Histo/Path Flashcards
______________ is an obstructive lung disease characterized by an FEV1/FVC ratio < 80%
Chronic bronchitis
Pathology reveals both mucus-secreting gland hypertrophy (as shown in the image) and hyperplasia, = ???
Chronic bronchitis
What is the Reid Index and what disease pathology is is ~w/?
Reid index, is the ratio of the thickness of the mucus gland layer to the thickness of the entire airway wall (from end of epithelium to the start of the cartilage).
The Reid index, which is normally 0.4, is increased in chronic bronchitis (>0.5). Chronic bronchitis is associated with smoking and is an obstructive lung disease.
WBC casts in the urine indicates what?
WBC casts in the urine indicates that this is acute pyelonephritis and not just a lower urinary tract infection (UTI).
acute phases of inflammation, is characterized by what ?
acute phases of inflammation, is characterized by a predominance of polymorphonuclear leukocytes
Using a statin drug can cause rhabdomyolysis. This can cause what kidney dysfunction?
acute tubular necrosis (ATN); all of the tubules are necrotic with sloughed pink epithelial cells and debris and loss of nuclear detail.
Symptoms of carcinoid syndrome include:
- Flushing of the skin
- Secretory (watery, voluminous) diarrhea
- Abdominal cramps with nausea and vomiting
- Wheezing, caused by bronchoconstriction and/or bronchospasm
- Tricuspid insufficiency or pulmonic valve stenosis (TIPS)
What receptors are spindle-shaped, encapsulated mechanoreceptors that are found in the soles of the feet and are responsible for transducing pressure.
Ruffini corpuscles
What receptors are responsible for conveying the sensation of light touch, are small encapsulated sensory receptors found just beneath the dermis of hairless skin, most prominently in the fingertips, soles of the feet, and lips.
Meissner corpuscles
Meissner corpuscles are involved in the reception of light discriminatory touch
What receptors are involved in the reception of light discriminatory touch
Meissner corpuscles are involved in the reception of light discriminatory touch
What receptors are nonencapsulated and found in all skin types (both hairy and hairless) and, along with Meissner corpuscles, are believed to be responsible for discriminatory touch.
Merkel nerve endings
Diabetic neuropathy can manifest as a loss of vibratory sense, a snesation that involves what sensory receptors?
pacinian corpuscles
What are causes of Eosinophilia? (5)
“NAACP”
- Neoplasm
- Asthma
- Allergy
- Collagen
- Parasites
What can be distinguished by their bi-lobate nuclei and multiple, large, eosinophilic (pinkish) granules containing histaminases and arylsulfatases.
Eosinophils
Peds that can present clinically with asymptomatic eosinophilia and mild symptoms such as fever, malaise, anorexia/weight loss, cough, wheezing, and skin rash. == ?
Toxocara canis
What cells are the macrophages of the liver?
Kupffer cells
What cells are the macrophages of the skin?
Langerhans cells
What cells are the macrophages of the CNS?
Microglia;
HIV encephalitis is an infection of microglia
S cells of the duodenum release ________, which increases pancreatic and biliary bicarbonate secretion and decreases gastric acid secretion.
secretin
S cells of the duodenum release secretin, which increases _______1_______ and decreases _____2_____
- pancreatic and biliary bicarbonate secretion
2. gastric acid secretion
Paneth cells are found in ___________ in the small intestine and release α-defensins (antibacterial and antifungal peptides) as well as lysozymes and tumor necrosis factor (TNF).
the crypts of Lieberkühn
Paneth cells are found in the crypts of Lieberkühn in the small intestine and release __________________ as well as lysozymes and tumor necrosis factor (TNF).
α-defensins (antibacterial and antifungal peptides)
β-Thalassemia, like iron deficiency anemia, is characterized by hypochromic microcytic RBCs. What cells would be been on the PBS?
target cells
What are the paraneoplastic syndromes associated with squamous cell carcinoma?
(2)
Hypercalcemia, from secretion of PTHRP (parathyroid hormone related peptide)
dermatomyositis
Patients with α-1 antitrypsin deficiency typically present in their 30s or 40s with: (3)
Panacinar emphysema (e.g. shortness of breath, wheezing, cough) Liver disease (e.g. coagulopathy, portal hypertension, encephalopathy) Skin disease (e.g. panniculitis)
Hypertrophy and hyperplasia of goblet cells = ?
Chronic bronchitis
histopathologic findings of increase type 2 pneumocytes = ?
