Patho Qs Flashcards by g ram

When does the proliferation phase of wound healing begin?

6 days

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Most important cause of delay in wound healing?

Infection

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Hypertrophic scars vs Keloid

Hypertrophic scar - along the edge of the wound

Keloid - beyond original wound edges

Both with same histologic findings

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Interstitial fluid compartment makes up what % of TBW?

15%

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At what capillary pressure do you expect pulmonary edema?

> 28mmHg

Normal = 7mmHg
Safety factor = 21 mmHg

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Pathophysiologic cause of edema in renal insufficiency?

Sodium retention

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Pathophysiologic cause of edema in chronic inflammation?

Inflammation

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Pathophysiologic cause of edema in DVT?

Increased hydrostatic pressure

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What is the most common primary hypercoagulable state?

Factor V Leiden mutation

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Amount of protein loss in nephrotic syndrome?

> 3.5g per day

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Tx for heparin-induced thrombocytopenia?

Direct thrombin inhibitors (lepirudin, argatroban)

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Pathogenesis of APAS?

Antibody-mediated inhibition of t-Pa activity (necessary for trophoblast invasion)

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Why can you have a false positive RPR in APAS?

RPR is embedded in cardiolopin, which is found in patients with APAS

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Laminations seen in antemortem thrombosis

Lines of Zahn

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Gelatinous with dark red dependent portion and yellow “chicken fat” upper portion

Postmortem thrombosis

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Location of mural thrombi?

Heart chambers or aortic lumen

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MC site of arterial thrombosis?

Coronary arteries

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MC site if venous thrombosis?

Lower extremities (90%) - calf veins

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MCC of acute endocarditis?

Staph aureus

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MCC of native valve endocarditis?

Strep viridans

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MCC of subacute endocarditis?

Strep viridans

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MCC of prosthetic valve endocarditis?

Staph epidermidis

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Bacteria involved in marantic endocarditis?

Strep bovis type 1 (strep gallolyticus)

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MCC symptom of pulmo embolism?

Dyspnea

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Cardiac auscultation findings in pulmo embolism?

Accentuated pulmonic component of second heart sound

Organs with dual blood supply

Lungs, liver, intestines

Principal test for diagnosing pulmo embolism?

Chest CT with contrast

Gold standard for diagnosis of pulmo embolism?

Pulmonary angiography

Ischemic necrosis of femoral heads, tibia, humerus due to formation of nitrogen bubbles

Caisson's disease

Dominant histologic characteristic of infarction

Ischemic coagulative necrosis

Infarction --> scar tissue | Septic infarction --> ?

Abscess formation

Valvular heart defect that usually leads to septic embolism to the lungs

Tricuspid valve endocarditis

Tissues that manifest red infarction

Lungs, liver, intestines (organs with dual blood supply)

Organs with end-arterial circulation

Heart, spleen, kidneys

ECG changes seen in cardiogenic shock

Low voltage complex

Type of shock seen in burn patients

Hypovolemic shock

Waterhouse-Fridreichsen syndrome?

Most severe form of meningococcemia (N. meningitidis)

Most severe form of meningococcemia

Waterhouse-Fridreichsen syndrome

Findings in Waterhouse-Fridreichsen syndrome?

Bilateral adrenal hemorrhage leading to acute adrenal cortical insufficiency

Kidney damage in shock

Acute tubular necrosis

Shock lung?

Alveolar damage secondary to shock (non-cardiac cause)

Genetic disorders with high penetrance

Mendelian disorders

Germ cell mutations vs somatic cell mutations

Germ cell mutation - transmitted to progeny | Somatic cell mutation - do not cause hereditary diseases but are important in carcinogenesis

Autosomal dominant disorders are often due to defects in what type of genes?

Structural genes - cause physical, structural problems

What is the probability that the son of a male with a X-linked disorder will have the defect?

None. The affected male does not transmit the disorder to his sons

Loss of intercellular connections between keratinocytes

Acantholysis

Epidermal hyperplasia

Acanthosis

Epidermal intercellular edema

Spongiosis

What is the likelihood that the daughter of a man with a X-linked genetic defect will present with symptoms?

None. All daughters are carriers only.

A man has a X-linked dominant disorder. How many of his sons will be affected? Daughters?

