PATHOLOGY Flashcards
Most common cause of cellular injury
Hypoxia
The irreversible condensation of chromatin in the nucleus of a cell undergoing necrosis or apoptosis
Pyknosis or karyopyknosis
Fragmentation of nucleus
Karyorrhexis
Disintegration and dissolution of a cell nucleus when a cell dies
Karyolysis
Refers to conditions caused by exposure to chemical or physical agents in the ambient workplace and personal environment, including diseases of nutritional origin
Environmental disease
Studies the distribution, effects and mechanisms of action of toxic agents
Toxicology
Exogenous chemicals in the environment in air, water, food and soil that may be absorbed into the body through inhalation, ingestion and skin contact
Xenobiotics
Xenobiotics can be metabolized to non toxic metabolites and eliminated from the body
Detoxification
Cherry red color of mucosa
Bitter almond odor
Carbon monoxide poisoning
Carbon monoxide + hemoglobin = ?
Irreversible
Carboxyhemoglobin
Child ingesting flakes of paint
Lead poisoning
Severe abdominal pain not compatible with physical exam. Diagnosis?
Mesenteric ischemia
MC location: Griffith’s point (splenic flexure)
DOC for acute management of lead poisoning
EDTA +/- Dimercaprol
Toxicity due to contaminated fish, dental amalgams and gold mining l
Mercury poisoning
Mercury poisoning with cerebral palsy, deafness, blindness and mental retardation
Minamata disease
Due to Methylmercury
Main protective mechanism againts mercury poison
Intracellular glutathione
Poison of kings and the king of poisons
Sources: pesticides, agricultural products and burning of coal
Arsenic poisoning
Toxicity manifested as milk and roses complexion, hyperkeratosis, diarrhea, transverse bands in nails (Mee’s lines) and convulsions
Arsenic poisoning
What organ in the GI tract does not have a serosa?
Esophagus
- more prone to infection and cancer
Aschoff bodies
Vegetations
Rheumatic fever
Rokitansky aschoff bodies
Chronic cholecystitis
Anitschow cells or caterpillar cells
Aschoff bodies
Rheumatic fever
Immune response of Rheumatic heart disease
Molecular mimicry
Machinery like murmur
PDA
Holosystolic murmur with opening snap
Severe Mitral Stenosis
Native valve endocarditis (NVE)
S. Viridans
Endocarditis in IV drug users
S. Aureus
Prosthetic valve endocarditis
S. Epidermidis
Uninfected vegetations seen on patients with malignancy and chronic diseases
Marantic endocarditis
Dysphagi
Iron deficiency anemia
Esophageal webs
Plummer vinson
Excess iodide intake initially increases organification but this is later followed by supression
Wolf chaikoff effect
Iodine induced hyperthyroidism
Hyperthyroidism following administration of iodine or iodide either as a dietary supplement or as a contrast medium
Jod basedow phenomenon
Thyrotoxicosis
Ophthalmopathy
Dermopathy
Graves disease
Most common cause of hypothyroidism in iodine sufficient areas of the world
Autoimmune hypothyroidism
Chernobyl
Papillary thyroid carcinoma
Thyroid cancer: calcitonin
Medullary thyroid carcinoma
Pathogenesis:
Failure of the mechanisms that maintain self- tolerance
SLE
Most common etiology of Hypertension
Primary or essential hypertension
Most common etiology of Secondary Hypertension
Renovascular hypertension
approximate weight of the heart in the average adult male
300 to 360 grams
Female : 250 to 320 grams
A chronic process involving damage to endothelium and the build up of vessel-occluding lesions called plaque
Atherosclerosis
Most common cause of myocardial ischemia
Coronary artery disease
The earliest detectable feature of myocyte necrosis
Sarcolemmal membrane disruption
What is the most important disease affecting the heart?
Coronary Heart Disease
The most abundant form of lactate dehydrogenase in the heart is:
LD1
Most cardio-specific troponin?
