breast in which the nipple invaginates due to the connective tissue pulling on it.
- Ex) Scirrhous cancer of the stomach (Leather Bottle Stomach).
In scirr (scirrhous cancer) the majority of tumor mass consists of which type of tissues?
Supportive (connective) tissue.
What do tumors undergo once they are larger than 1mm?
Malignant tumors secrete tumor angiogenesis factor (TAF) in order to start angiogenesis. True or false?
- The vessels will have larger gaps in between them, & some may be lacking a basement membrane = increased permeability.
Hemoptysis may be associated with which form of cancer?
- Lung cancer.
- Hemoptysis: blood in sputum.
- Resulting from the inability of the necrosis to keep up with the tumor, leading to necrosis of the tumor within the lungs.
Which type of cancer has the presence of a CT capsule around it?
- Benign tumors.
- Ex) Leioyoma: smooth muscle of the stomach.
Name 3 reasons why malignant tumors are so invasive.
- 1. Reduced adhesiveness: cannot be kept within the mass of the tumor.
- 2. The malignant cells are attracted to normal cells as a source of nutrients.
- 3. Autocrine motility factors: chemotaxic comminuication between malignant cells signaling to sources of food = path of destruction to get to the nutrients.
What 3 areas of the body are resistant to invasion?
- 1. Pleura.
- 2. Pericardium.
- 3. Fibrous layer.
True or false: generally speaking, the first symptoms of cancer are due to secondary tumors following metastasis.
Which area of the circulatory system do cancer cells attack first?
What is the normal path of metastasis?
- Capillaries --> venous system (veins/lymph vessels) --> multiplication & breaking --> embolus --> gets stuck in vessel --> lytic enzymes break through & cancer is spread to tissue.
- Metastasis rarely travels through the arterial system.
Where do venous system metastases generally wind up?
- In the lungs.
- Ex) Breast cancer.
- Ex) Osteosarcoma.
- Ex) Melanoma.
What is the most common primary bone malignant tumor in young people, characterized by a cannon ball tumor?
Osteosarcoma: starts in the tibia or fibula & metasizes to the lungs via the venous system.
Tumors starting in the alimentary tract wind up in the heart. True or false?
False: they wind up in the liver via the portal venous system.
Which form of cancer spreads in the arterial system?
Lung cancer: winds up in the brain, spleen, or kidneys.
Metastases spreading through the veins are usually found in which organ?
Malignant tumors of the intestines & stomach usually metastasize into which organ?
What is another name for lymph node enlargement?
- Lymphadenopathy: results from a tumor spreading via the lymphatic system.
- Ex) from stomach cancer to supraclavicular nodes.
- Ex) Virchow's nodes.
What are the 3 possible manifestations of a lymphadenopathy?
- 1. Normal lymph tissue may be completely replaced by neoplastic tissue.
- 2. Lymph flow is blocked, collateral vessels take over leading to further metastasis.
- 3. Once large enough, it may metastasize some cells into blood circulation do to the lymphatic & circulatory systems' close connections.
Where do Virchow's Nodes generally metastasize from?
What does large cell lung carcinoma lead to?
Regional metastasis into the peritracheal lymph nodes = no cure.
What is the name for the secondary ovarian tumor which is composed of stomach cancer cells?
- Krukenberg tumor: secondary ovarian tumor that is composed of stomach cancer cells that spread from the stomach to the ovary via the abdominal cavity.
- Note it is very rare for cancer to metastasize through a cavity.
Where do prosthetic carcinomas spread to?
Prosthetic carcinoma: spreads to bones & spine as a result of lung cancer.
What does cachexia mean?
- Cachexia: generalized weakness, fever, anorexia, wasting, pallor, & fever in the late stages of malignant cancer.
- Infection = fever & weakness.
- Hemorrhage & anemia = weakness & palor.
- Pain & depression = anorexia.
- Bowel tumors = wasting.
- Cachectin & TNF = wasting & pain.
- (Cachectin & TFN: chemicals produced by tumors).
What type of tumors is ectopic secretion associated with?
- Most common location: bronchial mucousa.
- Generally malignant.
Ectopic secretions associated with lung cancer result in overproduction of what? And with breast cancer?
- Lung cancer = overproduction of ADH.
- Breast cancer = overproduction of PTH = osteoporosis.
Name 2 examples of adenomas.
- 1. Somatotroph cell pituitary adenoma: causes acromegaly in adults (giagantism in children) due to excessive growth hormone.
- 2. Pheochromocytoma: benign tumor of the adrenal medulla that causes excessive production of NorEpi = secondary hypertension.
Name 2 manifestations of hypertrophic pulmonary osteoarthropathy (malignant tumors from chest organs).
- 1. Hyperostosis: abnormal growth of bones beyond it’s anatomical boundaries.
- 2. Clubbing of fingers (distal phalanxes enlarges).
True or false: tumors most often form from labile tissues.
- Labile tissues are continually going through mitosis to replace old cells.
- Blood cells, spermatozoa, ova, epithelia, & endothelial cells.
Name 3 types of cancer which can be genetically transmitted from parents to children (hereditarily).
- 1. Retinoblastoma: malignant tumor of the retina in new borns = death within first few years of life.
- 2. Polyposis coli: polyps form on the colon & become cancerous.
- 3. Xeroderma pigmentosum: skin cancer.