Male parent passes the trait to ALL his daughters but NONE of his sons (assuming female is normal)

A female has a X-linked dominant trait. How many of her daughters are affected? Sons?

Half her sons and half her daughters

Genetic defect in Marfan syndrome

Inherited defect in fibrillin-1 (extra cellular glycoprotein)

Ocular changes in Marfan's

Ectopia lentis - bilateral subluxation or dislocation (superotemporal)

Cardiac auscultation findings likely seen in a patient with Marfan's

Mid systolic click (mitral valve prolapse)

What generic disorder predisposes to aortic dissection?

Marfan syndrome

Pathology in aortic dissection?

Tear in the tunica media

Defect in Ehler's Danlos syndrome

Defect in the synthesis or structure of fibrillar collagen

Most common defect in Ehler's Danlos

Defect in type 3 collagen

Defect in Familial Hypercholesterolemia disorders

Mutation in the gene encoding for LDL receptors

Deficiency in Tay-Sachs disease

Hexodaminidase a-subunit deficiency

Tay-Sachs disease: what accumulates? What is deficient?

Deficiency: hexosaminisase alpha Accumulates: GM2 ganglioside

Accentuated macular chorioid contrasted with pale retina

Cherry red macula

Niemann-Pick disease: what accumulates? What is deficient?

Deficient: sphingomyelinase Accumulates: ---

Cytoplasmic bodies resembling concentric lamellated myelin figures

Zebra bodies (seen in Niemann-Pick Disease)

What is the most common lysosomal storage disorder?

Gaucher disease

Gaucher disease. What is deficient? accumulates?

Deficiency: glucocerebrosidase Accumulation: --

Distended phagocytic cells with crumpled tissue paper appearance

Gaucher disease

Distended phagocytic cells with crumpled tissue paper appearance in the brain

Virchow-Robin spaces (seen in Gaucher disease)

Mode of inheritance of most mucopolysaccharidoses

Autosomal recessive (except Hunter syndrome which is X-linked recessive)

Enzyme defect in Hurler syndrome?

a-L-iduronidase

Enzyme defect in Hunter syndrome

Iduronosulfate sulfatase

Enzyme defect in Morquio syndrome

N-acetylgalactosamine-6-sulfatase

Urinary metabolites that accumulate in Sanfillipo syndrome

Heparan sulfate

Distended cells with apparent clearing of cytoplasm

Balloon cells

Microscopic findings seen in mucopolysaccharidoses

Balloon cells | Zebra bodies

Enzyme deficiency in Pompe disease

a-1,4-glucosidase

Enzyme deficiency in Von Gierke disease

Glucose 6-phosphatase

Enzyme deficiency in Cori Syndrome

Glycogen debranching

Enzyme deficiency in Andersen syndrome

Branching enzyme

Glycogen storage disease that presents with infantile hypotonia

Andersen disease, type IV

Glycogen storage disease deficient in muscle glycogen phosphorylase

McArdle, type V

Enzyme deficient in Alkalptonuria

Homogentisic oxidase

Blue-black pigmentation in ears, nose, cheeks is called? Seen in what disease?

Onchronosis | Seen in Alkalptonuria

No loss of generic material during translocation

Balanced translocation

Robertsonian translocation?

Transfer if segments leads to one very large chromosome and one very small one

Endocardial cushion defects seen in Trisomy 21

ASD primum + AVSD

Ultrasound finding in a baby with Trisomy 21

Nuchal translucency

DiGeorge syndrome - branchial pouches involved

3rd and 4th branchial pouches

Male hypogonadism

Klinefelter syndrome (47 XXY)

Genetically make but phenotypically female

Klinefelter syndrome (47 XXY)

Testosterone and LH levels in primary hypogonadism

Low testosterone | Elevates LH

Testosterone and LH levels in hupogonadotropic hypogonadism

Low testosterone, low LH

Streak ovary seen in?

