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Dukes PATHOMA Deck: Questions & Answers (Solved)
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Dukes PATHOMA Deck: Questions & Answers (Solved)
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Dukes PATHOMA Deck: Questions & Answers (Solved)An increase in stress on an organ leads to? Right Ans - An increase in organ
size by hypertrophy or hyperplasia .
By what three general processes does cellular hypertrophy occur? Right
Ans - Gene activation; Increased Protein synthesis Increased production of
organelles.
By what general mechanism does hyperplasia occur? Right Ans -
Production of new cells from stem cells.
Is the pregnant uterus an example of hypertrophy or hyperplasia? Right
Ans - Both
What is a permanent tissue? Can a permanent tissue grow? What are the (3)
permanent tissues? Right Ans - A permanent tissue is one that cannot make
new cells (no lingering stem cells/progenitors).; Permanent tissues can only
grow by hypertrophy. Skeletal muscle, cardiac muscle, and nerve.
How does the heart respond to persistent hypertension? What are the two
basic types of cardiac hypertrophy and what causes them?; Right Ans -
Being a permanent tissue, it grows via hypertrophy . Pressure overload '
concentric hypertrophy (sarcomeres added in parallel. HCM) Volume
overload ' eccentric hypertrophy (sarcomeres added in sequence. DCM)
What concern exists with endometrial hyperplasia? What hyperplastic
process doesn't carry this same concern? Right Ans - As a general rule:
pathologic hyperplasias increase risk for cancer.; Endometrial hyperplasia is a
pathologic hyperplasia (caused by excess estrogen secretion) that carries a
risk for progression to dysplasia and eventually cancer. BPH is a type of
pathologic hyperplasia does not increase the risk for cancer ;(is an exception
to the rule);
What are three examples of "decreases in stress" that lead to atrophy?
Right Ans - Decreased hormonal stimulation (breast atrophy); Disuse (muscle
atrophy); Decreased nutrient/blood supply (kidney atrophy)
,What cellular changes does atrophy represent? Right Ans - Decrease in size
and number of cells
How is cell number ;decreased in an;atrophic process? Right Ans -
Apoptosis
In what two ways is cell size reduced in atrophy? Right Ans - Ubiquitin-
proteosome degradation of the cytoskeleton and autophagy of cellular
components.
What is ubiquitin-proteosome degradation? Right Ans - Proteins (in
atrophic processes, intermediate filaments of the cytoskeleton) are tagged
with ubiquitin and destroyed by proteosomes.
How does autophagy occur in atrophy? Right Ans - Autophagic vacuoles
engulf cellular components that are no longer needed. These vacuoles then
fuse with lysosomes.
What does a change in stress on an organ lead to? Right Ans - Metaplasia
What is metaplasia? Right Ans - A change in cell type , most commonly
involving surface epithelium (changing to a type more suitable to handle the
change in stress)
Describe the metaplastic process observed in Barrett esophagus:; Right
Ans - Change from non-keratinizing stratified squamous (handles friction of
food bolus) to non-ciliated columnar with goblet cells (better for handling
acid). <img src="paste-33870112096259.jpg" />
How does metaplasia occur? Right Ans - Reprogramming of stem cells
Is metaplasia reversible? Right Ans - Yes, in theory, with the removal of the
stressor.
How do you treat Barrett esophagus? Right Ans - Remove the stressor, i.e.
treat the acid reflux
Are we concerned about metaplastic processes? Right Ans - Yes -
metaplasia can progress to dysplasia and eventually cancer
,Does all metaplasia lead to cancer? Can you name a metaplastic process that
has 0% chance of causing cancer? Right Ans - Though most types of
metaplasias can theoretically progress to cancer (e.g. Barrett esophagus-
>adenocarcinoma), many do not. ; Apocrine metaplasia of breast ;has no
propensity for malignant transformation
What processes is vitamin A essential for? Right Ans - It's necessary for
differentiation of specialized epithelial surfaces (e.g. conjunctiva), and
essential for the maturation of certain immune cells (such as neutrophils).;
*Note: also helps reduce mortality in measles
Describe the pathological effects of vitamin A deficiency:; Right Ans -
Deficiency of vitamin A results in metaplastic ; specialized epithelium . For
example, the squamous epithelium of the conjunctiva undergoes metaplasia
into stratified keratinizing squamous epithelium . This is keratomalacia .
Vitamin A is also important for maturation of immune cells. Remember that
retinoic acid (vitmain A derivative) is important for neutrophil maturation
(remember, ATRA is used to treat APL).; <img src="paste-
35815732281347.jpg" />
What is myositis ossificans? Right Ans - Inflammation of the skeletal
muscle induces metaplastic change in the connective tissue of the muscle to
produce bone.; *Note: it's clinically important to differentiate this process
from osteosarcoma. myositis ossificans is clearly detached from bone on
imaging. osteosarcoma would not be.; <img src="paste-
36790689857539.jpg" />
What is dysplasia? Right Ans - Disordered cellular growth . Often refers to
proliferation of precancerous cells.
What pathologic proliferation is a precursor to cervical cancer? How is it
categorized? Right Ans - Cervical intraepithelial neoplasia (CIN), which is a
dysplastic process. A: CIN1: dysplastic cells in lower 1/3 of epithelium B:
CIN2: dysplastic cells in lower 2/3 of epithelium C: CIN3: dysplastic squamous
cells throughout full thickness of epithelium <img src="paste-
36885179138051.jpg" />
, What processes can precede a dysplastic process? Right Ans -
Longstanding pathologic hyperplasia (e.g. endometrial hyperplasia) or
metaplasia (e.g. Barrett esophagus);
Is dysplasia reversible? Right Ans - Yes, in theory , with alleviation of the
stress. If it persists it can progress to carcinoma, which is irreversible.
What is aplasia? Example? Right Ans - Failure of cell production during
embryogenesis (e.g. unilateral renal agenesis).
What is hypoplasia? Example? Right Ans - Decrease in cell production
during embryogenesis , resulting in a small organ (e.g. streak ovary in Turner
syndrome).
When does cellular injury occur? Right Ans - When a stress exceeds the
cell's ability to adapt
Which is more susceptible to ischemic injury: neurons or skeletal myocytes?
Right Ans - Neurons are highly susceptible (3-5 minutes), skeletal muscle is
fairly resistant (long periods of time).
How does the rapidity of a stressor affect the response of the cells (e.g.
ischemia)? Right Ans - Slowly developing ischemia (e.g. renal artery
atherosclerosis) will lead to atrophy. Acute ischemia (e.g. renal artery
embolus) will result in injury.
What are 5 common causes of cellular injury? Right Ans - Inflammation
Nutritional deficiency (or excess) Hypoxia Trauma Genetic mutations
How does hypoxia cause cellular injury? Right Ans - Oxygen is the final
electron acceptor in the ETC of oxidative phosphorylation, so hypoxia hinders
ATP production , disabling important cell functions.;
What is ischemia? Right Ans - Reduced blood flow through an organ.
What 3 pathologies/pathologic states can cause ischemia? Right Ans -
Decreased arterial perfusion (e.g. atherosclerosis). Decreased venous
drainage (e.g. Budd Chiari) Shock - generalized hypotension resulting in poor
tissue perfusion
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