Pathology Final Exam Review Questions PDF

Maryam Badr December 3, 2024 Pathology Final Review 1. Explain the Cardinal signs of inflammation - There are five main cardinal signs of inflammation. Those signs are rubor, calor, dolor, tumor, and functio laesa. Each one of these cardinal signs or symptoms that...

Maryam Badr December 3, 2024 Pathology Final Review 1. Explain the Cardinal signs of inflammation - There are five main cardinal signs of inflammation. Those signs are rubor, calor, dolor, tumor, and functio laesa. Each one of these cardinal signs or symptoms that arise as a result of inflammation in the body. Rubor refers to redness which is due to a rush of blood. Calor refers to warmth or feeling hot, this is also due to a rush of blood. Then there is dolor which refers to pain, this signals the body that there is something wrong. Next, we have a tumor which is swelling and this is due to the presence of too much blood. Lastly, we have functio laesa which is defined as an inflamed organ. This is one of the most important cardinal signs of inflammation because inflamed organs don’t work right and lose function which can be a threat to one’s health. 2. Discuss the cells of inflammation - The cells of inflammation are extremely important to the body as they act as the body’s defense mechanism by responding to the infections or viruses in the body. There are many cells of inflammation. Fixed cells are an important group of phagocytic cells called the reticuloendothelial system or RES. Its primary function is to remove dead cells, abnormal cells, and foreign substances. Next are granulocytes which fight off infections and allergens, some types of granulocytes include neutrophils, basophils, and eosinophils. Neutrophils are one of the first cells to respond to bacteria and viruses, and they essentially travel to the site of infection and engulf the microorganisms. Basophils are a type of white blood cell that protect the body from infection and allergens by releasing histamines. Eosinophils are secreted in response to allergic reactions, parasitic, and fungal infections. Agranulocytes also help the body fight off infections. Types of agranulocytes include lymphocytes and monocytes. Lymphocytes recognize foreign antibodies and produce antigens and monocytes transform to macrophages and engulf pathogens and dead cells. In addition to these cells, there are also kupffer cells which protect and repair the liver and there are sinusoidal cells of spleen and bone. 3. `Discuss developmental defects - give examples - There are many types of morphological manifestations of abnormal development. Few instances of overgrowth of tissue as the primary result of genetic influence. Most congenital anomalies which influence size cause the involved organs or  tissues to be smaller than normal or absent all together. Some examples of developmental defects include agenesis, aplasia, and hypoplasia. Agenesis is the failure of an organ to develop during embryonic growth and development due to the absence of the primordial tissue. Aplasia is the failure of an organ or tissue to develop or function normally. Hypoplasia is the incomplete development of an organ or tissue. Hence , organs or tissues affected by hypoplasia have a below average number of cells. Developmental defects can be hereditary, somatic mutations, and acquired defects. Some principal systems involved in congenital malformations are the circulatory system, the CNS, digestive system, and the urogenital system. It is believed that most malformations are the result of a genetic predisposition coupled with intrauterine injury. There are three levels of diseases which result from genetic fault and they are grossly evident malformations, obvious metabolic disturbances, and more complex less obvious hereditary disease. Genetic influences are responsible for the characteristics of the individual which determine his/her reaction to injury. A large influence on the pathogenesis of the disease is genetics and whether or not it was hereditary. 4. Discuss chromosomal disease - Most diseases of autosomal chromosomes are so severe and tend to be incompatible with life and cause approximately ⅓ of spontaneous abortions during the first trimester. Down syndrome or trisomy 21 is a chromosomal disease. This chromosomal disorder is associated with mental deficiency and characteristic facial expression. Most children die in childhood but some live to adulthood. This chromosomal disease does have some relationship to maternal age, meaning the age the woman gives birth. Patients with down syndrome have difficulties with brain function including issues with learning, memory, and speech throughout life. Later in life they may face increased cognitive problems associated with brain changes of Alzheimer's disease. There are also sex linked chromosomal diseases such as Klinefeilter’s Syndrome (XXY) and Turner’s Syndrome (X). 5. Discuss sex-linked disorders and give an example - In regards to sex linked disorders females with abnormal recessive genes on the X chromosome will not have the disease because they have the opposing normal gene on the other X chromosome. While males with abnormal recessive genes will have the disease because the Y chromosomes have no genes to oppose the abnormal X. Sex linked recessive disorders will appear in every other generation. They tend to be very difficult to control. Dominant diseases usually arise from the genetic mutation and usually will disappear. Some examples of sex linked disorders are Turner’s Syndrome (X) and Klinefelter's Syndrome (XXY). Turner’s  Syndrome is a genetic disorder that affects females and causes developmental and health problems. In this disorder the female has one X chromosome that is missing or partially missing. Kinefelter’s Syndrome is a genetic condition that occurs in males. This disorder leads to male having an extra X chromosome which causes males to have larger than normal breasts, small testes, osteoporosis, and poor beard growth. 