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Pathology
o Inflammation apoptosis
Necrosis
Cell injury
Ischemia: susceptl areas
Infarcts: red vs pale
Shock
Atrophy
Inflammation
Leukocyte extravasation
Free radical injury
Wound healing
Granulmoatus dx
Exudate vs transudate
ESR
Iron poisoing
Amyloidosis
On histological exam, a dying cell is noted to
lack signs of acute inflammation in its
vicinity. What type of cell death has likely
occurred?
o Apoptosis
Ribosomal detachment R or I?
oR
USMLE
o Pts cell shows nuclear clumping and
fragmentation. Is this R or I signs of cell
injury?
Irreversible: pyknosis (nuclear
clumping) and karyolysis (nuclear
framgantion) are irrersbiel changes
Low
Pt admitted to the ICU is cold and clammy.
o Hypovolemic or dardiogneic
In a pt with hypovolimc/cardiogenic shock,
TPR?
o Incrase
To componste for low CO
Pt expierences widespread bactermia. He is
warm to the touch. CO to be?
o High
Septic shock
Septic shock CO state?
o High
Reduction in the size or number of cells?
o Atreophy
Causes?
Decrase in hromones
Blood flow,
Innervation,
Nutrients
Occlusion of secretary ducts
Incrase in pressure
o A man severs his right bracial pleux can
cannot more his arm.
He develops vast mucsuclar atrophy,
unepxoed by lack of use alone.
MOA?
o Dnervation fo msucles in his
right arm accelerated the
atrophy
o Why does the endoemetrial ining of the
uterus undero atrophy after menopause?
It loses of growth signals from
endogenous hromeons
A man is diagnosed with CF. What sithe
pathogenesis of his pancreatic atrophy ove
rtthe long term?
o Occlusion fo secretary ducts
40 yo man has PF. Wha type cell type in his
lugns will repdomiante in cuasing the
pathologic hanges?
o Fibroblasts
50 yo man has left lower lobe exudative
inflammation from bacterial pneumonia.
What sepcts of the inflammatory process led
to this?
o Increased?
Vascular permability
o Vasodilation
o Endothelial injury
Abnormal ocmmuicatnion between 2
epitheliaized surfaces
o Fisutal
Present?
Resolution phase of
inflammation
What is the ce3lularl component of the
inflammatory process?
o Neutrophil extrvation (circulation to the
in injured tissue) to mediate?
Phagocytosis;
Degranulation
Inflammatory mediator release
What cells and proteins mediate acute
inflammation?
o Neutrophils, esoinphopls
o And antibodies
Chronic inflammation?
o Persistent destruction and repair
Charc of granulation tissue?
o Highly vascularized fibroti citssue
Present?
Resolution phse of inflammation
Inflammation:
o What should normally happen in the
resoluation phase of inflammation?
Restoration Normal tissue structure
What is an abscess?
USMLE:
o Chronic inflammation is mediabed by
cells?
Mononuclear cells
W
What are the pathological charc
of such an inflammation?
o Persistent destruction and
repair
Nodular collecitons of epithelioid
macorphages and giant cells?
o Granuloma
Chronic phase of inflammation
4 main cytokinase
o Triggered by bacterial prodcuts) that
guide leukocytes to a site of injury or
infection (CILK)
C5a
IL-8
LTB4
Kallikrein
Tight binding is mediated by?
o ICAM-1
On the vascular endotheium
o And by binding to what? Ont eh
leukyoctyes
LFA-1 (integrin)
4 steps involved in leukocyte extrvation:
o Rolling
o Tight binding
o Diapedesis
o Migration
Leucokcytes travel between endotehliuc
cells adne xits the blood vessel?
o Diapedesis
Mediated by ?
Ont eh vascular endothium?
o PECAM-1
And binding to on the leukocytes?
o PECAM-1
The cell travesl to the site of infection or
injury with tethe guidance of chemotactic
signals?
o Migration
Rolling is medicated by what ont eh vascular
endoium?
o E and P selectins
o By binding on the leukocytes
Sialyl Lewis
Name 3 pathays for free radical
degradation?
o Antioxidants
(vitamins, ACE)
o Enzymes (i.e.?
Catalase, superoxide dismutase)
o Spontaneous degradation (decay)
Free radical damage by carbon tetrachlrodi
causes what pathlogic change int eh uman
body?
o Fatty change in the liver
Some enzyems that degrade free radicals:
o Catalase
o Glutathione peroxidase
o Superoxide dismutase
Via what mechiansid do free radicals
damage cells?
o Membrane lipid peroxidation,
o Protein modification
o DNA breakage
3 vit with antioxidants properties that
involve in degrading free radicals?
o E, A, C
Fat soluble vitamins?
o DEAK
USMLE:
o An infant is born at 22 weeks gestation.
Exposure to free radicals predispose him
towha tpathological processes in his
eyes and lung?
Bronchopulmonary dyslplaisa (lungs)
Retionphaty of prematurity (eyes )
Pt undergoes thrombolysis for acute limb
ischemia. What type of fre radical injury is
of most concern?
o Reperfusion injury
o MI pt that had fibrinolysis: why do
troponin rise again?
