Term
| hypoxia is inadequate ___ of ____. |
|
Definition
| inadequate oxygenation of tissues |
|
|
Term
| Ischemia refers to decreased ____. |
|
Definition
- perfusion
- decreased arterial flow or venous outflow of blood |
|
|
Term
| Hypoxemia is ___ ___ of ___. |
|
Definition
| decreased oxygenation of blood |
|
|
Term
| Possible causes of hypoxemia: |
|
Definition
- traveling to high altitudes
- hypoventilation resulting in respiratory acidosis b/c of CO2 retention in lungs, seen with chronic bronchitis
- impaired oxygen delivery to alveoli as seen with respiratory distress syndrome (RDS) with collapse of distal airways due to lack of surfactant |
|
|
Term
| Respiratory acidosis resulting from _____ is caused by too much ___ being in the lungs. This results in ____. This is often seen with ___ ___. |
|
Definition
- hypoventilation
- CO2
- hypoxemia
- chronic bronchitis |
|
|
Term
| With respiratory distress syndrome, ____ occurs b/c distal airways collapse due to a lack of surfactant. |
|
Definition
|
|
Term
| Explain how your body adapts to higher altitudes and corrects hypoxemia. |
|
Definition
- carotid body senses the lowering of the arterial oxygen partial pressure due to diminished barometric pressure
- blood increases the number of red cells to carry more O2 per volume |
|
|
Term
| Go to high altitude> diminished barometric pressure> decrease in arterial oxygen partial pressure> sensed by the carotid body> body makes more RBCS (hematocrit goes up) |
|
Definition
|
|
Term
| Hypoxemia can be caused by a ___ ___. Explain what this means. |
|
Definition
- perfusion defect
- absense of blood flow to the alveoli due to pulmonary embolism |
|
|
Term
| Hyemoemia can also occur with anemia b/c: |
|
Definition
| b/c anemic people have decreased RBCS and hemoglobin concentrations |
|
|
Term
| Hypoxemia also occurs with CO poisoning, explain: |
|
Definition
- CO competes with oxygen binding sites on hemoglobin
- results from automobile exhaust and smoke inhalation |
|
|
Term
| Saddle pulmonary thromboembolus: |
|
Definition
| pulmonary embolism where the pulmonary trunk branches into the right and left pulmonary arteries |
|
|
Term
| Tissues susceptible to hypoxia are called: |
|
Definition
|
|
Term
| Watershed areas are between ___ ___ of major ___ blood supplies. |
|
Definition
- terminal branches
- arterial |
|
|
Term
| When ischemia occurs in the brain, it produces unique focal neurological symptoms that help clinicians diagnose and locate. |
|
Definition
|
|
Term
| Hypoperfusion in waterhsed areas of the intestines can lead to wall and mucosal infarctions in ___ ___ ___ . |
|
Definition
|
|
Term
| watershed areas of the brain: |
|
Definition
- cortical borders of the brain
- where anterior cerebral and middle cerebral arteries meet
- where middle cerebral and posterior cerebral arteries meet
- when ischemia occurs in these areas, it is called cortical border zone infarct |
|
|
Term
| Examples of reversible change: |
|
Definition
- hydropic change
- fatty change |
|
|
Term
| clinical significance of fatty liver: |
|
Definition
- reversible short term consequence of alcohol toxicity
- may develop after a single binge
- does NOT predict development of alcoholic hepatitis or cirrhosis
- moderate to slightly enlarged liver
- asymptomatic or mild elevation of bilirubin and alkaline phosphatase
- resolves completely within 4-6 weeks of alcohol discontinuation |
|
|
Term
| ___ ___ seen on a slide is indicative of ductal carcinoma. |
|
Definition
|
|
Term
| ___ ___ seen on a slide is indicative of ductal carcinoma. |
|
Definition
|
|
Term
| dystrophic calcifactions= ductal carcinoma |
|
Definition
|
|
Term
| With ductal carcinoma you will see ___ ___ and the breast will appear hard and gritty due to increased ____. This is called a ____ appearance. |
|
Definition
- dystrophic calcifications
- collagen
- scirrhous |
|
|
Term
| With degeneration of the aortic valve, one may have ____ ____. This is what you're looking for on an EKG ? |
|
Definition
| dystrophic calcifications |
|
|
Term
| ____ responses allow a cell to respond to stimuli/injury and preserve the viability of the cell. |
|
Definition
|
|
Term
| hyperplasia means increase in ____. |
|
Definition
|
|
Term
| hypertrophy means increase in ___. |
|
Definition
|
|
Term
| Female has increased menstrual bleeding, biopsy of endometrium shows hyperplastic glands but no atypia. Ultrasound reveals a right adnexal mass. Why is the endometrium experiencing hyperplasia? |