Adenocarcinoma; (increases in Club/Clara cells also seen)
Adenocarcinoma of the lung is a malignant epithelial neoplasm with histologic glandular differentiation and/or mucin production.
Adenocarcinoma of the lung commonly stains positive for ???
thyroid-transcription factor 1.
Symptoms of ARDS include:
5
Symptoms of ARDS include:
- acute dyspnea
- cyanosis
- tachypnea
- wheezing
- rales and rhonchi
Kulchitsky cells = what cancer
Small Cell Lung Cancer
Kulchitsky cells are thought to be of a what cell origin?
Kulchitsky cells are thought to be of a neuroendocrine cell origin because immunohistochemistry shows positive staining for the following:
Chromogranin
Synaptophysin
CD57
Asthma occurs in what part of the respiratory tract?
Bronchi only; d/t hyperreactivity of airways
Eosinophilic, needle-like crystals may also be present in sputum or bronchial secretions of patients with asthma. What are these crystal called?
Charcot-Leyden crystals
What are Kulchitsky cells?
hyper-mitotic, hyper-chomatic cells witha round, oval or spindle shape and a granulat “salt and pepper” nuclear pattern.
~w/ small cell lung cancer
rare, systemic diease that involves the small intestine, joints, and CNS. Histology findings are enlarged foamy macrophages packed with both rod-shaped bacilli & PAS(+) , diastase-resistant granules.
Whipple disease
G-E unction incompetence & nocturnal cough in the absence of heartburn?
GERD
Histo: basal zone hyperplasia, elongation of lamina propria papillae, scattered eosinophils and neutrophils =?
GERD
HistoL solid nest of neoplastic cells with abundant eosinophilic cytoplasm & distinct borders; keratinization and presences of intercellular bridges?
Esophageal SCC; malignancy with poor Px.
atherosclerosis leading to diminished blood flow to intestine after meals = ?
Chronic mesenteric ischemia; pathogenesis is similar to Angina pectoris.
episodic, painful, non-propulsive esophageal smooth muscle contraction= ?
Diffused esophageal spasms
[AD] disorders of LDL receptor gene mutation = ?
Familial hypercholesterolemia. leads to accelerated atherosclerosis and early-onset coronary artery disease.
What is the MC GI disorder in pt. with Cystic Fibrosis?
Pancreatic insufficiency; steatorrhea, failure to thrive; ADEK deficiency
Recurrent sinopulmonary infections and bronchiectasis & Situs Inversus is d/t to what?
Parimary Ciliary Dyskinesia (Kartagener synd.); does NOT have absences of vas deferens. **CF ~ absence of vas deferens
What anatomical structure is classically ABSENT in Cystic Fibrous pt.?
Vas deferens
What is the normal role of NF-kB?
pro-inflammatory transcription factor
What disease is ~w/ mutations in NOD2 resulting in decrease activity of NF-kB protein?
Crohn disease
fever, malaise, anorexia, n/v, RUQ pain, dark-colored urine, acholic stool ==?
Acute HepA infection; liver biopsy shows spotty hepatocyte necrosis & inflammatory cell infiltration.
Toxic megacolon is a complication of what?
UC. seen on plain x-ray; S/Sx abdominal pain/distension, bloody diarrhea, fever, signs of shock.
What are the 2 most significant risk factors for dev. of esophageal SCC in the US?
- Smoking
- alcohol
* *N-nitroso containing foods in Asian countries
Ulcer in DISTAL duodenum, heartburn, diarrhea, elevated gastrin levels that rise in response to exogenous secretin administration = ?
Zollinger-ellison syndrome.
Action of secretin?
Secretin inhibits the release of gastrin from normal gastic G-cells
Elevated gastrin levels that rise in response to exogenous secretin administration = ?
Z-E synd.
regular use of what drugs can decrease adenomatous polyp formation?
asaprin; COX inhibition
what is a manifestation of chronic cholecystitis and is often associated with multi gallstones?
Porcelain gallbladder; d/t to dystrophic intramural deposition of Ca2+ salts. ~w/ increase risk of Adenocarcinoma of gallbladder.
Karyorrhexis: ?
fragmentation of pyknotic (condensed) nuclei during apoptoic cells death.
What enzyme deficiency results in early emphysema and liver cirrohosis?
Alpha-1-antitrypsin
What is the pathognomonic sign of acute tubular necrosis
Muddy Brown Casts
What type of nephrolithiasis is caused by primary hyperparathroidism?
hypercalciuria
What type of kidney stones are caused by crohn disease?
