Cellular Adaptation & Proliferation

1. Cellular Adaptation & Proliferation OR WHY GOOD CELLS GO BAD!

2. Adaptation • Define and describe the different types of cellular adaptation? • Describe the mechanisms of cellular injury for: • Hypoxia • Free radicals • Inflammatory responses • Nutritional imbalances • Physical trauma

3. Necrosis • Define necrosis and describe the difference between necrosis and apoptosis • Provide examples of the cellular changes that support the two general theories of aging • Characterize somatic death and its manifestations.

4. Critical thinking • Can a dental hygienist observe that his or her patient has been persistently biting his or her cheek?

5. Critical thinking • Why are the neurons of the Central Nervous System (CNS) on of the first tissues to demonstrate the effects of systemic hypoxic condiditons?

6. During ischemia, what effect does the loss of adenosine triphosphate (ATP) level have on cells? • A. Cells shrink because of the influx of Ca. • B. Cells shrink because of the influx of KCl. • C. Cells swell because of the influx of NaCl. • D. Cells swell because of the influx of nitric oxide (NO)

7. Critical thinking • Can a crime scene investigation (CSI) team determine the location of an assailant to the victim based on entrance wound characteristics?

8. How does carbon monoxide cause tissue damage? • A. By competing with carbon dioxide so that it cannot be excreted. • B. By binding to hemoglobin so that it cannot carry oxygen. • C. By destroying the chemical bonds of hemoglobin so it cannot carry oxygen. • D. By removing iron from hemoglobin so it cannot carry oxygen.

9. Critical thinking • Is a nutritional deficiency the only form of nutritional imbalance?

10. What is the leading cause of injury to and death of patients? • A. Motor vehicle and airplane accidents. • B. Fires and burns. • C. Drug or alcohol-related accidents • D. Medical errors

11. Critical thinking • Explain how a deep sea diver develops decompressions sickness (“the bends”).

12. What organs are affected by the type of necrosis that results from hypoxia caused by severe ischemia or caused by chemical injury? • A. Lungs and pulmonary vessels. • B. Brain and spinal cord. • C. Kidneys and heart. • D. Muscles and bones.

13. Critical thinking • How does a medical laboratory practitioner provide laboratory evidence to a physician that cellular injury is taking place?

14. When the heart’s workload increases, what changes occur to the myocardial cells? • A. They divide. • B. They increase in size. • C. They increase in number. • D. They undergo metaplasia

15. Critical thinking • Ms. Jones has an annual Pap smear and gynecologic examination. Three years ago, immediately before her third pregnancy, the pathology report of her Pap smear indicated she had hormonal hyperplasia. Her current Pap smear indicates she has atypical hyperplasia or dysphasia. What is the difference between these two conditions and what does that mean to Ms. Jones

16. What is the single most common cause of cellular injury? • A. Hypoxic injury • B. Chemical injury • C. Infectious injury • D. Genetic injury

17. Critical thinking • Mr. Smith is diagnosed with a cerebral embolus (stroke). Explain how hypoxia causes the intracellular ion balance to change.

18. Which cell component is the most vulnerable target of radiation? • A. Plasma membrane • B. Mitochondria • C. Deoxyribonucleic acid (DNA) • D. Golgi body

19. Critical thinking • A victim of poisoning presents with a cherry-red appearance. How would you determine what type of poisoning this victim has?

20. Which is a description of the characteristics of apoptosis? • A. Programmed cell death of scattered, single cells. • B. Characterized by swelling of the nucleus and cytoplasm. • C. Has unpredictable patterns of cell death. • D. Results in benign malignancies.

21. Critical thinking • Mr. Young has been smoking one pack of cigarettes per day for 20 years. Describe the possible cellular changes that have occurred in his bronchial linings that can make him more prone to upper respiratory infections.

22. Critical thinking • Explain changes that occur in a body during the first 48 hours after death.

23. Biology of Cancer • Describe how neoplastic cellular growth differs from cellular adaptation. • Define and describe carcinoma in situ (CIS). • Define and relate angiogenesis t cancer growth. • Relate chronic inflammation to cancer cell development.

24. Biology of Cancer • Describe the mechanisms of cancer development for: • Helicobacter pylori • Tobacco use • Physical activity • Nutritional balance • Sexual and reproductive behavior • Ultraviolet radiation • Alcohol consumption

25. Critical thinking • A neighbor is diagnosed with hepatocellular adenoma. Obviously, he is concerned about his newly diagnosed condition. He would like to know more about his condition. What type of cell is involved? Is it benign or malignant? What are the characteristics of benign versus malignant tumors?

