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Labs-Findings 1 Flashcards

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1
Q
A
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1
Q

Fetal ultrasound screening reveals unilateral fetal hydronephrosis

A

Obstruction of URETEROPELVIC JUNCTION (inadequate recanalization of this junction between kidney and ureter)

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2
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Ovaries infiltrated with fibrous tissue, fail to produce estrogen

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“Streak ovaries” found in Turner syndrome (45 XO) fail to produce estrogen leading to primary ovarian failure in addition to short stature, broad chest, webbed neck_

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3
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DIFFUSE BALLONING DEGENERATION (hepatocyte swelling), mononuclear cell infiltrates, councilman bodies (APOPTOSIS - eosinophilic apoptotic hepatocytes)

A

Histological findings always found in ACUTE VIRAL HEPATITIS

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4
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Fibrinoid necrosis

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Histologic pattern of injury seen in walls of blood vessels affected by immune complex and vasculitis

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5
Q

Polymorphonuclear cells are present in stool

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Inflammatory etiology -> Shigella, EHEC, EIEC, C. difficile, C. jejuni

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6
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Subperiosteal resporption with cystic degeneration of cortical, compact bone, appendicular skeleton (pectoral girdle, pelvic girdle, limbs)

A

Hyperparathyroidism,

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7
Q

“Salt-and-pepper” appearance of skull with thinning of subperiosteal erosions in medial side of second and third phalanges of hand)

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Hyperparathyroidsism

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8
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Radiological finding of Granular, “salt-and-pepper” appearance of calvarieae

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Primary hyperparathyroidism (Calvaria - upper domelike protion of skull, SYN skullcap)

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9
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Persistence of primary, unmineralized spongiosa in medullary canals

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Osteopetrosis (marble bone disease) normally, bone marrow replaces primary spongiosa

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10
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Osteoid matrix accumulation around trabeculae (Excessive unmineralized osteoid and widened osteoid seams)

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Vitamin D deficiency - low bone mineral density

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11
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Trabecular thinning with fewer interconnections

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Osteoporosis (total bone mass decreased, normal bone architecture disrupted)

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12
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Mosaic pattern of lamellar bone with irregular sections of lamellar bone linked by cement lines

A

Paget’s disease - (cement lines represent previous areas of bone resportion)

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13
Q

Low serum levels of C1 esterase inhibitor is diagnostic for this condition

A

Hereditary angioedema, an inherited AD condition causing episodes of painless, non-pitting, well-circumscribed edema.

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14
Q

Sodium cyanide is added to urine, followed by nitroprusside solution, urine becomes red-purple in color.

A

Sodium cyanide-nitroprusside test detects cystine’s sulfhydryl groups, diagnositc for Cystinuria

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15
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Urinalysis shows hexagonal cystine crystals

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Pathognomonic for Cystinuria, renal proximal defect in reabsorption of cystine

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16
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Elevated immunoglobulin G (IgG) levels in CSF

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Oligoclonal band on electrophoresis suggests activation of B cells in MS. Waxing and waning neurological deficits in a 20-30 year old patient suggestive of MS.

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17
Q

Granulomatous inflammation of the media

A

Takayasu arteritis (aortic arch) and Giant cell arteritis

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18
Q

Segmental transmural necrotizing inflammation of medium to small-sized arteries. Necrotic tisue and deposits of immune complexes, complement, and plasma proteins produce a smudgy eosinophilic deposit (fibrinoid necrosis) to give histologic pattern consist

A

Polyarteritis nodosa

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19
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UA & Micro: +Leukocyte Esterase, +Nitrites, +bacteria, +WBC, +RBC occasionally

A

Cystitis: E. coli, S. saprophyticus, P. mirabilis, Klebsiella, Enterococci

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20
Q

Non-motile Gram-negative coccobacilli

A

Haemophilus influenzae

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21
Q

Motile Gram-positive rods

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Listeria monocytogenes (facultatively intracellular, motile) #3 cause of meningitis in neonates

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22
Q

Gram-positive cocci in clusters

A

Staphylococcus species - common cause of meningitis in neurosurgical patients, gain access to meinges by direct inoculation during procedure or postop through the wound.

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23
Q

$ Lancet-shaped, Gram-positive cocci in pairs

A

Streptococcus pneumonia - leading cause of community acquired pneumonia, otitis media, and meningitis in adults.