Hyperoxaluria
What type of kidney stones is caused by distal renal tubular acidosis?
hypocitraturia
what kind of kidney stone is caused by gout?
hyperuricosuria
when are waxy casts seen?
advanced renal disease (chronic renal failure)
COmplications of herditatary spherocytosis?
Pigmented gallstones; aplastic crisis from Parvo B19 infection
- increase MCHC
- Negative Coombs test
- Increase osmotic fragility on acidified glycerol lysis test.
???
Hereditary spherocytosis; classic sign are Spherocytes
Risk of Factor V Leiden mutation?
Hyperocoagulable state that predisposes DVTs; the mcc pulmonary emboli.
What disease will clinically present similar to acute osteomyelitis?
Ewing Sarcoma
Opcoclonus (non-rhythmic conjugate eye movement)-myoclonus is a paraneoplastic syndrome ~w/ what neoplasm?
Neuroblastoma; to to increase copies of the N-Myc. mc extracranial neoplasm in children.
aciteis and a larfe mass surrounding the small intestine, with uniform, round, medium-soized tumors cells with basophilic sytoplasm and high-mitotic index ==?
B-cell lymphoma; high mitotic-index ~ BURKITT’s Lymphoma.
Vacuoles in the gray matter with not inflammatory changes= ?
spongiform encephalopathy, prion diseases like CJD
On histo: cytoplasmic inclusion in oligodendrocytes =?
progressive multifocal leukoencephalopathy
On Histo: neurofibrillary tangles and neocortical plaques = ?
Alzheimer’s disease
Patches of white matter destruction = ?
MS; this is d/t demyelination.
pulmonary HTN in pt. with systemic sclerosis (CREST) is d/t to what?
damage of pulmonary arterioles –> restrictive lung diz labs
amyloid deposition in the myocardium causes ????
restrictive cardiomyoathy
what should you be thinking for a pt. who is under 50 years old, with numerous DVTs and has no other risk factors like drug use?
Inherited hypercoagulability like factor V leiden
What mediates paraneoplastic cachexia by suppressing appetite and increase basal metabolic rate?
TNF-alpha
what is the classic finding in the CSF of a pt. with subacute sclerosing panencephalitis?
oligoclonal bands of measles virus anti-bodies.
Neurological deficits in immunocompromised individual s with an infection from a double-stranded DNA polyomavirus?
progressive multifocal leukoencephalopathy.
increase muscle response with repetitive motor never stimulation (weakness improves as the day goes on)
Lambert-eaton syndrome; Ab. vs. PRE-synaptic Ca2+ channels
Ab. vs. POST-synaptic Ach-Receptors = ?
Myasthenia gravis; also highly ~w/ thymoma
women who recently gave birth, with low TSH, low free-T4, and low Hb == ?
Ischemic necrosis of pituitary gland leading to pan-hypopituitarism (Sheehand Synd.); d/t high estrogen levels during pregnancy and overgrowth of pit. gland without adequate growth of blood supply
H. pylori causing duodenal ulcers are typically found in the high concentration where?
prepyloric area of the gastric antrum; you don’t find H. pylori in the duodenum b/c they only colonize aresa of gastric metaplasia
mmmc of subunual splinter hemorrhages?
Microembolis from valvular vegetation of bacterial endocarditis (heart isseue)
squamous metaplasia of pancreatic ducts is most related to what vitamin deficiency?
Vitamin A, which maintains orderly differentiation of specialized epithelia. ~w/ CF pt.
what results from the failed obliteration of the vitelline (omphalomesenteric duct and presents with spontaneous but painless lower GI bleeding?
Meckels diverticulum
99m_pertechnetate localized ectopic gastric mucosa in what?
Meckels diverticulum
intestine that is fixed by fibroud adhesive bands that can cause obstruction and pain bilious emesis in the newborn is d/t failure of what?
failure of midgut rotation around the SMA
failure of hindgut descent along the inferior mesenteric a. results in what?
inperforate anus; does not bleed.
spontaneous but painless lower GI bleeding, colicky abd. pain, red currant jelly stools, potential lead point for intussusception ==?
Meckels diverticulum.
what is the result of estrogen replacement therapy without progesterone, in the breast, endometrium and vaginal tissue?
atrophy
what process is the result of prolonged glucocorticoid therapy in the adrenal glands?
Atrophy; d/t suppression of ATCH release.
FOOSH and fucked scaphoid bone leads to what?
a vascular necrosis
aside from skin cancer, what cancers have the highest incidence in women?
highest: breast > lung > colon cancer (same order for mortality rate)
Th1, IL-2, IFN-gamma together makes what?
non-caseating granulomas; **think sarcoidosis.