|
Definition
| - the right adnexal mass must be secreting estrogen |
|
|
Term
| Explain concept of unopposed estrogen: |
|
Definition
Normally estrogen= first part of cycle, progesterone= second part of cycle
- A pt with mass secreting estrogen does not have progesterone to oppose it, so the endometrium can keep building this can lead to cancer |
|
|
Term
| How does the concept of unopposed estrogen apply to post menopausal women? |
|
Definition
| - you cannot give post menopausal women only estrogen, they must be given estrogen and progesterone |
|
|
Term
| Breast development is an example of ____. |
|
Definition
|
|
Term
| Estrogen causing the endometrium to thicken is an example of ____. |
|
Definition
|
|
Term
| With breast development, what is estrogen's role and what is progesterone's role? |
|
Definition
- estrogen: development of stroma, ductile system, and fat deposition
- progesterone: develops lobules and alveoli |
|
|
Term
| Examples of physiological hyperplasia: |
|
Definition
- menarche and lactation cause hyperplasia of ducts
- proliferative and secretory phase of menstrual cycle |
|
|
Term
| Why may an alcoholic man have gynecomastia? |
|
Definition
- liver normally metabolizes estrogen, but with liver damage not as well> breasts
- example of pathologic hyperplasia of breast tissue |
|
|
Term
| Male breast tissue is mostly ___ tissue, major ___ ___, and ___ ___. They do not have ___ ___. Estrogen may induce hyperplasia in the ____ ___ and ___ |
|
Definition
- fibrostromal
- major mammary ducts
- secondary branches
- NO lobular units in men
- ductal epithelium
- stroma |
|
|
Term
| Does the uterus undergo hyperplasia or hypertrophy during pregnancy? |
|
Definition
Both
- hypertrophy- smooth muscle increases in size
- hyperplasia- increase in number of smooth muscle cells
This is all occuring in the myometrium |
|
|
Term
| Dividing cells can undergo ___ and ____. Nondividing cells can only do ____. |
|
Definition
- hypertrophy and hyperplasia
- hypertrophy |
|
|
Term
| Skeletal muscles can only go through ____ b/c they cannot ___. |
|
Definition
- hypertrophy
- cannot divide |
|
|
Term
| name 3 tissues that cannot undergo hyperplasia. |
|
Definition
- nerve
- cardiac muscle cells
- skeletal muscle cells |
|
|
Term
| 34 year old female has dyspnea during pregnancy. As a child she had streptococcal pharyngititis and rheumatic heart disease. You discover that her left atria is enlarged. Why? |
|
Definition
- she has mitral valve stenosis so the left atrium has hypertrophied to try to expell the blood into the left ventricle
- patient may be asymptomatic until the left atrium has reached a certain size and cannot go through anymore hypertrophy> symptoms |
|
|
Term
| 54 year old male with HTN, DM, and angina. Dies of a heart attack. What would you expect his heart to look like considering is chronic hypertension? |
|
Definition
| - enlarged hypertrophied left ventricle |
|
|
Term
| chronic hypertension causes what change in the heart? |
|
Definition
| - enlarged left ventricle |
|
|
Term
| mitral stenosis causes what change in the heart? |
|
Definition
|
|
Term
| How does chronic hypertension lead to angina? |
|
Definition
| - chronic hypertension> enlarged left ventricle> messed up ventilation profusion matching> angina |
|
|
Term
| patient is sluggish and forgetful. High TSH, atrophied thyroid gland. Whats wrong with her? |
|
Definition
| Hypothyroidism caused by Hashimoto's thyroiditis- inflammatory disease that destroys the thyroid gland so less cells to release T3 and T4 |
|
|
Term
| Patient has hypotension, small adrenal glands, low ACTH, and has weaknes, nausea, and vomitting. Whats wrong with him? |
|
Definition
|
|
Term
|
Definition
- Hashimoto's disease
- Addison's disease
- Amyotrophic lateral sclerosis aka Leu Gerig's disease |
|
|
Term
| With amyotrophic lateral sclerosis, aka leu gerig's disease, neurons of the ___ ___ are degenerating, so skeletal muscle has decreased innervation. Patient will have weakness, paralysis, and loss of ___ ___ reflexes. |
|
Definition
- ventral horn
- loss of deep tendon reflexes |
|
|
Term
| Regenerative capacity is what? |
|
Definition
|
|
Term
| Three categories of regenerative capacity: |
|
Definition
- permanent: do not turn over
- stable: turn over if they need to
- labile: constantly dividing |
|
|
Term
|
Definition
|
|
Term
|
Definition
| - loss of muscle bulk= amyotrophic |
|
|
Term