26. Carcinoma refers to abnormal cell proliferation originating from which tissue origin? • A. Blood vessels • B. Epithelium cells • C. Connective tissue • D. Glandular tissue

27. Critical thinking • Three patients are diagnosed with different types of cancer. One patient is a life-long smoker and has lung cancer, one has active Crohn disease and has colorectal cancer, and the other is a farmer with newly diagnosed melanoma. Other than the obvious thing, cancer, what do these individuals have in common?

28. What are tumor cell markers? • A. Hormones, enzymes, antigens, and antibodies produced by cancer cells. • B. Receptor sites on tumor cells that can be identified and marked. • C. Cytokines produced against cancer cells. • D. Identification marks used in administering radiation therapy.

29. Critical thinking • Is the prostate-specific antigen (PSA) an ideal tumor cell marker?

30. What is autocrine stimulation? • A. The ability of cancer cells to stimulate angiogenesis to create their own blood supply. • B. The ability of cancer cells to stimulate secretions that turn off normal growth inhibitors. • C. The ability of cancer cells to secrete growth factors that stimulate their own growth. • D. The ability of cancer cells to divert nutrients away from normal tissue for their own use.

31. Critical thinking • How can bladder and pancreatic cancer be linked to smoking? Is not lung cancer the only cancer linked to smoking?

32. What are oncogenes? • A. Genes that have undergone mutation that direct the synthesis of protein to accelerate the rate of tissue proliferation. • B. Genes that direct synthesis of proteins to regulate growth and provide necessary replacement of tissue. • C. Genes that encode proteins that negatively regulate the synthesis of proteins to show or halt replacement of tissue. • D. Genes that have undergone mutation to direct malignant tissue toward blood vessels and lymph nodes for metastasis.

33. Critical thinking • A patient is being given a treatment regimen consisting of a monoclonal vascular endothelial growth factor (VEGF) inhibitor. What is the treatment trying to accomplish?

34. Why are two “hits” required to inactivate tumor suppressor genes? • A. Because each allele must be altered and each person has two copies, or alleles, of each gene, one from each parent. • B. Because the first “hit” stops tissue growth and the second “hit” is needed to cause abnormal tissue growth. • C. Because they are larger than proto-oncogenes requiring two “hits” to effect carcinogenesis. • D. Because the first “hit” is insufficient to cause sufficient damage to cause a mutation.

35. Critical thinking • The history of the atomic bombs use in Hiroshima and Nagasaki demonstrated increased frequencies of leukemias, thyroid cancer, breast carcinomas, and other tumors. Offspring of the atomic bomb survivors did not have an increased risk of malformations and cancer. What does this information tell us about the affect on the somatic or germline cells?

36. Normally, which cells are “immortal” (never die)? • A. None, all cells eventually die. • B. Stem cells and germ cells. • C. Blood cells. • D. Epithelial cells.

37. Critical thinking • Mr. Benson, 60 years old, lives near phosphate and uranium deposits. His father was a uranium miner. Mr. Benson has worked in a phosphate processing plant since his early twenties (phosphate ore is combined with low-grade uranium and emits constant low alpha-radiation). He is a pack-a-day smoker and drinks alcohol moderately. He describes himself as a “meat and potatoes man” and likes to barbeque. Explain the contributing factors for Mr. Benson developing lung tumor.

38. Which cancers are associated with chronic inflammation? • A. Skin, lung, and pancreatic • B. Colon, liver, and lung • C. Bone, blood cells, and pancreatic • D. Bladder, skin, and kidney

39. Critical thinking • Present an argument for why one 60 year old individual develops cancer and another 60 year old with identical promoters does not develop cancer.

40. How does chronic inflammation cause cancer? • A. By vasodilation and increased permeability that alter cellular response to DNA damage. • B. By liberating lysosomal enzymes when cells are damaged, which initiates mutations. • C. By releasing compounds such as reactive oxygen species that promote mutations. • D. By increasing the abundance of leukotrienes that are associated with some cancers.

41. Inherited mutations that predispose to cancer are almost invariably what kind of gene? • A. Proto-oncogenes • B. Oncogenes • C. Tumor suppressor genes • D. Growth promoting genes

42. Resources • Classroom Quiz on the Cell • http://publications.nigms.nih.gov/classroom/quiz/ • Breast Cancer Risk Tool • http://www.cancer.gov/bcrisktool/