African American female with hilar adenopathy and pulmonary infiltrates…think?
Sarcoidosis mofo!!!
bronchial hyper-reactivity is a hallmark of what?
chronic asthma
interstitial infiltration of the lungs in a finding ~w/?
interstitial pneumonitis
intra-alveolar substance accumulation is a finding ~w/
alveolar proteinosis
pulmonary vascular obstruction is a finding in cases what?
PE and vasculopathy
Berry aneurysms of the circle of willis leading to SAH, in a young adult pt. is ~w/?
adult-type coarctation of the aorta. (type of AV-malformation)
Differnetial clubbing and cyanosis without BP or pulse disceprepancy are pathognomonic for what?
Large PDA complicated by Eisenmanger Synd (reversal of a Left-to-Right to Right-to-Left shunt.
Right-to-Left shunting in Pt. with large septal defects and ToF results in what S/Sx?
whole body cyanosis.
Chronic transmural inflammation and ECM degradation with in the wall of the aorta leads to what?
Abdominal aortic aneurysm.
versus an intimal tear in the aortic wall, which is the primary event causing aortic dissection
Malignant endothelial proliferation is characteristic of what?
Angiosarcoma, neoplasm that arise from blood or lymphatic vessels in the SubQ tissue that most commonly involves the scalp or face.
Avsa vasorum endateritis = ?
“endarteritis obliterans”; mechanism by which tertiary syphilis causes thoracic aortic aneurysm
on Histo: what is a benign-appearing cellular or myxois stroma that encicles epithelium-lined granular and cystic spaces?
Fibroadenoma; ~w/ youn women (15-35); nodules that are well-demarcted, painless, mobile, and spherical, 1-10cm in size.
what process reduces cellular capacity for ATP generation and is ~w/ irreversible injury?
Mitochronical vacuolization (not ~w/ changes in creatine kinase.
What process occurs secondary to ROS damage, mitochondrial damage, and inflammation?
Reperfusion injury; leads to cell membrane damage.
Why are reticulocytes blue on W-G stain?
bluish cytoplasm and reticular precpitates of residual RIBOSOMAL RNA
What is synthized by cells in response to a VIRAL infection, and what are its actions?
Type 1 interferons (Alpha, Beta interferons);
they suppress viral replication by stopping protein synthesis and promoting apoptosis of infected cells, limiting viral spread.
The interferons bind to receptors, which results in transcription of anti-viral enzymes (RNase L, protein kindase R); these proteins are ONLY active in presence of dsDNA.
____________ are a result of rupture of the middle meningeal a. in the setting of head trauma?
Epidural hematoma. ex: skull fracture at the pterion.
Are subarchnoid hemorrhage a consequences of bleeding vascular malformations?
NO! SAH d/t ruptures saccular aneurysms.
enlarged, hypercellular glomeruli on LM = ?
PSGN
“lumby-bumby granular deposits of IgG and C3 on IM = ?
PSGN
electron-dense deposits on the epithelial side of the basal membrane on EM = ?
PSGN
Linear IgG and C3 deposits on IM = ?
Goodpasture syndrome.(anti-GBM)
Glomerular basement membrane (GBM) disruptions and fibrin deposition on EM = ?
Goodpasture syndrome (anti-GBM)
uniform, diffuses thickening of glomerular capillary walls on LM = ?
Membranous glomerulopathy
In kidneys, basement membrane splitting is seen in ?
membranoprolifertive glomerulonephritis (MPGN) and Alport syndrome
What is seen on histo of the brain in a pt. with HIV-assoc. dementia?
microglial nodules; group of microgial/macrophage that form multinuc. giant cells.
overexpression of antiapoptotic BCL2 = ?
t(14;18) translocation = follicular lymphoma; generalized Lymphadenopathy and tends to affect elderly.
BRC-ABL rearrangement is found in CML, leads to what at the molecular level?
increase tyrosine kinase activity
What is c-Myc?
oncogene; ~w/ Burkitt lymphoma, starry sky, EBV,
What does basal cell carcinoma look like on histo?
nest of basaloid cells and peripheral palisading of nuclei.
gastrinomas, prolactin, visual defects, hypercalcemia = ?
MEN1; primary hyperparathyroidism, pit. tumors. pancreatic tumors.
Pheo - what MEN?
MEN2A and MEN2B
Parathyoid hyperplasia is what MEN?
MEN2A
Mucosal neuromas/marfanoid habitus = what MEN?
MEN2B
Issues with calcitonin on biopsy of a mass = what MEN?