Trop I
Hemosiderin-laden macrophages that are telltale signs of previous episodes of pulmonary edema
Heart failure cells
Macrophages seen in placenta
Hofbauer cells
Histopathologic finding in interstitial lung disease suggestive of significant asbestos exposure (asbestosis)
Ferruginous bodies
The most common congenital cardiac malformation
Ventricular septal defect
The most common genetic cause of CHD
Down Syndrome (Trisomy 21)
The most likely gene defect in DiGeorge Syndrome
TBX1
Most common location of atrial septal defect
Near the center of the atrial septum
Most common type of Atrial Septal Defect
Ostium secundum
Most common cardiac anomaly seen in an infant presenting with mental retardation, brushfield spots and a simian crease
Endocardial cushion defect
Most common cyanotic Congenital Heart Disease
Tetralogy of Fallot
The most common manifestation in Rheumatic Fever
Migratory Arthritis
The antecedent infection associated with the molecular mimicry seen in Rheumatic Fever
Streptococcus pyogenes
Libman-sacks disease refers to
Endocarditis of systemic lupus erythematosus
The most common etiology of Myocarditis
Coxsackie B virus
Infective endocarditis associated with virulent organisms; affects previously normal valves; highly destructive; bulkier vegetations; valve perforation common
acute IE
Known as Apical ballooning syndrome, Stress cardiomyopathy or “Broken-hearted” syndrome
Takotsubo Syndrome
Peripheral manifestations of infective endocarditis
Roth’s spots
Janeway lesions
Osler’s nodes
Drug of choice for the prophylaxis of Rheumatic Fever
benzathine Penicillin
Most common location of Ventricular septal defect
Membranous interventricular septum
Oncogenes and tumor suppressor genes of Papillary Thyroid CA
RET
Most common alteration in Papillary Thyroid CA
BRAF
Oncogene and tumor suppressor gene for follicular thyroid CA
PAX8-PPARy1
Oncogene and tumor suppressor genes for Anaplastic Thyroid CA
p53
TERT, BRAF and CTNNB1
Guardian of the genome
p53
BRAF mutation
- loss of iodine uptake by tumor cells
- increase recurrence rate
Most common type of thyroid CA
Well differentiated thyroid malignancy
Orphan Annie eyes/ clear cell nuclei
Papillary thyroid CA
Most common thyroid cancer seen in iodine deficient regions
Capsular and or vascular invasion
Hurtle cell histology
Follicular thyroid Ca
Hallmark of intestinal metaplasia
+ of goblet cell
Drug that causes gingival hyperplasia
Phenytoin
Most common cause of death of young athletes
Hypertrophic obstructive cardiomyopathy
Acute cause of Right Ventricular Hypertrophy
Pulmonary embolism
First sign of puberty in girls
Thelarch/ breast bud
8 yr/old
Virchow’s triad?
Stasis
Increased vascular permeability
Hypercoaguability
Earliest manifestatiob of almost all forms of injury to cell
Cellular swelling
Pro-apoptotic proteins
Bax
Bad
Bak
Anti-apoptotic
Bcl-2
Necrosis in solid parenchymal organs like heart and kidney that preserves architecture and with ghost cells
Coagulative
Necrosis in brain (acute cerebral infarct) abscess and pleural effusion
Liquefactive
Necrosis in TB granuloma with lysed cells surrounded by inflammatory cells
Caseation
Necrosis in pancreas and adipose tissues
Fat necrosis
Necrosis in arteries
Fibrinoid necrosis
Necrosis in DM foot
Gangrenous necrosis
A genetically controlled form of cell death that resembles necrosis morphologically but like apoptosis genetically.
Ligation of TNFRI
Necroptosis
This occurs in cells infected by microbes and involves activation of caspase-I, whick cleaves the precursor form of IL-1 to generate biochemically active IL-1
Pyroptosis
An iron dependent pathway of cell death induced by lipid peroxidation
Ferroptosis
Most common cause of fatty change in adults
Alcohol
Neurofibrillary tangles
Alzheimer’s disease
Russel bodies
Multiple myeloma
PSaMMoma bodies
Papillary thyroid
Serous ovarian carcinoma
Meningioma
Mesothelioma
Most reactive oxygen-derived free radical
Hydroxyl radical
Pathogenesis:
Loss of CFTR leads to defects in chloride transport
Cystic fibrosis
Pathogenesis:
Loss of LDL receptor leads to hypercholesterolimia
Familial hypercholesterolemia
Pathogenesis:
Lack of lysosomal enzyme leads to storage of GM2 gangliosides i neurons
Hexosaminidase B subunit
Tay sachs disease
Abnormal folding of PrPsc causes neuronal cell death
Prion
Creutzfeldt-jacob disease
Abnormal folding of AB peptides causes aggregation within neurons and apoptosis
AB Peptide
Alzheimers disease
Wernicke’s triad
Ophthalmoplegia
Ataxia
Altered mental status
Most common cause of acute pancreatitis
Gallstone
Most common cause of chronic pancreatitis
Alcoholism
Most common hyperthermic syndrome
Heat exhaustion
Nitrosylation of ryanodine receptor type 1 (RYR 1)
Malignant hyperthermia
Drugs that can cause malignant hyperthermia
Succinylcholine and Halothane
Treatment of malignant hyperthermia
Dantrolene
Most dangerous type of electrical current
AC
Produces tetanic contractions
DC produces single shock
Most common form of PEM
Kwashiorkor
Loss of body fat and atrophy of muscles
“Broomstick extremities”
Bone marrow hypoplasia
Marasmus
Russel’s sign
Calluses on back of hands
Bulimia nervosa
Nyctalopia
Xerophthalmia
Bitot spot
Keratomalacia
Vitamin A disorder
Earliest manifestation of Vitamin A deficiency
Nyctalopia or night blindedness
Pathologic fractures
Bow legs (genu varum)
Tetany
Craniotabes
Rachitic rosary
Pigeon breast deformity
Osteomalacia
Dx?
