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Skin, Blood, Lymph > Exam 1 Pathology > Flashcards

Exam 1 Pathology Flashcards

1
Q

Layers of the Epidermis

A

Stratum… Corneum, Lucidum, Granulosum, Spinosum, Basale

Come, Let’s Get Sun Burned

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2
Q

Acanthosis vs papillomatosis

A

acanthosis: epidermal hyperplasia
papillomatosis: dermal papilla enlargement and hyperplasia

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3
Q

Lentigo

A

flat lesion

melanocyte hyperplasia

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4
Q

suborrheic keratoses

A

Flat, greasy, pigmented squamous epithelial proliferation
Benign tumor in older patients

Leser-Trelat sign: rapid onset of multiple keratoses may indicates possible malignancy (GI adenocarcinoma)

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5
Q

acanthosis nigricans

A

80% benign: diabetes, pitutary/pineal tumor

20% associated with malignacy (GI adenocarcinoma)

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6
Q

Acrochordon

A

skin tag

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7
Q

actinic keratosis

A

Premalignant skin lesion associated with sun exposure
rough brown plaques
may be horn like

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8
Q

benign fibrous histiocytoma (dermatofibroma)

A

painless scar-like lesion leftover from trauma

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9
Q

dermatofibrosarcoma protuberans

A

overexpression of PDGF-B (platelet derived growth factor)

translocation of COL1A1 (collagen) onto the PDGF gene causes upregulation

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10
Q

wheals

A

hives, aka uticaria

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11
Q

Eczema

A

atopic dermatitis

allergic skin contact

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12
Q

Erythema multiforme

A

hypersensitivity in response to infections (mycoplasma, HSV) or drugs (sulfa drugs, B-lactams, phenytoin)
Target lesions

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13
Q

Psoriasis

A

silver scaly lesions, nail pitting

+ Auspitz sign → bleed when picked

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14
Q

Seborrheic dermatitis

A

occurs in areas rich with sebaceous glands, (scalp, face, periocular, ear)
possibly caused by fungus called Malassezia.
correlated with Parkinsons and HIV

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15
Q

Lichen Planus

A

Pruritic, Purple, Polygonal, Planar Papules, and plaques
with Wickham striae and sawtooth pattern at the dermal-epidermal junction
resolve spontaneously

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16
Q

Pemphigus

A 
IgG autoantibodies against desmoglein
flaccid blisters (subcorneal or suprabasal)
type 2 hypersensitivity disorder
potentially fatal
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17
Q

Bullous pemphigoid

A 
IgG autoantibodies against hemidesmosomes (epidermal basement membrane)
tense blisters (subepidermal)
type 2 hypersensitivity
less severe than pemphigus
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18
Q

Dermatitis herpetiformis

A

IgA deposits
grouped pruritic blisters
associated with celiacs disease

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19
Q

Epidermolysis bullosa

A

defects in structural proteins

↑ blisters, trauma, rubbing

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20
Q

Porphyria cutana tarda

A

blistering in response to sunlight

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21
Q

Red marrow

A

hematopioetic

axial skeleton, hands and feet

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22
Q

yellow marrow

A

fat

long bones

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23
Q

Normal WBC ranges

A

5,000-10,000

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24
Q

Normal granuloocyte ranges

A

40-70%

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25
Q

Normal RBC ranges

A

3,500,000 - 5,000,000 (higher in men)

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26
Q

Normal platelet ranges

A

150,000 - 450,000

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27
Q

Most numerous white blood cell

A

neutrophil (40-80%)

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28
Q

Leukemia

A

Bone marrow cancer of WBCs causes…
marrow failure
↓ RBCs and mature WBCs
infections
hemorrhage (↓ platelets)
presents with circulating malignant WBCs
Metastasis to liver, spleen, lymph nodes, and skin possible

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29
Q

Acute Lymphoblastic leukemia/lymphoma (ALL)

A 
Lymphoid neoplasm
Children
TdT+ (pre-T and pre-B cells)
CD10+ (pre-B cells)
t(12;21) → better prognosis
May spread to CNS and testis
T-cell ALL can present with mediastinal mass
associated with Down Syndrome
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30
Q

Chonic lymphocytic leukemia/small lymphocytic lymphoma

A 
lymphoid neoplasm (B-cell)
age > 60
most common adult leukemia
CD20+
CD23+
CD5+
smudge cells in peripheral blood smear
CLL (crushed little lymphocytes)
autoimmune hemolytic anemia
Richter transformation → CLL/SLL can transform into an aggressive lymphoma, diffuse large B-cell lymphoma
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31
Q

TdT+

CD10+

A

ALL

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32
Q

CD20+
CD23+
CD5+

A

CLL/SLL

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33
Q

Richter transformation

A

CLL/SLL

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34
Q

smudge cells

A

CLL/SLL

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35
Q

Hairy cell leukemia

A

Lymphoid neoplasm
adult males
mature B-cell tumor
cells have filamentous hair-like projections
marrow fibrosis → massive splenomegaly and pancytopenia
TRAP+ stain
BRAF mutations