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24
Bean-shaped, gram-negative cocci in pairs
Neisseria meningitidis - #2 most common cause of meningitis in patients \<60 years old. Outbreaks in close quarters (eg, army barracks)
25
Signs of liver failure that indicate a poor prognosis
Hypoalbuminemia and prolonged PT are of greates prognostic significance - indicators of synthetic function of liver. Alcoholic liver injury develops through stages of alcoholic steatosis, alcoholic hepatitis, and cirrhosis
26
Septate hyphae with V-shaping branches
Aspergillus fumigatus
27
Dimorphic funghi that grow as molds in nature, yeasts in the body.
Blastomyces, Histoplasma, Coccidioides are dimorphic fungi (Coccidioides exists in an endospore form at body temperature) HYPHAE WOULD NOT BE SEEN
28
Broad, non-septate hypae that branch at right angles
Rhizopus and Mucor - mucormycosis - presenting as paranasal infection in diabetic
29
"tram-track" calcifications on skull radiographs. Patient has mental retardation, seizures, hemiplegia, and skull radiopacities.
Sturge-Weber syndrome (encephalotrigeminal angiomatosis). Leptomeningeal angiomas also present with cutaneous facial angiomas
30
CRESCENT-SHAPED mass on CT scan of head.
Subdural hematoma, blood accumulats between the DURA MATER and ARACHNOID due to rupture of Bridging veins with gradual onset of symptoms.
31
Biconvex hematoma on CT
Epidural hematoma, often due to temporal bone fracture, blood accumulates between skull and dura
32
$ Most common cause of elevated AFP
DATING ERROR (underestimation of gestational age), also neural tube defects, anterior abdominal wall defects (omphalocele, gastroschisis), multiple gestation
33
$ Decreased AFP
Down's syndrome. Alpha-fetoprotein (AFP) is synthesized by the fetal liver, GIT, and yolk sac (early gestation only) Maternal serum AFP levels increase with gestational age.
34
Decreased Estriol levels in pregnancy
Placental insufficiency
35
hCG levels may indicate
synthesized by trophoblastic tissue, increased levels associated with MULTIPLE GESTATION, HYDATIDIFORM MOLE, CHORIOCARCINOMA
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Triple test
Determines AFP, hCG, and estriol levels, performed between week 16 and 18 of gestation. Abnormal test is indication for fetal ultrasonography (USG)
37
Culture at 25 deg C, forms hyphae, biposy at 37 deg forms DOUBLY REFRACTILE THICK-WALLED SPHERULES filled with endospors
Coccidioides immitis
38
Transmural inflammation of the arterial wall with fibrinoid necrosis
Polyarteritis nodosa
39
Segmental thrombosing vasculitis extending into contiguous veins and nerves, encasing them in fibrous tissue
Thromboangiitis obliterans (Buerger's disease). Also show hypersensitivity to intradermal injections of tobacco extracts
40
Onion-like concentric thickening of arteriolar walls as a result of laminated SMC and reduplicated basement membranes
Hyperplastic arteriolosclerosis, resulting from malignant hypertension (diastolic pressures \> 120-130 mm Hg)
41
Another name for apoptotic bodies
Acidophilic bodies, councilman bodies
42
Inflammation, necrosis and regeneration of muscle fibers, over-expression of MHC class I proteins on sarcolemma leads to infiltration with CD8+ T lymphocytes and myocyte damage
Polymyositis, patient presents with muscle weakness worst in hips and shoulders, symetric proximal weakness
43
ADD IMAGE: Hepatitis B histology
Hepatocellular cytoplasm filled with spheres and tubules of HBsAg and take on FINELY GRANULAR, EOSINOPHILIC APPEARANCE, "GROUND GLASS"
44
Small, 5 mm cavities located within the basal ganglia, posterior limb of the IC, pons, and cerebellum that result from small vessel lipohyalinosis and atherosclerosis involving penetrating vessels supplying deep brain structures
LACUNAR infarctions. Uncontrolled HTN and DM are risk factors
45
Acid Base status in PE
Hypoxemia (65) and Resiratory Alkalosis
46
Elongation of papilllae, basal cell hypertrophy, intraepithelial eosinophils seen on LM of esophagus
Reflux esophagitis
47
ADD IMAGE - Solid nests of neoplastic squamous cells with abundant eosinophilic cytoplasm and distinct borders with areas of keratinization
SCC esophagus - keratinization varies
48
What would hematologic lab values show in uremia (bleeding time etc)
NORMAL PT, aPTT, Platelet count, Bleeding time VERY PROLONGED. Uremia is a qualitative platelet disorder
49
Lab evaluation of a patient with Klinefelter syndrome