Ovarian day genesis (Turner syndrome)

Cardiovascular problem in Turner syndrome

Preductal coarctation of the aorta

Micro deletion of long arm of chromosome 7

Williams syndrome

Elfin facies, extreme friendliness with strangers

Williams syndrome

Happy puppet, inappropriate laughter

Angelman syndrome

Type of hypersensitivity rxn: Contact dermatitis

Type IV (delayed)

Type of hypersensitivity rxn: GBS

Type IV (delayed)

Type of hypersensitivity rxn: rheumatoid arthritis

Type IV

Type of hypersensitivity rxn: acute rheumatic fever

Type II

Type of hypersensitivity rxn: MS

Type IV

Type of hypersensitivity rxn: MG

Type II

Type of hypersensitivity rxn: SLE

Type III

Type of hypersensitivity rxn: type I DM

Type IV

Type of hypersensitivity rxn: post-strep glomerulonephritis

Type III

Type of hypersensitivity rxn: Graves' disease

Type II

In what disease can you see nonerosive synovitis with little deformity?

SLE

In what disease can you see erosive synovitis?

Psoriasis

Diseases that histologically show bread and butter appearance?

Rheumatic fever, SLE, MI

Bread and butter appearance

Fibrinous pericarditis

Drugs that cause drug-induced lupus

Hydralazine, isoniazid, procainamide, penicillamine

Anti-histone antibodies seen in?

Drug induced lupus

Earliest finding in Sjögren's syndrome

Periductal and perivascular lymphocytic infiltration of lacrimal and salivary glands

Drugs for tx of Sjögren's

Steroids, artificial tears, pilocarpine

Rubber hose inflexibility of the esophagus seen in?

Scleroderma | Lower 2/3 of the esophagus

Extensive subcutaneous fibrosis leading to claw-like flexion deformity

Sclerodactyly (seen in scleroderma)

MCC of death in patients with scleroderma

Renal failure (50%) of patients

Type of fibrosis that damages the kidneys in scleroderma

Fibrinoid necrosis involving renal arteries

Antibodies seen in MCTDs?

Anti-ribonucleoprotein (anti-RNP)

Transplant rejection that shows necrotizing vasculitis with endothelial cell necrosis, neutrophilic infiltration, deposition of Ig, complement and fibrin

Acute humoral rejection - type II hypersensitivity

Type of transplant rejection that shows thrombotic occlusion of capillaries and fibrinoid necrosis in arterial walls

Hyperacute rejection (type II)

Type of transplant that shows vascular changes, interstitial fibrosis and tubular atrophy with loss of renal parenchyma

Chronic transplant - Type IV

Mutation in Bruton agammaglonulinemia

Tyrosine kinase mutation | Virtual absence of B cells

Patients with Bruton's agammaglonulinemia are predisposed to having infections with what organisms?

Step pneumonia, H. influenzae

Treatment for Bruton's agammaglonulinemia

Pooled gamma globulin

Selective IgA deficiency pathogenesis

Failure of isotope switching

MC form of severe antibody deficiency? Tx?

CVID | Pooled gamma globulin

Pathogenesis of SCID?

X-linked: mutation in gene encoding common gamma chain/ IL-2 Autosomal: ADA deficiency

How to diagnose CGD?

Nitroblue tetrazolium test

CGD: what is lacking?

NADPH oxidase activity, failure of oxidative burst

Patients with CGD are predisposed to having what kind of infections?

Catalase positive bacteria, fungi (A. fumigatus)

Chediak-Higashi syndrome: pathogenesis?

Failure of phagolysosomal fusion, faulty micro tubules impair neutrophil chemotaxis

Patients with terminal complement deficient are predisposed to having bacteremia secondary to what organisms?

N. meningitidis, N. gonorrhea

Deficiency in Paroxysmal nocturnal hemoglobinuria

Deficiency of decay accelerating factor (DAF)

HIV major capsid protein

p24

HIV screening test? Confirmatory test? Test for monitoring?

Screening: ELISA Confirmatory: Western blot Monitoring: CD4 count

Amyloidosis in polarized light? What stain?