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36
Q

Acute myelogenous leukemia

A

Myeloid neoplasm
age ~ 65
Auer rods
↑↑↑ circulating myeloblasts on peripheral smear
Can arise of pre-existing myelodysplastic syndromes
exhibit anemia, neutropenia, thrombocytopenia

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37
Q

Chronic myelogenous leukemia

A 
myeloid neoplasm
age 45-85 
Philadelphia chromosome (t[9;22], BCR-ABL)
splenomegaly
low LAP
38
Q

Hodgkin vs NH lymphomas

A

Both present with low grade fever, night sweats, weight loss

Hodgkin:
better prognosis
localized group of nodes
Reed sternberg cells
EBV

NHL:
multiple lymph nodes, extranodal involvement
majority are B-cells
Autoimmune disease and EBV, HIV, HTLV
frequently involve waldeyer ring and mesenteric nodes

39
Q

Hodgkin lymphomas and its subtypes

A

Reed sternberg cells (binucleate, owl eye cells that are CD15+ and CD30+)
subtypes:
Nodular sclerosis → most common
Lymphocyte rich → best prognosis
Mixed cellularity → eosinophilia, seen in the immunocompromised (EBV)
Lymphocyte depleted → seen in the immunocompromised (EBV)

40
Q

Burkitt lymphoma

A

NHL
CHILDREN OR YOUNG ADULTS (all other NHL are adults)
t(8;14) translocation of c-MYC(8) and heavy chain Ig (14)
Starry sky appearance with interspersed tingible body macrophages
jaw lesions in Africa
pelvis or abdomen in sporadic form

41
Q

Diffuse large B-cell lymphoma

A

NHL (most common one)
older adults (80%), children (20%)
BCL-2 and BCL-6 alterations

42
Q

Follicular lymphoma

A

NHL
adults
t(14;18) translocation of heavy chain Ig (14) and BCL-2 (18)
painless waxing and waning lymphadenopathy

43
Q

Mantle cell lymphoma

A

NHL
Adult males (MANtle)
t(11;14) translocation of cyclin D1 (11) and heavy chain Ig (14)
CD5+
very aggressive, patients present in late stages

44
Q

Marginal cell lymphoma

A

NHL
adults
t(11;18) translocation of cyclin D1 (11) and BCL-2 (18)
associated with chronic inflammation (sjogrens, chronic gastritis)

45
Q

Primary central nervous system lymphoma

A 
NHL
adults
associated with HIV/EBV
considered AIDs defining illness
ring enhancing mass lesion on MRI of brain
46
Q

Adult T-cell lymphoma

A 
NHL of T-cells
adults
caused by HTLV (associated with IV drug abuse)
present with cutaneous lesions
common in Japan, Africa, and caribbean
47
Q

Mycosis fungoides

A

NHL of T-cells
Adults
skin patches and plaques characterized by atypical CD4+ cells with cerebriform nuclei and intraepidermal neoplastic cell aggregates (Pautrier microabcesses)
may progress to Sezary syndrome (T-cell leukemia)

48
Q

Sezary syndrome

A

T-cell leukemia

associated with mycosis fungoides

49
Q

t(8;14)

A

Burkitt lymphoma (burk-8)

50
Q

t(11;14)

A

mantle cell lymphoma

51
Q

t(11;18)

A

marginal zone lymphoma

52
Q

t(14;18)

A

follicular lymphoma

53
Q

t(15;17)

A

APL (M3 type AML)

54
Q

t(9;22)

A

Philadelphia chromosome

CML

55
Q

Multiple myeloma

A 
Plasma cell cancer in marrow
produces large amounts of IgG or IgA
↑ susceptibility to infection
Punched-out lytic bone lesions 
hypercalcemia and renal failure
Ig light chains in urine (Bence jones protein)
M spike on electrophoresis
Rouleaux formation (RBC's stacked like poker chips)
56
Q

Hypercalcemia
Renal failure
anemia
bone lytic lesions / back pain

A

Multiple myeloma

57
Q

M spike on electrophoresis

A

multiple myeloma

58
Q

Rouleaux formation

A

mutliple myeloma (RBCs stack up like poker chips)

59
Q

Elevated serum Ig and Bence Jones protein in urine

A

multiple myeloma

60
Q

monoclonal gammopathy of undetermined significance

A

Monoclonal expansion of plasma cells which may progress to multiple myeloma
asymptomatic and no other findings

61
Q

Waldenstrom macroglobulinemia

A 
hyperviscosity syndrome (blurred vision, Reynaud's)
differentiate from multiple myeloma, no CRAB findings
62
Q

myelodysplastic syndromes

A

Disorders involving ineffective hematopoiesis
Risk of transforming into AML
Refractory anemias…. (RA, RARS, RAEB…)

63
Q

Polycythemia Vera

A 
↑ in all Blood cell types, but RBCs in particular
intense pruritus
red-blue cyanosis 
DVT, stroke
↓ in EPO
64
Q

Essential thrombocythemia

A

↑↑ in platelets and megakaryocytes

thrombosis

65
Q

myelofibrosis

A

obliteration of bone marrow with fibrosis from non-neoplastic fibroblasts
massive splenomegaly
teardrop RBCs