Medullary thyroid cancer = MEN2A and MEN2B
defect in purine catabolism = ?
Lesch-Nyhand syndrome
grayish-white, “Fishy-smelling”, pruritis vaginal discharge, NO inflammation, Clue Cells, wet-mount ==?
bacterial vaginosis, gardnerella vaginalis; Tx with metro or clindamycin
wet mount with epithelial cells and rare leukocytes = ?
normal vaginal discharge (leukorrhea)
wet-mount with leukocytes and pear-shpaed organisms = ?
Trichomonas vaginitis
Clue Cells, positive whiff test (amine odor with KOH) == ?
Gardnerella vaginalis
What microbe is strongly ~w/ anal and cervical Sq. Cell Carcinoma
HPV 16/18; HIV infection increase prevalence of HPV infection.
What is the key heme-lab finding in Herd. Spherocytosis?
increase MCHC d/t mild dehydroation of RBCs. Also, elevated LDH, recticulocytosis, and decrease haptoglobin.
Normocyctic!
what is one blood smear in splenectomy pt. and in sideroblastic anemia?
howell-jolly bodies
What is haptoglobin and what does its levels indicate?
Haptoglobin is an acute phase reactant that combines with free Hb in the circulation to preserve body irons stores and prevent tissue damage.
Haptoglobin levels decrease in any form of hemolytic anemia!
Single, painless ulcers at inoculation site with heaped up borders and CLEAN base == ?
primary Syphillis
Acidosis in the body stims renal ammoniagenesis, which is what?
process by which renal tubular epithelial cells metabolize Glutamine to glutaMATE; generates ammonuim that is excreted in urine and bicarb that is absorbed into blood.
sub-epithelial depoition of ICs, which leads to damage to capillary wall leading to proteinuria; spike and dome pattern and granular deposits of IgG and/or C3 ==?
Membranous Nephropathy
“tram-track” appearance of basement membrane on PAS or H-E stain = ?
MPGN; IC deposition in the GBM.
Tram-Track appearance due to GBM splitting = ?
Type-1 MPGN
Dense intramembranous deposits = ?
Type-2 MPGN
“Spike and Dome” on EM =?
membranous nephropathy; Spike = basement membrane material; Domes = IC deposits
Cells with increased intracytoplasmic mucin = ?
Adenocarcinoma of the lungs
Lungs: Epithelial cells without keratin pearls or glands
Large cell carcinoma of the lung
Kulchitsky cells: ?
Small cell carcinoma; Kulchitsky cells are of neuro-endo origins, (positive for chromogranin, synaptophysin, and CD57).
Intercellular bridges ~ ?
Squamous cell carcinoma
Tissue that stains positive for chromogranin: ?
Carcinoid tumors; neuroendocrine cell origin (positive for chromogranin, synaptophysin, and CD57).
On histological examination, they appear as neatly arranged cells in a trabecular pattern surrounded by a fibrovascular stroma.
Pleural plaques and interstitial lung disease = ?
Mesothelioma
Widespread destruction of type I and II pneumocytes = ?
ARDS
LUNGS: Permanent dilation of bronchi
Bronchiectasis; recurrent cycles of infection/inflammation leading to fibrosis and remodeling.
LUNGS: Hypertrophy and hyperplasia of goblet cells: ?
Chronic bronchitis is a clinical condition related to COPD
LUNGS: Increased vascular hydrostatic pressure: ?
pleural effusion is a collection of fluid between the parietal and visceral pleura.
LUNGS: One-way valve formed by the pleura: ?
pneumothorax
LUNGS: Slow, Progressive nodular fibrosis: ?
Silicosis
LUNGS: Inactivation of the BMPR2 gene: ?
Primary pulmonary hypertension is caused by an inactivating mutation in the BMPR2 gene.
Alveolar wall destruction ~ ?
emphysema; d/t protease-antiprotease hypothesis
What is an adverse outcome of Sq, cell lung cancer that has to do with PTH-rP?
PTH-rP functions like PTH, increases osteoCLAST reaborption of bone, leading to osteopenia and elevated Ca2+ levels.
What type of lung cancers arises peripherally?
Large Cell Lung Cancer, more common in males.
Histo: undifferentiated cells with vesicular nuclei, prominent nucleoli, and abundant eosinophilic cytoplasm arranged in sheets without distinct architectural features.
undifferentiated tumor of pleomorphic cells found in lungs= ?
Large Cell Lung Cancers; typ presents as large necrotic peripheral masses. Can secrete B-hCG