Apple-green birefringence with Congo Red

Protein structure involved in Amyloidosis

Secondary protein structure (Beta pleated sheets)

Most common and most serious form of Amyloidosis

Renal Amyloidosis

Tapioca-like granules in the splenic follicles

Amyloidosis (sago spleen)

Map-like areas in walls of splenic sinuses

Lardaceous spleen - seen in Amyloidosis

Benign or malignant? Mature teratoma in women

Benign

Benign or malignant? Mature teratoma in men

Malignant

Benign or malignant? Hepatoma

Malignant

Benign or malignant? Immature teratoma

Malignant

Benign or malignant? Hemangioma

Benign

Benign or malignant? Leukemia

Malignant

Normal cells in normal location but with overgrowth

Hamartoma

Normal cells in abnormal locations

Choristoma

Reversible or Irreversible? Hyperplasia

Reversible

Reversible or irreversible? Metaplasia

Reversible

Reversible or irreversible? Dysplasia

Reversible

Reversible or irreversible? Anaplasia

Irreversible

Fibrous tissue formation in response to neoplasm

Desmoplasia

Degree of cellular differentiation based on histologic appearance, reflects the character of the tumor itself.

Tumor grade

What does the tumor stage reflect?

Degree of localization/ spread. Has more prognostic value than tumor grade.

MC cancer in children

Leukemias (ALL)

MC cancer in women

Breast CA

MC cancer in men

Prostate CA

Most common cancer that causes death in men?

Lung CA. Also for women.

Eating large amounts of smoked food is associated with what CA?

Gastric adenocarcinoma. Common among Japanese.

Infectious agents associated with cholangiocarcinoma

Chlonorchis sinensis | Opistorchis viverrini

Schistosoma hematobium is associated with what malignancy?

Bladder squamous carcinoma

Cytokine involved in cahexia

TNF-alpha

Paraneoplastic syndrome associated with small cell CA of the lung?

SIADH

Trousseau syndrome is associated with what cancer?

Pancreatic cancer

Disease with antibodies against the pre synaptic calcium channel

Lambert Eaton myasthenia

Tumor marker for ovarian CA

CA-125

Tumor marker for pancreatic adenocarcinoma

CA 19-9

Tumor marker for gastric CA

CEA

Tumor markers (2) for prostrate cancer

PSA, prostatic acid phosphatase

Tumor marker for melanoma

S-100

Tumor marker for choriocarcinoma

b-HCG

Tumor marker for Hairy cell leukemia

Tartrate-resistant acid phosphatase (TRAP)

Where are Weibel-Palade bodies seen?

Endothelial cells

True vs False aneurysm

True - intact wall | False - with extravasation of blood in between two vessel layers

MC location of AAA?

Below the renal arteries

Triad of AAA rupture

Flank pain, hypotension, pulsatile mass

MC site of berry aneurysm

ACOM. Junction of the communicating branches with the main cerebral vessels

What vessel (and parts) are involved in syphillitic aneurysm?

Invasion of the vasa vasorum of the thoracic aorta

Appearance of syphillitic aorta

Tree-bark appearance with wrinkling of the tunica intima

Aortic dissection involves what layer?

Dissection of blood between and along the laminar parts of the tunica media

Aortic dissection is more frequent in Marfan's or Ehler's Danlos?

Marfan's

Type of aortic dissection with worse prognosis

Type A - Proximal | Associated with ascending or both ascending and descending

What is the MC per-existing histologic lesion of aortic dissection

Cystic medial degeneration/necrosis

Presenting s/s if aortic dissection

Acute severe reteosternal chest pain radiating to the back with loss of upper extremity pulses and aortic valve regurgitation

MC site if varicose veins

Superficial saphenous veins

Which is more common, left or right varicocele? Why?

Left. The right drains directly into the IVC.

Phlebothrombosis most common location

Calf deep vein | Phlebothrombosis = aka DVT

Pain on foot dorsiflexion

DVT

Orange discoloration and ischemic ulcers around the ankles

DVT

Phlebothrombosis vs Thrombophlebitis

Phlebothrombosis: DVT, vein thrombosis without inflammation Thrombophlebitis: pain and tenderness of the superficial vein secondary to inflammation

Carcinoma associated with thrombophlebitis

Pancreatic cancer (head) - superficial migratory thrombophlebitis

Compression of the neurovascular components of the neck

Thoracic outlet syndrome

Adson test

Test for thoracic outlet syndrome

Physical examination for DVT

Homan's test

Lymphangitis is commonly due to what organism

GABHS

Differentiate the primary lymphedema caused by Turner's syndrome and Lymphedema praecox

Turners - females, newborn, upper part of the body (cystic hygroma) Lymphedema praecox - females, puberty, lower part of the body (cankles!)