Vitamin D deficiency
Perifollicular hemorrhage
Hemarthrosis
Bleeding gums
Loosened teeth
Glossitis
Poor wound healing
Dx?
Scurvy
Vitamin C deficiency
Vitamin A toxicity
Papilledema
Pseudotumor cerebri
Hepatitis
Seizure bone pains
Acrodermatitis enterohepatica
Anorexia and diarrhea
Growth retardation
Depressed wound healing
Dx?
Zinc deficiency
Hypochromic microcytic anemia
Dx?
Iron deficiency
Goiter and hypothyroidism
Iodine deficiency
Muscle weakness
Neuro defect
Abnormal collagen cross-linking
Copper deficiency
Squamous metaplasia of lactiferousducts
Periductal mastitis/abscess
Zuska disease
KERATINIZING SQ METAPLASIA OF THE NIPPLE DUCTS
Subareolar mass with nipple retraction (not breast CA)
Smokers and vitA deficiency
Inflammation and dilation of the subareolar ducts
Multifarious post menopausal women
(-) sq metaplasia
Mammary duct ecstasies
Most common change in premenopausal women (25-45y.o)
Unopposed estrogen stimulation
Fibrocystic change
Gross appearance of fibrocystic change of the breast
Blue dome appearance
Bloody nipple discharge in a premenopausal women
Fibrovascular core lined with epithelial and myoepithelial cells
Intraductal papilloma
Bloody nipple discharge in a postmenopausal women
(-) myoepithelial cells
Papillary carcinoma
Most common benign neoplasm of the breast
Fibroadenoma
Premenopausal in 20’s and 30’s
Marble-like mass
Estrogen sensitive
Fibroadenoma-liketumor with overgrowth of fibrous component
Leaf-like projection
Phyllodes tumor
Postmenopausal women
Can be Malignant
Most common carcinoma by incidence
2nd most common by mortality
Breast cancer
Mammographic signs of CA
Densities and calcifications
(+) calcifications on mammogram
No invasion of basement membrane
Malignant proliferation of cells in ducts
Ductal carcinoma in situ (DCIS)
Other Conditions which may cause calcification on mammography
Fat necrosis
Sclerosing adenosis
Nipple ulceration and skin erythema
DCIS that extends up to the skin of the nipple
Associated with CA
Microscope: RETE PEGS
Pagets disease
Most common type of invasive carcinoma
Invasive ductal carcinoma
Palpable mass
(+) calcifications on mammography
(+) skin dimpling
(+) nipple retraction
Biopsy: duct like structures in a DESMOPLASTIC STROMA
Invasive ductal carcinoma
Breast:
Swollen
Erythematous
Peau d’Orange
Mistaken for mastitis
Inflammatory Breast cancer (IBC)
Malignant proliferation of cells in lobules
No invasion of basement membrane
Incidental finding in premenopausal women
DYSCOHESIVE CELLS LACKING E-CADHERIN
Lobular carcinoma in situ
Indian file configuration(single file pattern)
No duct formation due to loss of e-cadherin
Invasive lobular carcinoma
ER and PR predict response to antiestrogenic agent such as ______
Tamoxifen
HER2-NEU amplification is associated with response to ______
Trastuzumab
Triple negative ER, PR, HER2NEU
Prognosis?
