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Block 4 Pathology
Things to remember
62
Medical
Graduate
05/13/2008

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Term
Artery or Vein? Media thin and adventitia thick.
Definition
Vein
Term
Location of vaso vasorum?
Definition
Tunica adventitia of arteries.
Term
Blood supply for arteries?
Definition
Vaso vasorum.
Term
Where are Purkinje fibers located in the ventricle?
Definition
The endocardial layer.
Term
Calcific deposits in medium size muscular arteries?
Definition
Arteriosclerosis.
Term
Eccentric intimal lesions in medium to large vessels?
Definition
Artherosclerosis.
Term
Hyaline or hyperplastic vascular disease associated with hypertension or diabetes?
Definition
Arteriolosclerosis.
Term
Vascular disease seen in malignant hypertension.
Definition
Arteriolosclerosis.
Term
Onion skinning arterial lumen?
Definition
Arteriolosclerosis.
Term
5 phases of artherosclerotic development.
Definition
1. Endothelial injury
2. Endothelial dysfunction.
3. Smooth muscle immigration from media to intima
4. Lipid engulfment by macrophages and SM cells.
5. Smooth muscle proliferation and ECM deposition (fibrous cap)
Term
What are principal features of Type I artherosclerotic lesion?
Definition
Isolated macrophage foam cells (not grossly visible).
Term
What are principal features of Type II artherosclerotic lesion?
Definition
Fatty streak. Intracellular lipid accumulation.
Term
What are principal features of Type III artherosclerotic lesion?
Definition
Type II changes + small extracellular lipid pools.
Term
What are principal features of Type IV artherosclerotic lesion?
Definition
Artheroma. Type II changes + core of extracellular lipid.
Term
Artheroma?
Definition
Type IV artherosclerotic lesion with intracellular lipid accumulation and extracellular lipid core.
Term
Fibroartheroma?
Definition
Type V artherosclerotic lesion. Artheroma with fibrous cap, or fibrous ("healed") only.
Term
What are principal features of Type V artherosclerotic lesion?
Definition
Extracellular lipid core with fibrous cap, or all fibrous. Fibroartheroma.
Term
What are principal features of Type VI artherosclerotic lesion?
Definition
Ruptured and thrombogenic.
Term
What are the key features of an artheromatous plaque?
Definition
Fibrous cap with necrotic core.
Term
What are the ECM components that you would see in an artherosclerotic thickening?
Definition
Collagen, elastin, proteoglycans.
Term
Can see calcification, necrosis, and thrombus with this lesion.
Definition
Artherosclerotic lesion.
Term
What are two best markers for cardiac ischemia?
Definition
CK-MB and troponin.
Term
What is the window for seeing troponin following MI?
Definition
From 3-4 hours to 14 days.
Term
What is the window for seeing CK-MB following MI?
Definition
From 3-4 hours to 3 days.
Term
MI stage of injury: wavy cells and edema?
Definition
1 to 6 hours.
Term
What will we see at 1-6 hours following irreversible myocardial injury?
Definition
Wavy fibers separated by edematous fluid.
Term
What will you see 3 days following irreversible myocardial ischemic injury?
Definition
Coagulative necrosis with pyknotic nuclei and PMN infiltration.
Term
What will you see 7 days following irreversible myocardial ischemic injury?
Definition
Granulation tissue with myocytes and more necrosis. Looks like chunky debris between some intact looking fibers.
Term
What will you see 14 days following irreversible myocardial ischemic injury?
Definition
Granulation tissue and collagen deposition. New blood vessels.
Term
What will you see long after irreversible myocardial ischemic injury?
Definition
A dense collaginous scar, acellular.
Term
What are the levels of division of the renal circulatory system?
Definition
Renal a. -> interlobar a -> arcuate a. -> interlobular a. -> afferent arteriole -> glomerulus...
Term
What are the layers of the glomerular basement membrane?
Definition
Lamina rara interna (endothelial), lamina densa, and lamina rara externa (epithelial)
Term
Principal function of mesangial cells?