INCREASED PLASMA FSH - reflects gonadal failure in patients with Klinefelter syndrome (47, XXY). Estrogen:testosterone ratio determines the extent of feminization. Testes small with tubules atropihed and replaed by pink, hyalinzed tissue
50
Non-lactosefermenting gram(-) common cause of urinary tract infections in patients with indwelling bladder catheters
P. aeruginosa
51
How do you tst the integrity of the sciatic nerve?
Ankle-jerk reflex, S1 and S2 roots mediate the achilles reflex. Lesions would ause sensory loss or parasthesias over posterior leg and thigh.
52
Erosions involve which layers of the gastric mucosa?
ONLY the MUCOSA and DO NOT PENETRATE the MUSCULARIS MUCOSA (SEE image). Ulcers can extend into submucosal, inner muscular, and outer muscular layers.
53
Positive "whiff" test
Production of fishy odor (volatization of amines produced by gardnerella and other anaerobes) on addition of potassium hydroxide (KOH) to vaginal discharge = BACTERIAL VAGINOSIS
54
Clue cells on saline wet mount microscopy
Bacterial vaginosis (BV) due to Gram variable rod Gardnerella vaginalis
55
Intense vaginal pruritus, white curd-like discharge, labial erythema
Candida albicans with KOH showing yeast forms and pseudohyphae. No abnormal odor
56
Toxic effects seen in meningococcemia due to this virulence factor
Meningococcal lipooligosaccharide (LOS) - correlates with M&M. Acts as ENDOTOXIN
57
Schilling test helps differentiate between:
Dietary deficiency of vitamin B12 (urine output after phase I), pernicious anemia and malabsorption syndromes. Low absorption of cobalamin not correctable by intrinsic factor is indicative of malabsorption syndrome such as ileal disease, pancreatic insuff
58
Most helpful red cell index in making the diagnosis of hereditary spherocytosis?
Mean Corpuscular Hemoglobin Concentration (MCHC) - indicates membrane loss and red cell dehydration.
59
Characteristic histological finding in Reye syndrome
MICROVESCULAR STEATOSIS (presence of small fat vaculoes in the cytoplasm of hepatocytes) without inflammation and cerebral edema
60
EM findings in Reye syndrome
Swelling, decreased number of mitochondria and glycogen depletion
61
Acute vs chronic rejection of lungs
Acute - perivascular mononuclear infiltrates. Chronic - lymphocytic inflammation and necrosis of bronchiolar walls, with early fibrinopurulent exudate and granulation tissue found in lumen of bronchioli later replaced by connective tissue and scaring obli
62
Normal tracheal pO2 and normal alveolar pO2
Tracheal pO2 is 150 mmHg, normal alveolar pO2 is 104 mm Hg.
63
tracheal pO2 of 150 mmHg and alveolar pO2 of 145 mmHg
Poor alveolar perfusion ie PE (atmospheric and venous blood gases cannot equilibrate)
64
Normal pO2 of venous blood
40 mm Hg of oxygen
65
Normal alveolar pCO2, tracheal pCO2, and venous blood pCO2
Alveoli have CO2 of 40 mm Hg, tracheal 0 mm Hg, and venous blood 45 mm Hg of CO2
66
What is a MacConkey agar?
used to grow ENTERIC bactiera, bile salts prevent growth of gram (+)
67
Thayer-Martin VCN medium grows what organism?
NEISSERIA species (Heated blood agar with vancomycin, clistin (polymyxin) and Nystatin (VCN) kill everything but neisseria)
68
Bordet-Gengou medium
used to culture the very sensitive BORDETELLA PERTUSSIS, causative agent in whooping cough
69
Symmetrical enlargement of ventriculi
COMMUNICATING hydrocephalus - NO OBSTRUCTION to CSF flow from ventriculi to subarachnoid space
70
What is the cause of communicating hydrocephalus?
secondary to dysfunction or obliteration of SUBARACHNOID VILLI typically from meningeal infections (ie TB meningitis) or subarachnoid/intraventricular hemorrhage.
71
Muddy-brown, granular casts in a severely ill hospitalized patient
ISCHEMIC TUBULAR NECROSIS
72
Location of damage to kidney in ATN vs Renal Papillary necrosis
ATN - Proximal tubule and medullary segment of the TAL are most susceptible to ischemic damage. Renal papilla - apex of renal pyramid that projects into minor calyx, with 10-25 papillary ducts opening
73
Ulcer found in duodenal bulb (first portion) vs. distal duodenum
Most ulcers in first portion, if found in DISTAL or ATYPICAL location -\> Zollinger-Ellison syndrome.
74
Diffuse injury to pulmonary microvascular endothelium and or alveolar epithelium, resulting in increased pulmonary capillary permeability and leaky alveolocapillary membrane
ARDS - interstitial ad intra-alveolar edema, inflammation, and hyalin membrane formation cause lung compliance to DECREASE, work of breating INCREASE, and oxygen diffusion capacity decrease with V/Q mismatch.