| Patient has CHF and has had 2 MIs in the past, he complains of orthopnea, shortness of breath, and swelling of ankles and feet. He later dies. What would you expect his heart to look like? |
|
Definition
- since he has had 2 MIs the heart is damaged, so its not getting enough blood
- heart not getting enough blood> atrophies
- example of chronic ischemic heart disease |
|
|
Term
| Person will CHF and history of MIS or chronic ischemic heart disease will have a/an ___ heart. |
|
Definition
|
|
Term
| Chronic ischemic heart disease is characterized by ___ ___ ___ of the myocardium, leading to ___ ___, with or without previous ___ ____. what will this heart look like? |
|
Definition
- insidious ischemic atrophy
- heart failure
- with or without myocardial infarctions
- diffuse myocardial atrophic myofibers within diffuse fibrotic interstitial space
- will also see scars |
|
|
Term
| The esophagus and respiratory epithlium should have ___ cells. |
|
Definition
|
|
Term
| Pt presents with chronic heart burn symptoms, biopsy reveals glands mixed with squamous cells proximal to GE junctions. How has she adapted? |
|
Definition
| acid from the stomach was burning the esophagus> metaplaia from squamous to glandular epithelium |
|
|
Term
| Second most common cancer of esophagus? |
|
Definition
| adenocarcinoma from chronic GERD b/c glands overtime become atypical |
|
|
Term
| After metaplasia has occured, if the insult (acid reflux) keeps occuring, malignancy can occur. |
|
Definition
|
|
Term
| normal> persistent inflammation> metaplasia> dysplasia> carcinoma |
|
Definition
|
|
Term
| The common form of lung carcinoma seen in smokers is composed of ___ cells, which arise in areas of ____ where the normal ___ ___ has become ____ ____. |
|
Definition
- squamous
- metaplasia
- normal columnar epithelium has become squamous epithelium |
|
|
Term
Metaplsia is orderly .
Dysplasia is NOT orderly. |
|
Definition
|
|
Term
|
Definition
| disorderly proliferation of cells with loss of cell maturation, this is a precursor to cancer |
|
|
Term
|
Definition
- increased nuclear size and chromatin
- increased mitotic activity |
|
|
Term
| Endometrial hyperplasia usually results from periods of prolonged ___ excess and can lead to ___, ____ , or ____. |
|
Definition
- estrogen
- metrorrhagia (uterine bleeding at irregular intervals)
- menorrhagia (excessive bleeding with menstrual periods)
- menometrorrhagia |
|
|
Term
| The gold standard for histologic evaluation of the endometrium has been dilatation and curettage (D&C). But most office practices will sample with a biopsy or ultrasonographic measurement of endometrial thickness has been suggested as a screening technique to obtain an image of the endometrial lining and predict the likelihood of disease based on its thickness |
|
Definition
|
|
Term
| 2 big things about necrosis: |
|
Definition
necrosis= irreversible cell injury
- loss of the nucleus
- decreased plasma membrane integrity |
|
|
Term
| Man has heart attack and angiography shows coronary artery atherosclerosis, this means that reduced coronary blood flow may have lead to myocardial ischemia and initiation of irreversible injury |
|
Definition
|
|
Term
| irreversible damage to heart may be caused by: |
|
Definition
| coronary atherosclerosis with thrombosis |
|
|
Term
MI heart> necrosis of tissue> ischemia leads to reversible injury and then irreversible injury called necrosis
Once there is heart necrosis, you cannot regenerate that muscle. |
|
Definition
|
|
Term
| ischemia causes reversible cell injury but if long enough can cause irreversible cell death |
|
Definition
|
|
Term
| ___ ___, the most common type of necrosis, occurs with ischemia. |
|
Definition
|
|
Term
| Pt presents with severe substernal chest pain every time he exerts himself moderatley. These episodes have become more frequent and severe in the past year. What does this indicate? |
|
Definition
| - irreversible cell injury to myocardial cells (coagulative necrosis) |
|
|
Term
| Irreversible cell injury: |
|
Definition
| The loss of the nucleus (pyknosis, karyolysis, and karyohhexis) and loss of membrane integrity= necrosis |
|
|
Term
| > LDH, triponin, myoglobin, and other enzymes- used as markers to tell if there has been a MI b/c these enzyme leak out when necrosis occurs b/c decreased integrity of plasma membranes |
|
Definition
|
|
Term
| 3 enzymes measured to check for MI: |
|
Definition
- lactate dehydrogenase
- troponin
- creatine kinase |
|
|
Term