Presenting s/s of Monckeberg medial calcific sclerosis

None. Patients are asymptomatic.

Necrotizing arteriolitis

Hyperplastic arteriolosclerosis

Major characteristic of benign nephrosclerosis

Hyaline variant arteriolosclerosis

Hyaline vs Hyperplastic variant arteriolosclerosis: which is associated with benign hypertension and DM

Hyaline variant

Hyaline vs Hyperplastic variant arteriolosclerosis: which is associated with onion-skinning

Hyperplastic variant

MCC of MI

Atherosclerosis

Why do males have an increased risk for MI?

Estrogen is cardio protective

Earliest lesion in atherosclerosis

Fatty streak

Lipid core surrounded by a fibrous plug

Atherosclerotic plaque

MC site for atherosclerosis

Abdominal aorta

Earliest manifestation of hypertensive heart disease

Increase in transverse diameter of myocytes

p-ANCA: with antibodies against?

Antibodies against myeloperoxidase (MPO)

c-ANCA: with antibodies against?

Proteinase-3 (PR-3)

MC systemic vasculitis in adults

Temporal (Giant Cell) arteritis

Vessels most commonly involved in Giant Cell arteritis

Temporal artery, ophthalmic artery, vertebral artery, aorta

Vasculitis that presents with nodular intimal thickening of large vessels with multinucleate giant cells

Temporal arteritis

Polymyalgia rheumatica is seen in?

Temporal arteritis

Pulseless disease

Takayasu arteritis

Weakened upper extremities with BP difference > 10mmHg between arms

Takayasu arteritis

Aortic arch syndrome

Takayasu arteritis

Granulomatous inflammation of the aorta with giant cells

Takayasu arteritis

MC vessel involved in PAN?

Renal artery > coronary > hepatic > mesenteric arteries

Treatment for Takayasu arteritis

Steroids

What organ is not involved in PAN?

Pulmonary arteries

Segmental transmural necrotizing inflammation of small to medium sized arteries

Polyarteritis nodosa

MC acquired heart disease in children

Kawasaki disease

Vessels most frequently involved in Kawasaki disease

Coronary arteries

Treatment for Kawasaki disease

IVIg, Aspirin

Where can you see leukocytoclastic vasculitis

Microscopic Polyarteritis/ polyangitis

Penicillin can induce this small vessel vasculitidis

Microscopic polyangitis

Necrotizing vasculitis with granulomas with eosinophilic necrosis

Churg-Strauss | Syndrome

What is spared in: Churg-Strauss syndrome

Renal vessels

What is spared in: Polyarteritis | Nodosa

Pulmonary vessels

Necrotizing vasculitis of Wegener Granulomatosis is most prominent in what organ?

Lungs

Geographic patterns of central necrosis and accompanying vasculitis

Wegener Granulomatosis

4 C's of Wegener Granulomatosis

C ANCA C resenteric GN C yclophosphamide C orticosteroids

Buerger's syndrome: commonly involves what age group?

< 35yo

Sharply segmental acute and chronic vasculitis of medium sized and small vessels; thrombus with microabscesses

Thromboangitis obliterans

Resting pain on forefoot

Thromboangitis obliterans

Morphology of arterial walls in Raynaud's phenomenon

Normal arterial walls except in late stages (intimal thickening)

Arsenic is associated with what tumor?

Hepatic angiosarcoma

Rust colored sputum

Left sided heart failure

Bat wing configuration

CXR finding - perihilar congestion in left sided heart failure

First symptom of CHF

Dyspnea

First sign of left sided HF

Left sided S3

Predictor of survival in CHF

BNP levels

Hallmark of right sided heart failure

Ankle/ pedal and pretibial edema

Nutmeg liver

Chronic passive congestion of liver secondary to CHF

4 causes of high output cardiac failure

Beri-beri Anemia Hyperthyroidism AV fistula

Greatest risk factor for developing congenital heart disease

Congenital heart disease in a parent or preceding sibling

Most important component of TOF

Pulmonic stenosis

Congenital heart disease associated with diabetic mothers

TGA

Heart shape: TOF

Boot shaped

Heart shape: TGA

Egg shaped, egg on a string

Most common variant of TAPVR

Supra cardiac (drains to inominate/ brachoicephalic

Cardiac auscultation findings in ASD

Fixed widely split S2

MC variant of ASD

Secundum

ASD variant associated with Trisomy 21

ASD primum

Likely congenital heart disease in a patient with fetal alcohol syndrome

VSD

MC type of VSD

Membranous (90%) - hole is in the membranous septum

Multiple VSDs seen in the muscular septum

Swiss cheese septum

Management of VSD

50% will close spontaneously | Surgical correction if still persistent at 1yr old