6. Compare benign and malignant neoplasia - Neoplasia is abnormal and uncontrolled growth of cells or tissue in the body. Benign neoplasm is the growth of a noncancerous mass of cells, grows in one place and does not spread to other parts of the body. Cells that comprise this neoplasia are ordinarily well differentiated, they resemble normal cells. These cells do not metastasize. Some characteristics of benign neoplasm is that they are relatively normal cells, slight mitotic activity, slow rate of growth, expansive, encapsulated, rarely recurs, never metastasizes, little vascularity, and necrosis is rare. Malignant neoplasia is cancerous or abnormal growth of mass tissue and can spread to other parts of the body. Characteristics of malignant neoplasia at a cellular level include anaplasia which is the reversal of the process of differentiation. Anaplasia signifies the loss of normal differentiation, meaning the loss of a specific function. Other characteristics include hyperchromatism, abnormal mitosis, abnormal function, and pleomorphism to name a few. Malignant neoplasia also has specific characteristics on a tissue level. These include altered organization, invasion, necrosis, heterotopia, non-septic inflammatory reaction, and abnormal function. 7. Discuss metastasis and circulatory patterns - Metastasis refers to the formation of a new focus of cancer within the body and it is the result of spread from a primary focus somewhere else in the body. Cancers spread in many ways. Some of them include spreading locally by progressive growth, invasion and destruction of surrounding tissue. Cancers are extremely aggressive and can even enter the blood and lymphatic vascular channels from the tumor emboli or enter the pleural or peritoneal cavity by gravity. The development of cancer metastasis is based on penetration (invasion) into the vascular space, separation of a group of cancer cells from the primary mass, dissemination with localization at a new site, establishment at new site, and proliferation. This dissemination can be from vascular systems, gravity, or ameboid movement. Staging of metastasis can occur 3 different ways. One stage metastatic process is when carcinoma of the lung invades the pulmonary veins and mass dissemination. Two stage metastatic process is when the carcinoma of the liver which invades the hepatic veins to the vena cava and goes to the lung  then pulmonary veins the mass dissemination. Three stage metastasis is when the carcinoma of the colon to the hepatic portal vein to liver to hepatic veins to vena cava and goes to the lung and then to the pulmonary veins for mass dissemination. It is important to mention that the paths of metastasis are general, not all neoplasms behave like this. Metastasis to the striated muscle, duodenum and spleen is uncommon. Cancer cells distribute in many ways. First is hematogenous metastasis. This is the localization of the metastasis controlled by blood circulating factors, this could occur through branching or tissue and organ architecture. Hematogenous metastasis tends to occur first in the lung whenever the primary site is drained by veins which empty into vena cava. Tissue which has a venous drainage into the portal system metastasize to the lover first. There is also lymphatic spread as well which is more restricted in area, normal lymphatic pathways are utilized initially. Lymph nodes which normally drain the site of the primary cancer are first involved. Metastasis here occurs two ways one through tumor thrombi or tumor emboli. Sarcomas tend to metastasis early through blood vessels which carcinomas metastasize first through lymphatics then hematogenous dissemination. Tumor emboli that enter the systemic venous circulation will lodge in lungs, tumor emboli that enter the portal venous circulation will lodge in the liver, tumor emboli which enter the systemic arterial circulation may lodge in any part of the systemic capillary bed. 8. Discuss the etiology of cancer - Cancer is a malignant neoplasm. It is considered a state of imbalance in which the rate of growth of a particular tissue greatly exceeds maintenance requirements. Cancer is the most universal disease and in the United States 1 out of 6 deaths is the result of cancer and about 1 million new cases develop each year. Oncology is the branch of biology which is the study of neoplasia. Some general characteristics of cancer is that cancers don't rise de novo, meaning that they do not develop out of nothing, they usually arise from already abnormal cells. It can be a result of some chemical reaction which occurs within previously normal cells, the alteration leads to abnormal changed growth pattern. Cancer begins from a transformed single cell or small focus of cells. This is important to note because the curability depends upon the extent to which the cancer has spread. Some cancers will have already spread throughout the body before discovery. It is believed that the cause of cancer is due to a sequence of events, not something that occurs abruptly. Initiation is essentially the first step in which cells undergo a genetic mutation due to a carcinogen causing it to potentially become cancerous. Next is promotion which is when the initiated cells start to proliferate. Lastly, there is transformation in which cancerous cells acquire the ability to metastasize. We must examine the initiating cause of cancer, and they can be due to chemical carcinogens (smoking), physical carcinogens (trauma  and radiation), and biologic carcinogens (microorganisms especially