| Troponin will be ___ times higher within the first ___ days of a MI and will remain elevated (though not as high as at day 2) for ___ days. |
|
Definition
30 times higher
two days
fourteen days |
|
|
Term
| Creatine kinase will be about __ times normal on the __ day and will be elevated for __ days before returning to normal. |
|
Definition
- 5 times normal
- first
- six |
|
|
Term
| After a MI, lactate dehydrogenase will rise until the __ or ___ day to about __ times normal, and then remain elevated (though not at max), until day ___. |
|
Definition
- third or fourth
- 7 times normal
- fourteen |
|
|
Term
| When looking at a slide of myocardium, how will you know its coagulative necrosis? |
|
Definition
| lack of nuclei in the fibers |
|
|
Term
| best example of cause of coagulative necrosis? |
|
Definition
|
|
Term
| Pulmonary thrombosis secondary to immobilization: will develop a hemorrhagic (red) type due to loose-textured tissue (e.g., lungs, small bowel) allows RBCs to diffuse through necrotic tissue |
|
Definition
|
|
Term
| Define hemorrhagic infarct: |
|
Definition
| ischemic coagulative necrosis due to decreased blood flow |
|
|
Term
| etiology of hemorrhagic infarct: |
|
Definition
| - inadequate oxygenation is most common cause of cell injury and is usually due to insufficient blood flow (ischemia) |
|
|
Term
| A pulmonary infarct caused by a thromboembolism in a pulmonary artery branch leads to localized ischemic necrosis. It is ____ b/c the ___ artery circulation supplies a small amount of blood to the affected area. |
|
Definition
- hemorrhagic
- bronchial |
|
|
Term
| Liquefactive necrosis is seen with ____ and ____ and is caused by ___ of ___ cells. |
|
Definition
inflammation and infections
enzymes of inflammatory cells |
|
|
Term
| Female pt with RLQ pain, fever, and swollen fallopian tube with gonarrhea will have what kind of necrosis? |
|
Definition
|
|
Term
|
Definition
Bacterial infections (+fungal)
Neutrophils and lysosomal enzymes
Completely digest bacteria and tissue
Liquid mass
Abscess formation |
|
|
Term
liquefactive necrosis:
bacterial infection> neutrophils> hyrolytic enzymes> liquefy dead tissue> absess |
|
Definition
|
|
Term
|
Definition
inflammatory fluid with high protein concentration, cellular debris, and neutrophils
Bacteria: E.coli, Klebsiella pneumoniae, Proteus fecalis, Streptocococcus faecalis, Staphylococcus aureus |
|
|
Term
| liquefactive necrosis in the brain results from : |
|
Definition
| - cerebrovascular occlusion= stroke |
|
|
Term
| caseous necrosis is caused by : |
|
Definition
| TB: microbacterium tuberculosis (an acid fast bacterium) |
|
|
Term
| Mycobacterium are inhaled and proliferate in ____. Then mediators cause the macrophages to kill the ____ and to form ____. Then __ cells kill the ____ with the mycobacterium, resulting in ____ ____. |
|
Definition
- macrophages
- mycobacterium
- granulomas
- T
- macrophages
- caseous necrosis |
|
|
Term
| mycobacterium have a high ___ content. So they require special type of dye and more time and heat. This is called ___ ___ staining. |
|
Definition
|
|
Term
|
Definition
fatigue
night fever
chills
weight loss
chronic cough producing sputum with red flecks |
|
|
Term
| Casseous necrosis is a variant of ___ necrosis associated with a cellular ___ ___ ___ ___ material, usually in the center of a ____. |
|
Definition
- coagulative
- cheese-like, friable, casseous
- granuloma |
|
|
Term
| Pt with TB will have granuloma lung mass with center area of caseous necrosis- where macrophages are trying to control bacteria. So in the center of the granuloma is the casseous necrosis |
|
Definition
|
|
Term
| Caseous Necrosis and granuloma: collection of fragmented or lysed cells and amorphous granular debris enclosed within a distinctive inflammatory border; has central caseous necrosis and peripheral giant cells |
|
Definition
|
|
Term
|
Definition
| focal area of fat destruction, enzymatic due to release of pancreatic lipases or from macrophages |
|
|
Term
| Fat necrosis of breast will be an inflammatory mass, expand on this: |
|
Definition
hard mass
damaged necrotic fat is phagocytosed by macrophages
may resemble inflammatory carcinoma |
|
|
Term
| when breast has fat necrosis it is called: |
|
Definition
| Non-enzymatic fat necrosis inflammatory mass |
|
|
Term
Necrosis:
1. Coagulative necrosis due to ischemia: MI or pulmonary embolism
2. Liquefactive necrosis due to infection or stroke
3. Casseous necrosis due to TB
4. Fat necrosis- breast or pancreatitis |
|
Definition
|
|