66
Q

Langerhans cell histiocytosis

A

Group of proliferative disorders
S-100 and CD1a + cells
Birbeck granules (tennis racket)
Presents in children as bony lytic lesions, with rash and recurrent otitis media

67
Q

Birbeck granules

A

Langerhan cell histiocytosis

68
Q

S-100 and CD1a +

A

Langerhan cell histiocytosis

69
Q

Intravascular hemolysis vs Extravascular hemolysis

A

Intravascular → RBC destroyed in circulation
Extravascular → RBC destroyed in spleen or liver

intra → ↓haptoglobin, hemoglobinemia/uria
extra → spherocytes, splenomegaly

70
Q

Hereditary spherocytosis

A 
Intrinsic, extravascular anemia
AD
sphere-shaped RBCs eliminated in spleen
splenomegaly
↑ MCHC (mean cell hemoglobin conc)
↓ MCV
Many patients asymptomatic
aplastic crisis can occur if infected with Parvovirus
71
Q

G6PD deficiency

A

↑ RBC susceptibility to oxidant stress (infections, drugs, fava beans)
RBCs with Heinz bodies and bite cells

72
Q

Hemoglobin C disease

A

Similar to Sickle Cell, but milder, confers same resistance to malaria
Distinctive Crystalline bars in RBCs
causes extravascular hemolysis

73
Q

α-thalassemia

A 
Microcytic, hypochromic anemia
defect in α chain of hemoblobin
gene deletion (vs ß which is due to point mutation)

(αα/α-) → minima (silent carrier)
(α-/α- ;trans) or (αα,– ;cis) → minor (mild anemia)
(–/-α) Hemoglobin H disease (moderate to severe anemia)
(–/–) Hemoglobin Barts disease (hydrops fetalis)

74
Q

ß-thalassemia

A

Microcytic, hypochromic anemia
point mutation ↓ ß-globin synthesis

Heterozygote → minor (usually asymptomatic, ↑HbA)
Homozygote → major (severe anemia require transfusions, “Crew-cut” marrow expansion on skull x-ray)

75
Q

Paroxysmal nocturnal hemoglobinuria

A

hemolytic anemia
Acquired mutation of PIGA

at risk for thrombosis and leukemia

76
Q

Autoimmune hemolytic anemia

A

Warm (IgG) - chronic anemia seen in SLE, CLL, and certain drugs
Cold (IgM) - acute/chronic anemia triggered by cold seen in CLL, M. pneumoniae, Mononucleosis, painful blue fingers and toes

Both are Coombs +

77
Q

Direct vs Indirect Coombs test

A

Direct → Pt RBCs

Indirect → Pt serum

78
Q

Microangiopathic anemia

A

RBCs damaged when passing through obstructd or narrowed vessel
Schistocytes (helmet cells) on blood smear

79
Q

megaloblastic anemia

A

Impaired DNA synthesis

includes: folate deficiency, Vit B12 deficiency, orotic aciduria

80
Q

Vit B12 defic

A

causes megaloblastic anemia with neurologic symptoms

↑ homocysteine, methylmalonic acid

81
Q

Pernicious anemia

A

megaloblastic anemia caused by autoimmune gastritis that impairs intrinsic factor production → vit B12 deficiency

82
Q

Folate deficiency

A

megaloblastic anemia with no neurologic symptoms

↑ homocysteine

83
Q

Iron deficiency

A 
Microcytic, hypochromic anemia
↓ iron
↓ ferritin (iron stores)
↑ TIBC (total iron binding capacity)
↑ RDW (red cell distribution width)
84
Q

Anemia of chronic disease

A 
Normocytic anemia
Chronic infection
Chronic autoimmune disease
Cancer
iron is not released from tissue to be used, nor absorbed in the gut

↓ iron
↓ TIBC
↑ ferritin

85
Q

Aplastic anemia

A 
Normocytic anemia
destruction or failure of hematopoietic cells due to...
Drugs
Virus (EBV, HIV, hepatitis)
Fanconi syn
Idiopathic (65%)

hypocellular marrow

86
Q

Coagulation cascade

A

Intrinsic pathway: Factor 12, 11, 9, (10)
Extrinsic pathway: Factor 7
Common pathway: Factor 10, 13

87
Q

PTT vs PT

A

PTT → intrinsic and common (monitors heparin)

PT → extrinsic and common (monitors coumadin)

88
Q

Thrombotic thrombocytopenic purpura and hemolytic uremic syndrome

A

Triad of thrombocytopenia, hemolytic anemia, and AKI
TTP → addition of neuro symptoms and fever
HUS → addition of bloody diarrhea

TTP → ↓ADAMTTS13
HUS → E.Coli (EHEC)

89
Q

Bernard-Soulier syndrome

A

Platelet disorder, defect in adhesion

90
Q

Glanzmann thrombasthenia

A

Platelet disorder, defect in aggregation

91
Q

von Willebrand disease

A

Intrinsic pathway defect (↑ PTT)
Platelet plug formation defect
Ristocetin assay will cause no platelet aggregation

Skin, Blood, Lymph (2 decks)

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