Poor prognosis
Triple negative breast carcinoma
Single gene mutation associated with Breast and Ovarian
BRCA1
Single gene mutation associated with Breast CA in males
BRCA 2
Most common malformation of the urethral groove and canal
HypOspadia
Ventral surface
Chordee (hook shaped)
Inguinal hernia
Cryptoorchidism
Defect of Genital tubercle
Epispadia
Dorsal surface
Bladder entropy
Female: bifid clitoris
Small orifice of prepuce preventing normal retraction
Phimosis
Tx: circumcision
Infection of glans and prepuce
Balanoposthitis
Candida albicans/ gardnerella
Accumulation of smegma
Fibromatosis of the Buck’s fascia
Painful contractures/ curvature of the penis and pain during intercourse
Peyronie disease
Causes infertility
Persistent painful erection
Priapism
Sickle cell disease
Penile trauma
Benign genital warts caused by low oncogenic virus
HPV 6 and 11
Hyperkeratosis (acanthosis)
Parakeratosis
Cytoplasmic vacuolization of the squamous cells (Koilocytes)
Fibrovascular cores
Condyloma acuminata
HPV 6 and 11
Men >35yo involving skin of shaft and scrotum
Solitary, thickened gray-white; opaque plaque; as single or multiple shiny red, velvet plaques
Bowen disease
Erythroplasia of Queyrat
(Precursor of Invasive SCCA)
Younger, sexually active males involving skin of shaft and scrotum
Multiple reddish brown popular lesions
May regress
Bowenoid papulosis
Most common carcinoma of penis
Squamous cell carcinoma of the penis
High risk HPV infections in Squamous cell carcinoma of penis
HPV 16 (MC)
HPV 18 (2nd MC)
Keratin pearls
Intercellular bridges
Squamous cell carcinoma
Common etiologic agents in inflammation of Epididymis
<35yo - Chlamydia trachomatis and neissreia gonorrhea
> 35yo - E. Coli and pseudomonas aeroginosa
Common etiologic agents of orchitis
Autoimmune granulomatous
Gonorrhea
Mumps
TB
Syphillis
Sudden testicular pain
Bell clapper abnormality
Only urogenital emergency should be untwist within 6hrs
Testicular torsion
Congestion, extravasating of blood
Testicular infarction
Most common testicular tumor in 15 to 34 yo males
Germ cell tumors
Factors:
KIT & BAK Genes
Testicular dysgenesis syndrome
Klinefelter syndrome
Germ cell tumors originate from GCNIS (Germ Cell Neoplasia In Situ) except:
Pediatric yolk sac tumor
Teratoma
Adult spermatic tumor
Most common type of germ cell tumor in males
Seminoma (50%)
Dysgerminoma in females
Most common tumor in infants and children up to 3years of age (very good prognosis)
Schiller ducal bodies
Hyaline globules: AFP & a1-antitrypsin
Yolk sac tumor/ endodermal sinus tumor
Helter smelter collection
(Collection of differentiated cells or organoid structures)
Teratoma
Serous fluid collection in the scrotum
Hydrocele
Inflammation of testis
Orchitis
Dilatation of veins of spermatic cord
Bag of worms
Varicocele
Most common germ cell tumor of the testis
Seminoma
Most common tumor of testis during infancy and early childhood
Yolk sac tumor
Major growth factor for prostatic tissue
DHT
Major cause of Vulvovaginitis
Candida albicans
PainFUL genital ulcer caused by?
ChancROID!
Hemophylus ducreyi
Causes genital Vesicular lesion
HSV type 2
Most common cause of vaginal discharge
Thin and hemogenous discharge
+10% KOH = fishy amine odor
“Clue cells”
Bacterial vaginosis
Gardrinella vaginalis
Common cause of pelvic inflammatory disease
Neisseria gonorrhoeae
Another cause of vaginosis
Wet mount - flagellated motile organisms
Trichomonas vaginalis
Common benign tumor of vulva presenting as nodule that may ulcerate and bleed
Papillary hidradenoma
In utero exposure to DES causes?
Clear cell adenocarcinoma
Indicates HPV infected epithelial cells
Koilocytes
Macrophage stuffed with numerous C. Granulomatis organism
Donovan bodies
Large cells surrounded by clear halo-like area
Paget cell
Most common benign tumor of female reproductive tract
Fibroids
Most common gynecologic malignancy
Endometrial cancer
Prolonged bad unopposed exposure to estrogen
Obesity, diabetes, nulliparylity and hypertension
Early sexual activity with multiple partners is associated with ?