Congenital heart problem associated with Rubella

PDA

Cardiac auscultation findings in PDA

Continuous harsh machinery-like murmur at 2nd ICS left

Types of AVSD

Partial - primary ASD and cleft anterior mitral leaflet causing mitral insufficiency Complete - hole in the center of the heart; 1/3 with trisomy 21

Infantile coarctation of the aorta associated with?

Turner's syndrome

Rib notching is associated with what malformation?

Coarctation of the aorta - post-ductal type

Congenital heart defects associated with Marfan Syndrome

MVP, Aortic dissection

What does the LAD artery supply?

Anterior wall of LV, anterior ventricular septum, apex

Romano-Ward syndrome

Autosomal dominant long QT syndrome that's a risk factor in sudden cardiac death

Two classifications of MI

Q-wave (ST elevation) and Non-Q-wave (ST depression)

Layers of the heart involved in Q wave infarction

Full thickness/ transmural (endo, myo and epicardium)

Layers of the heart involved in Non-Q wave infarction

Subendocardium, endocardium

Most common vessel blocked causing MI

LAD

Slender beaded gram positive organisms arranged in branching filaments

Nocardia asteroides

Haze of bacteria entangled with the cilia of bronchial epithelia

Bordetella Pertussis

Where can you see Meyers-Kouvenaar bodies?

Tropical Pulmonary Eosinophilia

Liver finding in severe schistosomiasis

Pipe stem fibrosis

Pipe stem fibrosis - seen where?

Severe schistosomiasis

Diffuse mucosal damage and glandular atrophy of oxyntic mucosa

Autoimmune gastritis

Islands, trabeculae, strands, glands or sheets of uniform cells with sly and pepper chromatin

Carcinoid tumor

Pedunculated, smooth surfaced, reddish lesions with cystic spaces in the colon

Juvenile polyps

Multiple GI hamartomatous polyps and mucocutaneous hyperpigmentation most common in the small intestines

Peutz-Jeghers syndrome

Most common and clinically important neoplastic colonic polyps

Colonic adenoma

Hyperplastic polyps: risk for CA?

None. They have no malignant potential.

Risk factor most closely associated with colorectal cancer

Dietary factors

Whitish ulcerated oral mucosal lesions near the opening of Stensen's duct

Koplick spots, seen in Measles/ Rubeola

Multinucleated giant cells, cough, fever, hyperemic conjunctiva

Warthin-Finkeldey cells

Perivenous demyelination and perivascular mononuclear cuffing

Mumps encephalitis

Lobe involved in Herpes Simplex encephalitis

Temporal lobe

Dewdrop on a rose petal

Varicella

Ganglion involved in shingles

Dorsal root ganglion

Mononuclear infiltration with herpetic intranuclear inclusions; facial nerve paralysis

Ramsay Hunt syndrome

Another name for herpes simplex oticus

Ramsay Hunt Syndrome

Ganglion involved in Herpes Simplex Oticus

Geniculate ganglion

Prominent intranuclear basophilic inclusions surrounded by a halo

Owl's eye inclusions

Atypical lymphocytes seen in EBV infection

Downey cells

Green to brown deposits of copper in Descemet's membrane in the corneal limbus

Kayser-Fleischer rings

Green to brown deposits of copper in Descemet's membrane in the limbus of the cornea

Eye manifestations of Wilson's disease

Kayser-Fleischer rings

Round to oval cytoplasmic globular inclusions in hepatocytes

Alpha-1 anti trypsin deficiency

Inflammation of the pancreas with irreversible destruction of exocrine parenchyma

Chronic pancreatitis

Localized collections of necrotic-hemorrhagic material rich in pancreatic enzymes

Pancreatic pseudocyst

Tumor marker for pancreatic cancer

CA 19-9