Definition
Cleaning basement membrane by phagocytosis.
Term
What is the difference between cells lining the thin limb of the loop of Henle and the cells lining the thick ascending limb?
Definition
Thin limb lined with squamous and thick ascending limb lined with cuboidal cells.
Term
What is the epithelium that lines the ureter?
Definition
Transitional epithelium.
Term
What is #1 cause of nephrotic syndrome in children?
Definition
Minimal change disease.
Term
What is #1 cause of nephrotic syndrome in adults?
Definition
Focal segmental glomerular sclerosis.
Term
What is "segmental" sclerosis?
Definition
Only affects part of the glomerular tuft.
Term
What is a "focal" sclerosis?
Definition
Only affects 50% or fewer of all glomerular tuftfs.
Term
What nephrotic syndrome do you see difuse thickening of basement membrane?
Definition
Membranous glomerulonephritis.
Term
What is the most common cause of membranous glomerulonephritis?
Definition
Idiopathic.
Term
What are less common causes of membranous glomerulonephritis?
Definition
SLE, Hep B, carcinoma, and drugs including NSAIDS.
Term
Do you see hypercellularity with membranous glomerulonephritis?
Definition
No.
Term
Two thinks at top of differential with acute proliferative glomerulonephritis?
Definition
Postinfectious glomerulonephritis and secondary to CT disease (like SLE)
Term
What is most likely with subepithelial bumpy deposits and hypercellular mesangium?
Definition
Acute proliferative glomerulonephritis.
Term
What cells are you likely to see in messangium in setting of acute proliferative glomerulonephritis?
Definition
Neutrophils, as well as mesangial cells.
Term
Tram tracks on EM?
Definition
Membranoproliferative glomerulonephritis.
Term
Subendothelial deposits (tram tracking) and hypercellular mesangium?
Definition
Type I membranoproliferative glomerulonephritis.
Term
Intramembranous deposits and hypercellular mesangium?
Definition
Type II membranoproliferative glomerulonephritis.
Term
Most common nodular glomerulopathy?
Definition
Diabetic glomerulosclerosis.
Term
How to tell diabetic glomerulosclerosis from amyloidosis?
Definition
Diabetic positive for trichrome, PAS, or silver. Amyloid positive for congo red or crystal violet.
Term
Kimmelstein-Wilson nodules?
Definition
Diabetic glomerulosclerosis.
Term
Clinical syndrome of Alport?
Definition
Sensorineural deafness, lens dislocation and cataracts, and nephrotic disease.
Term
Nephritis and foamy cells under light microscopy.
Definition
Alport syndrome.
Term
What is the pathogenesis of FSGS?
Definition
Systemic hypertension, intraglomerular hypertension, and glomerular hypertrophymessangial cell hyperplasia/ECM deposition, intraglomerular coagulation, and epithelial/endothelial injuryglomerulosclerosis and proteinuria
Term
What are the biochemical changes that are the features of diabetic ketoacidosis?
Definition
Increased sythesis of collagen type IV and fibronectin and decreasd heparan sulfate proteoglycan.
Term
What will the GBM from a person with diabetic glomarulosclerosis look like under EM?
Definition
You will see a homogenous thickening.
Term
What is the term for the nodular structures seen in the glomerulus of a person with diabetic glomerulosclerosis?
Definition
Kimmelsteil-Wilson nodules
Term
What immunofluorescence study would clarify the diagnosis of FSGS?
Definition
A study for IgA and C3 would show immunofluorescence in the sclerotic region of the glomeruli.
Term
How do ischemia induced ATN and toxin induced ATN differ morphologically?
Definition
Toxin induced ATN exhibits diffuse tubular damage whereas ischemia induced ATN exhibits patchy tubular damage.
Term
What is the key cellular morphology in renal cell carcinoma?
Definition
Polygonal cells with clear cytoplasm.
Term
Why do you see polycythemia in the setting of renal cell carcimoma?
Definition
Overproduction of EPO.
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