- *Bronchogenic carcinoma & breast cancer have a degree of genetic predisposition.
What are the 3 environmental factors which contribute to cancer?
- 1. Physical factors: ionizing radiation & ultraviolet radiation.
- 2. Viruses: HPV, HEP B&C.
- 3. Chemicals.
Which cancer causing chemicals form from the combustion of organic materials?
- Polycyclic hyrocarbons: formed from the combustion of organic materials.
- 1. Benzopryene: cigarette smoke = lung cancer.
- 2. Polycyclic hydrocarbons = scrotal cancer in chimney sweepers.
Aromatic amines are used in food coloring & fabric dyes which promote cancer in which 2 organs?
Nitrosamines are found in food preservatives for bacon, ham, sausage, & canned meat. Which 2 conditions result in these substances to interere with cellular DNA?
- 1. Acidity of the stomach.
- 2. Cooking food (high temperatures).
- *Vitamin C prevents nitrosamine formation.
Hepatocellular carcinomas grow on improperly stored vegetables, & are associated with which chemicals?
Aflatoxins: produced by fungi of the genus Aspergillus.
Nickel, cadmium, lead, cobalt, & asbestos are inorganic carcinogens which are associated with pleural cancers. True or flase?
- Asbestos = mesothelioma.
Which of the following substances in proven to promote development of liver cancer?
- Which of the following substances in proven to promote development of liver cancer?
- A. Benzpyrene - lung cancer.
- B. Asbestos - pleural cancer.
- C. Bacon - interferes with DNA = predisposing factor for cancer.
- D. Aflatoxin.
Smoking is a source of which of the following carcinogenic chemicals?
A. Aromatic amines.
- Smoking is a source of which of the following carcinogenic chemicals?
- A. Aromatic amines - from food coloring & fabric dyes = liver & bladder cancer.
- B. Aflatoxin - from fungi on veggies = hepatocellular carcinoma.
- C. Nitrisamines - from meat preservatives = predisposing factor for cancer.
- D. Benzpyrene.
What type of disease is characterized by the formation of autoantibodies against the body's own connective tissue?
Name 4 examples of autoimmune diseases.
- 1. Systemic lupus erythematosus (SLE).
- 2. Scleroderma (systemic sclerosis): fibrosis throughout the body due to overproduction of collagen.
- 3. Dermatomyositis (polymyositis).
- 4. Sjogren's syndrome.
What form of antibodies are associated with SLE?
Antinuclear antibodies: attack the nuclei.
Which 2 pathognomonic antibodies are associated with SLE?
- Pathognomonic: specific to one disease.
- 1. ANA's against double stranded DNA.
- 2. ANA's against Smith's antigens.
SLE is found mostly in young girls. Which 4 organs are generally attacked?
- 1. Kidneys: lupus nephritis.
- 2. Lungs: lupus pneumonitis.
- 3. Cerebral vessels = stroke.
- 4. Skin = butterfly rash.
Which autoimmune disease is characterized by the overproduction of collagen by fibroblasts?
Systemic sclerosis (scleroderma) = fibrous tissue slowly replacing the parenchyme (functional tissue) thus reducing function.
Name the 5 tissues which are most affected by scleroderma.
- 1. Skin.
- 2. GI-tract.
- 3. Vessels.
- 4. Kidneys.
- 5. Lungs.
True or false: diffused scleroderma is more benign & is associated with the mneumonic "C-R-E-S-T."
False: Localized scleroderm
a: much more benign
, associated with "C-R-E-S-T."
- Raynaud's phenomenon: vasoplastic reactions of fingers & toes = white, blue, red.
- Esophogeal dysmotility: loss of peristaltic activity.
- Sclerodactyly: capillaries in fingers become fibrous & dysfunction = dry gangrene.
- Telangiectasia: vascular lesions of the skin due to dilation of the capillaries... fine irregular lines.
True or false: Diffused scleroderma is less benign and promptly leads to the involvement of the internal organs.
- (less benign = more malignant).
True or false: the most prominent clinical sign of Scleroderma is a butterfly rash.
- False: the most prominent clinical sign associated with scleroderma is a mask-like appearance.
- Change in skin results in mummification.
What 2 autoimmune diseases are characterized by damage to the capillary nets of skeletal muscles?
- 1. Dermatomyositis.
- 2. Polymyositis.
What do patients with Dermatomyositis & Polymyositis wind up dying from?
- Atrophy of breathing musculature.
- These diseases cause skeletal muscles to undergo atrophy.
- 60% undergo paraneoplastic reactions: a tumor causes them to spontaneously occur.
- Treatments = very large doses of corticosteroids.
Where do autoantibodies generally attack with Sjogren's syndrome?
Tubular epithelium of external secretion glands.
What are the 2 a/k/a's for Sjogren's syndrome?
Destruction of glands = drying out of salivary glands, tear glands, mucous glands of GI-tract, mucous glands of the tracheobronchial tree, & mucous glands of the vagina.
- 1. Dry syndrome.
- 2. Sicca syndrome.
What are the 3 symptoms associated with Sjogren's syndrome?
- 1. Xerostomia: dry mouth = loss of teeth.
- 2. Xeropthalmia: dry eyes = corneal ulceration = blindness.
- 3. Joint pain: this disease is associated with rheumatic diseases.