Path lab 2 slides Flashcards
The following histo slide is of an MI, how old is it?
6-24hrs
Look out for:
- Myocardial fibers that are well-delineated & no nucleus
- Neutrophils
- Intense eosinophilia
A patient presents to the clinic who is a known diabetic and hypertensive. They have substernal chest pain radiating to the right since yesterday. EKG shows elevated ST segments in V1-V5 (ant) leads. Blood samples indicate elevated CK-MB (creatine kinase myocardial band) & Troponin.
The cause of this patient’s presenting condition is most likely what?
MI ~6-24hrs old
A patient suffering from an MI (6-24hrs) will most likely die from which complications?
Ventricular tachycardia
&
Left ventricular fibrillation
What are the key indicators of an MI having occurred 6-24hrs ago
Elevated troponin
Disintegrated nuclei
Neutrophils (which can also cause acute pericarditis)
Patient took antacids because of chest pain from last night but had no relief. They were brought to the ER and their blood was tested but they died. On autopsy a biopsy is as shown, how long ago did this patient actually have an MI?
24-48hrs
Heavy neutrophilic infiltrates (indicate inflammation) & most common complication of pericarditis
How old is the MI
24-48hrs old
Heavy neutrophilic infiltrates & the most common complication of pericarditis
How old is the MI?
6-24HRS (1day old max)
How old is the MI?
3-5days old
progressive inflammation the neutrophils begin to die and replaced by influx of macrophages and new vessel formation
What are the key characteristics of an MI this old?
3-5 days
Dead myocytes surrounded by macrophages (these indicate ongoing inflammation & phagocytosis which suggest healing post necrosis)
How old is the infarct?
1-2 weeks old
- Angiogenesis & granulation (these indicate start of tissue repair)
- Collagen deposition (scar formation)
- Granulation tissue (new blood vessels & weak collagen deposition increases the risk of balloon aneurysms)
Patient presenting with a 1–2-week-old MI are at risk of which condition?
Cardiac tamponade
(granulation formation can lead to muscle rupture and blood pooling in pericardial sac which doesn’t happen until angiogenesis)
What type of aneurysm is a patient most at risk of if they present to the clinic with a 1-2 week old infarct
1-2 weeks old Balloon aneurysm
An autopsy shows the following, how old was the MI & what was the underlying cause of death?
1-2week old MI
&
The underlying cause was likely cardiac tamponade leading to granulation formation and blood pooling in the pericardium.
How old is the MI?
3-4 weeks old
The following histo slide shows which of the following?
- Decreased cellularity in papillary muscles
- Increased collagen deposition in tissues
- Some remaining normal myocardial fibers & type 1 collagen
Key indicators of a 3-4 weeks old MI?
Decrease in cellularity
More collagen
Both of which indicate scarring & healing
Don’t give ______ during the _________ & _________ stages until a mural thrombus has formed or else there is a high risk of rupture
Don’t give anticoagulants during the fibrinous pericarditis & cardiac tamponade
Myocardial infarction leads to weakening of the muscular wall of the heart which can then bulge out under increased intraventricular pressure. This sac does not contain enough cardiac muscle to contract efficiently which leads to two problems:
decrease in CO & formation of blood clots (can lead to autoimmune pericarditis (Dressler’s syndrome)
An elderly presents with an ulcer-looking mass on the face (lower lip, neck, or cheek). It’s invasive but doesn’t metastases. The ulcer has raised margins and central necrosis.
Squamous cell carcinoma
The following histo slide shows epidermis that invades the dermis what is the diagnosis?
Squamous cell carcinoma
The histo slide shows keratin pearls this suggest which diagnosis?
squamous cell carcinoma
An elderly patient presents with a pearly nodule with superficial telangiectasia. The ulcer is not healing and doesn’t metastases. What is the likely condition?
Basal cell carcinoma
Histo slide shows a mass that arises from the basal layer of the epidermis & the tumor invades the dermis without any connection to the epidermis
Basal cell carcinoma
The key histological findings of Basal cell carcinomas include:
- Mass from the basal layer of the epi
- Tumor invades the dermis without connection to the epidermis
- Tumor cells are displaced in palisade at the periphery of tumor nests which are spindle shaped and irregular in the middle
The following histo slides have arrows: the green arrow points to ______ & the red arrow points to _______
Green arrow: Central area has high mitotic activity
Red arrow: Periphery has most mitotic cells
Patient presents with an injury and the following histo slide, what is the condition _______ &
Pyknotic nuclei with vertical streaming of the epidermis indicate Electrical burns
Patient presents with the following, what is the condition?
Electrical burns
Patient presents with pyknotic nuclei & vertical streaming of the epidermis, what is the likely condition?
Electrical burns
Patients with homogenous electrical burns to the epidermis deal with
changes to the nuclei
Patient presents with the following injury what is the condition?
Full thickness thermal burns
Patient presents with thermal burns, describe the histological features
Loss of epidermis with dermal fibrosis which leads to extensive tissue damage and impaired healing
This represents the what injury?
Radiation therapy burns
Describe the features of the histo slides
Normal epithelium with telangiectasia in the dermis (which indicate vascular changes induced by radiation therapy)
Patient goes for radioiodine therapy for thyroid cancer, but later develops these burns. Describe the features of this injury
Radiation burns which leave the epidermis but impact the underlying blood vessels & the dermis has fibrosis
The following histo slides show what
Hereditary elliptocytosis (cigar-shaped cells)
Patient presents to the ER with anemia & exertional dyspnea. Thier blood smear shows numerous cigar-shaped cells
Patient has Hereditary elliptocytosis due to mutated SPECTRIN**
Pyruvate Kinase deficiency shows what cells on blood smears
Echinocytes which are due to oxidative or colloid osmotic stress
Patient presents with chronic hemolytic anemia & elevated 2,3 BPG levels, with echinocytes on the blood smear the patient likely has what?
PKD
PKD can lead to
increased lactate & a right-shift in the O2 dissociation curve
What are the steps of PKD pathway
Histo slides show ringed sideroblasts
Sideroblastic anemia
Patient presents with colicky abdominal pain blood smear shows ringed sideroblasts. They also mention they live in an older house
Sideroblastic anemia
Describe the pathways of sideroblastic anemia
Patient’s Histo slides show fat lobules with islands of hematopoietic stem cells suggesting
aplastic anemia
aplastic anemia includes what 2 features
- fat lobules with islands of hematopoietic stem cells
- Hypocellular bone marrow
Patient took chloramphenicol (Ab for serious infection) who’s side effects include what?
aplastic anemia or bone marrow toxicity
Histo slides show misshapen & rigid RBC’s this is due to a genetic mutation in which gene causing what?
Point mutation in 6th codon of B-globin gene replacing
glutamate –> valine
Increases polymerization of deoxygenated hemoglobin
What are some of the features of sickle cell anemia
-Chronic hemolytic anemia
-Microvascular occlusions
-Priapism
-Osteomyelitis
-Ischemia tissue injury
-Non-healing ankle ulcer
-Bone/joint ischemia
-Asplenia or splenomegaly
-Dactylitis
Patient presents with hand-foot-mouth disease, acute chest syndrome, aplastic crisis, and Vaso occlusion what is the likely condition?
Sickle cell
AA point mutation in sickle cell anemia is
glutamate to valine