Cervical cancer
Stein-Leventhal syndrome aka
Polycystic ovary syndrome
A mass resembling a bunch of grapes projecting into the vagina
Sarcoma botryoides
Islands of endometrium in myometrium
Adenomyosis
Presents with signs and symptoms of excess estrogen production
Granulosa cell tumor
Rare histo resembles transitional epithelium of bladder
Brenner tumor
A monodermal teratoma composed of functional ectopic thyroid tissue
Struma ovarii
Young patient
Precocious puberty
Ovarian mass
Granulosa cell tumor
Small follicles filled with eosinophilic secretions found in granulosa cell tumor
Call exner bodies
Bilateral metastatic involvement of the ovaries by a Signet Ring Carcinoma arising in stomach
Krukenberg tumor
Sudden peripartal respiratory difficulty progressing to shock and often to death
Amniotic fluid embolism
Obstetric blood loss with resultant pituitary ischemia leading to postpartal hypopituitarysm
Sheehan syndrome
Pruritic, planar, polygonal, and purple papules often with retucular white lines on their surface (WICKHAM STRIAE) commonly involve wrist, elbow and oral mucosa
Lichen planus
Inflammation of the dermal-epidermal junction with a SAW-TOOTH appearance
Lichen planus
Well circumscribed, salmon colored plaques with SILVER SCALE, usually on extensor surface and scalp
Psoriasis
+ munro microabcess
+ auspitz sign
Psoriasis
Munro - collection of neutrophil in S. Corneum
Auspitz sign - bleed when scale is picked off
Autoimmune destruction of desmosomes between keratinocytes
Pemphigus vulgaris
Autoimmune destruction of hemidesmosomes between basal cells and the underlying basement membrane
Bullous pemphigoid
Due to IgG antibody againts basement membrane collagen
Tense bullae do not rupture easily
Bullous pemphigoid
Autoimmune deposition of IgA at the tips of dermal papillae
Pruritic vesivles and bullae that are grouped (herpetiform)
Dermatitis Herpetiformis
Hypersensitivity reaction characterized by TARGELOID RASH (central epidermal necrosis surrounded by erythema) and bullae
Erythema multiforme
Severe form of SJS characterized by diffuse sloughting of skin, resembling a large burn; most often due to adverse drug reaction
Toxic epidermal necrolysis
Raised, discolored plaques on the extremities or face; often has a COIN-LIKE waxy stuck on appearance
Seborrheic keratosis
Sudden onset of multiple seborrheic keratoses and suggests underlying GI CARCINOMA
Leser-Trelat sign
Epidermal hyperplasia with darkening of the skin (velvet like skin) often involes the axilla or groin
Acanthosis nigricans
Most common cutaneous malignancy
Basal cell carcinoma
Elevated nodule with central, ulcerated crated surrounded by dilated (telangiectatic) vessels
“Pink, pearl-like papule” — UPPER LIP
Basal cells with peripheral PALISADING
Basal cell carcinoma
Ulcerated, nodular mass, usually on the face — LOWER LIP
Squamous cell carcinoma
Precursor lesion of squamous cell carcinoma and presents as a hyperkeratotic, scaly plaque, often on the face, back or neck
Actinic keratosis
A well-differntiated squamous cell carcinoma that develops rapidly and regress spontaneously; presents as a cup-shaped tumor filled with keratin debris
Keratoacanthoma
Most common mole in children
Begins as nests of melanocytes at the dermal-epidermal junction
Junctional nevus
Most common mole in adults
Intradermal nevus
Nevus precursor to melanoma
Dysplastic nevus
Most common cause of death from skin cancer
Melanoma
Most important prognostic factor in predicting metastasis
Depth of extension
(According to Breslow thickness)
Erythematous macules that progress to pustules, usually on the face; rupture of pustules results in erosion and dry, crusted, honey-colored serum
Impetigo
Red, tender, swollen rash with fever
Due to S. Aureus or S. Pyogenes
Cellulitis
Sloughing of skin with erythematous rash and fever leads to significant skin loss
Due to S. Aureus infection, Exfoliative A and B toxins results in epidermolysis of stratum granulosum
Staphylococcal scalded skin syndrome (SSSS)
Flesh colored papules with rough surface due to HPV infection of keratinocytes — KOILOCYTIC CHANGE
Verruca (Wart)
Firm, pink, UMBILICATED papules due to Pox virus
Cytoplasmic inclusions
Molluscum contangiosum