Free radiacl injury can be induced by expose
to what substances and processes?
o Radiation
o Heavy metals
o Metabolism of drugs (phase 1)
o Redox reactions
o NO
o Leukocyte oxidative burst
Wound healing
o Which phase of wound healing has
infiltration of paltelets, neutorphils and
macrophages at the site of injury?
Inflammatory phase!!!
After wound
In which phase is the wound healing process
one week after an injury?
o Remodeling phase
What are the charc of the inflma phase?
o Clot formation
o Incrased vessel permability
o Neutrophil migrate into tissue
o Macoprhage clearance of debris two
days later
Which wound healing phase has collagen
deposition, angioegeniss, clot dissolution,
epitheliuc cell rplofieration and wound
contraction?
o Prlofieratif phase
When does the ifnlammaotyr phase of
wound healing occur?
o Immediatlye after injury
Granlumotase dixses
o Why must you check for granulmostu dx
before starting an anti-tumor necoriss
factor medication?
b/c these medication break down
granulomas and can predispose to
dissiminated disease
Catarrhal exudate is seen in the nose and throat and is characterized by a high content of
mucus.
Malignant (or cancerous) pleural effusion is effusion where cancer cells are present.[7] It is
usually classified as exudate.
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Transudate
Exudate
Increased hydrostatic
Main causes
pressure,
Decreased colloid
osmotic pressure
Appearance
Clear[8]
Cloudy[8]
Specific gravity
< 1.012
> 1.020
Protein content
< 0.5
> 0.5[10]
fluid protein/
serum protein
Difference of
albumin content
< 45 mg/dL
> 45 mg/dL[9]
There is an important distinction between transudates and exudates. Transudates are caused by
disturbances ofhydrostatic or colloid osmotic pressure, not by inflammation. They have a low protein
content in comparison to exudates. Medical distinction between transudates and exudates is through
the measurement of the specific gravity of extracted fluid. Specific gravity is used to measure the
protein content of the fluid. The higher the specific gravity, the greater the likelihood
of capillary permeability changes in relation to body cavities. For example, the specific gravity of the
transudate is usually less than 1.012 and a protein content of less than 2 g/100 mL (2 g%). Rivalta
test may be used to differentiate an exudate from a transudate. It is not clear if there is a distinction
in the difference of transudates and exudates in plants.
Transudates are characted by few cells, little protein and specfici gravity?
< 1.012
USMLE:
o A pt with decompensated CHF has
vasculature?
Decreased
ESR (erythrocyte sedimentation rate)
o Least 2 conditions that can
predispose pts to a lower ESR
Sickle cell anemia
Polycythemia
CHF
USMLE:
o A med student worries a pregnant
women has an b/c of her high ESR.
Do you agree?
ARTHRITIS
PHOTOSENSITIVTY
RAYNAUDS PHENOMENOM
Anti-histones
SHIPP
o Q-chimppps
Quinidine
Chlorpromazine
Hydralzine
Isoniazide
Methyldopa
Procainamide
Phenytoin
Penicylamine
Sulfonamides
What is the Mecnahims of cell death iron
poisoing?
o Membrane lipid peroxidation
In what population are your particularly
worried about iron poisoing?
o Children
o Why?
Iron poisoining is one of the MCC of
death in children secondary to
toxco.lgoci agents
What is the acute sign of iron poisoining?
o Gastric bleeding
What are the isgns of chronic iron poisoing?
o Metabolic acidosis scarring leading to
GI obstruction
USMLE:
o A man with no surgical history decides to
take 5 iron supplemnts a day. He later
develops a small bowle obstctruion?
MOA?
Chronic iron poisoing cause
scarring leads to the
gastrointestinal obstruction.
USMLE:
o A 5 yo is rushed to the ER after
swallowing 10 mutlivtamin pills. He has
acute gastric bleeding.
Likely cause?
Iron poisoing from the MVs
Amyloidosis
o Tissue affected by amyloidosis may
have?
Waxy appearance
o What protein is depsoisted in mayloidoss
in pts with medullary carcinoma of the
thyroid?
A-CAL
ATTR
transthyretin
Ig Light chain
Which type of amylidos is charc by AL
protein derived from Ig light chain?
o Bence jones amyloidosis
What dx can cause amyloidsi from an
cexcess of Ig light chain?
o Multiple myeloma
What is charc hisotlogica finding in tissed
affected by amlyodis?
o B pleated sheet that show apple green
birefreingche when stain with Congo red
and viewed under polarized light
Amyloidosis in AD pts is charac by
deposition of what protein?
o B-amyloid
What is the name of its precursor
protein?
Derived from ?
o Amyloid precursor protein
Senile cardiac amyloidosis sis characterized
by the depsitn of what protein?
o tr
o Transthyretin
What is the name of its repcurs
protein?
Derived from AF
AF Amyloidosis Amyloidosis Center | Boston University
www.bu.edu/amyloid/research/laboratory.../af-2/
o
o
Boston University
o
Describe the pathophyskogy fo age related
(senile) systemic amlyodis)