75
Chest XR shows round density with an air-fluid level in lower lobe of right lung
Pulmonary abscess
76
Shrunken, fibrosed gallbladder
Chronic cholecystitis from repeated mild attacks of acute cholecystis
77
Abdominal radiograph demonstrates rim of calcium deposits that outline the gallbladder
RISK FOR GALLBLADDER CARCINOMA "porcelain gallbladder" 11-33% will eventually develop gallbladder carcinoma. Cholecystectomy recommended
78
Black non-obstructing pigment gallstones
secondary to INTRAVASCULAR HEMOLYSIS - associated with acute calculous cholecystitis
79
Brown non-obstructing pigment gallstones
BILIARY INFECTION- associated with calculous cholecystitis
80
Small fibrotic focus in lower lobe of right lung and calcified lymph node in right lung hilus
Primary exposure to M tuberculosis. LOWER LOBE LUNG LESION (Ghon focus) is accompanied by ipsilateral hilar adenopathy is called the GHON COMPLEX.
81
Horseshoe-shpaed arrangment of nuclei
Langhans giant cells
82
T lymphocytes, epithelioid activated macrophages, Langhans giant cells, proliferating fibroblasts synhesizing collagen, creating fibrous capsule
Caseating necrosis resulting in a CASEATING GRANULOMA
83
High serum level of 17-Hydroxyprogesterone
Diagnostic for 21-hydroxylase deficiency, often performed during routine newborn screening
84
Colonoscopy shows nonulcerative inflammation + biopsy reveals BASOPHILIC CLUSTERS seen on surface of intestinal mucsal surface in AIDS patient
CRYPTOSPORIDIUM
85
Colonoscopy demonstrates multiple ulcers and mucosal erosions with biopsy showing cytomegalic cells with inclusion bodies
CMV
86
Colonoscopy reveals protuberant mass, biopsy shows dysplastic mucosal cells with variable degree of gland formation
Adenocarcinoma
87
Colonoscopy shows numerous discrete, flask-shaped ulcerative lesions, biopsy shows trophozoites containing red blood cells
Entamoeba histolytica
88
Colonoscopy shows reddish/violet, flat maculopapular lesions or hemorrhagic nodules, Biopsy reveals spindle-shaped tumor cells with small-vessel proliferation
Kaposi's sarcoma
89
Colonoscopy shows contiguous area of erythematous, friable, granular mucosa with pseudopolyps and biopsy shows inflammatory infiltrate involving mucosa and submucosa with crypt abscesses
Ulcerative colitis
90
Anion gap metabolic acidosis, increased osmolar gap, Multiple oxalate crystals observed in tubular lumen
ETHYLENE GLYCOL ingestion - precipitation of calcium oxalate crystals that damage tubular epithelium
91
Marked, one-sided kidney atrophy
RENAL ARTERY STENOSIS (RAS) Elderly due to atherosclerotic changes in arterial intima or women of childbearing age due to firomuscular dysplasia. HTN and abdominal bruit are present
92
Biopsy of brain shows well-differentiated neoplasm comprised of spindle cells with hair-like glial processes associated with microcysts
PILOCYTIC ASTOCYTOMA
93
Glial fibrillary acidic protine (GFAP)-positive processes tapering toward blood vessels, tumor was taken from roof of fourth ventricle
EPENDYMOMA (10% of posterior fossa tumors in children) ependymal pseudorosettes seen
94
High mitotic index, Homer-wright rosettes seen in 1/5 of cases, Primitive neuroectodermal tumor (PNET)
Medulloblastoma
95
Biopsy of brain tumor shows cells mixed with Rosenthal fibers and granular eosinophilic bodies
Juvenile Pilocytic Astrocytoma
96
NEURITIC PROCESS (pathognomonic), NSE, chromogranin, synaptohphysin, and S-100 positive, small, round blue-cell tumors. 90% of patients have elevated urinary HVA and/or VMA
Neuroblastoma - most common extracranial solid tumors in children
97
S-100 positive
Melanomas and Schwannomas (Melanocytes and Schwannc cells are derived from neural crest)
98
Spindle cells that are elongated with regular oval nuclei. Biphasic (highly cellular intermixed with myxoid areas of low cellularity)
SCWANNOMAs - Antoni A pattern (high cellular area, pallisading like picket fence) + Antoni B pattern (low cellular area)
99
Echocardiogram shows aorta lying anterior to and right of pulmonary artery
Transposition of the great arteries (TGA)
100
Patient with primary mineralocorticoid exess would have the following serum lab values for sodium, potassium, and bicarbonate?
Sodium is normal (aldosterone escape - ANP compensates allowing sodium loss) LOW potasium (due to high aldo) and HIGH BICARB (alkalosis, to secrete hydrogen, bicarb must be reabsorbed?)

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