viruses). There are 3 general initiating factors which are similar to the ones mentioned above and they are chemical carcinogens, radiation, and oncogenic viruses. Ultraviolet radiation, x-radiation, and gamma radiation are all carcinogenic and the effect is dependent on the dose, duration, and portion of the body exposed. Radiation produces localized breakdowns in DNA strands that cannot always be repaired, therefore introducing errors in transcription and translation. An example of radiation induced cancer is skin cancer. Next, we have viruses in relation to cancer. Both RNA and DNA have oncogenic potential. Tumor producing RNA viruses are known as retroviruses. Here the virus carries an enzyme, reverse transcriptase, that makes a copy of DNA complementary to virus RNA, this DNA then becomes inserted into the host genome. DNA oncogenic viruses are essentially when the viral genome is incorporated into the host cell genome and is expressed with it. The insertion of the viral genome occurs in only a few cells of an infected population. Genetic mutations are a predisposing factor for cancer development. For example, defective BRCA1 or BRCA2 are responsible for most familial breast and ovarian carcinomas. Lastly, chemical carcinogens. Many human cancers are known to be associated with exposure to carcinogenic chemicals in the workplace. Some examples include certain dyes, vinyl chloride, alkylating agents, and asbestos. Hormones can also be considered to be chemicals that initiate cancer. When speaking on cancer it is important to mention the cancer staging TNM system. In order for treatment to be effective one must determine the stage of the cancer. T describes the tumor, N describes the extent of lymph nodes metastasis, and M describes whether distant metastasis has occurred. The body does have an inflammatory response when it comes to cancer. More specific lymphocytes and monocytes respond to this. Cancer cells can undergo degeneration and that is because they need a blood flow, cannot live without nutrients, and need a blood supply. Without this they undergo degeneration and ischemic necrosis. Cancers do metastasize and spread. They can spread locally by progressive growth, invasion/destruction, and can even enter blood and lymphatic vascular channels. 9. Discuss various cancers discussed in class - Lung cancer also known as carcinoma of the lung is the most common malignant neoplasm that occurs in the entire respiratory system. It is the most common cause of death from cancer in the United States. Some types of lung cancer incluse NSCLC or non small cell lung cancer and SCLC, there are 5 other types however they are rare. The most common site of origin is the major bronchus, bronchogenic carcinoma and usually arise in the large or medium sized bronchi. The early symptom is a cough usually attributed to smoking. Prognosis for this carcinoma of the lung is about 1 in 15. Once the carcinoma is detected the  following diagnosis is followed, identification of cancer cells in the sputum, imaging, and bronchogenic examination. Sometimes the bronchogenic carcinoma arises in a very small bronchus near the periphery of the lung, when this occurs symptoms do not appear early, do not give characteristic imaging, do not discharge cells into the sputum, and are beyond the range of bronchoscope. Lung cancer often metastasizes to the bone and brain before the primary focus is found. Lung cancer is an occult neoplasm. Pneumonectomy, in which the complete removal of the affected lung is usually deemed ineffective since the cancer has already metastasized to pleura and is in the thoracic wall. Unfortunately carcinomas of the lung are resistant to radiation therapy. The marked vascularity of the lung leads to hematogenous metastasis, where it often invades the pulmonary artery and enters other places of the lung. It is one of the most widely metastasizing cancers and invades the brain, bone, adrenal glands, liver, and the opposite lung. It can eventually be in almost every organ. This leads to obstructed airways resulting in atelectasis which is a bacterial infection of the bronchus. Too much carcinoma leads to pulmonary insufficiency causing death from asphyxia, bronchopneumonia, and death by metastasis particularly the brain. Cancer of the prostate is said to be present in 6 in 10 men after the age of 65. This carcinoma of the prostate usually begins in the posterior lobe near the prostatic capsule. Obstructive symptoms are not seen early and by the time they do appear the cancer has spread to the seminal vesicles, bladder neck, and rectal wall. The most common site of metastasis is the bone, however it can metastasize to liver and bone marrow for instance. Radiologic studies often lead to immediate diagnosis since this cancer produces osteoplastic changes which is bone forming and osteolytic changes which is bone dissolving. The first symptoms of the carcinoma of the prostate is associated with metastasis include sciatic pain and back pain. Some treatments include castration which is the removal of testis, estrogen therapy, and adrenalectomy. 10. Discuss the characteristics of neoplasia - Neoplasia is abnormal uncontrolled growth of cells of tissues in the body. Neoplasia does not have an immediate exciting cause and it also has no regression. It can be characterized as atypical meaning it is undifferentiated, anaplastic, and pleomorphism. Neoplasia being anaplastic means that the cells divide quickly and have no resemblance to normal cells. They have varying degrees of disorganization and they tend to be delimited meaning they are singularly focused. They also exhibit heterotopia which is when mature tissue is found in an abnormal location. Neoplasia can be divided into benign neoplasm and malignant neoplasia.