Pathology Flashcards
Mobitz I
–Progressive PR int lengthening–>drop QRS
aka weinkebach
Usually due to inferior MI. Rarely progresses to 3rd degree heart block
Tx: Atropine or isoproterenol
Mobitz II
-intermittent P nonconduction
BBB association
Often progresses to 3rd deg AV block
Usually due to anterior MI
P wave
atrial depol
a wave
LA contraction
T wave
ventricular repolarization
Wavy fibers
Eiosinophilic bands of necrotic myocytes. Early sign of MI
Janeway’s Lesions
Acute bacterial endocarditis
Nontender, erythematous lesions on palms & soles
Osler’s Nodes
Subacute endocarditis sign?
Tender lesions of fingers & toes
“ouch ouch Osler”
Thiamine deficiency
Wet Beri Beri -> heart. Dilated cardiomyopathy due to chronic ETOH consump
Dry Beri Beri = peripheral neuropahty
Wernicke-Korsakoff= ataxia, confusion, confabulation, memory loss, vision changes
Fibrinous Pericarditis
Associated w MI–3-7 days ppost transmural MI
Dresslers (6-8 wk)– autoimmune Igs to pericardium
Serous pericarditis
Associate w/ nonbacterial causes: viral (Coxsackie) infection, immunologic rxns
Friction Rub
Pericarditis associated finding
Hemorrhagic pericarditis
Associated w TB or neoplasm
Restrictive Cardiomyopathy
stiffens heart, diastolic dysfct
Due to amyloidosis in elderly
Die to Schaumann & asteroid bodies in youn (<25)?
PML’s infectious agent
JC virus
papovirus= dsDNA, naked icosohedral capsid
Edema
- ↑Pc (more seeps out)
- ↓πc (less reabsorbed into vessel)
- ↑ permeability endothelium
- Block lymphatic drainage
Adult Polycystic Kidney Disease
AKA autosomal-dominant polycystic kidney disease
Commonly see: liver cysts, Berry aneurysms along w/ kidney cysts. Hematurea & HTN often present
3 cysts in each kidney w + fam hx confirms dx
Malignant HTN & Kidneys
Petechial hemorrhages are seen on kidney surfaces= Flea-bitten kidneys
Young AA men
Nephritic Signs
Hematuria; RBC casts; HTN
Nephrotic Signs
Proteinuria; hypoalbuminemia; edema
Podocyte Effacement
Seen w Minimal Changes Disease (lipoid nephrosis)
ASO
Seen in Acute post-streptococcal GN (due to βHGASrtep)
Anti streptinolysin O
Crescentic GN
Rapidly progressive GN- nephritic syndrome
Associated w/ multisystem disease or post-strep/post-infectious glomerular nephritis
Hereditary Nephritis
Alport’s syndrome…X linked
Renal disease w/ deafness & occular abnormalities
Membranoproliferative GN
Can be secondary to to complement deficiency, chronic infections, CLL
See “tram tracking” on histo
Type I Membranoproliferative GN Deposits
C3 and IgG deposits– immune complex deposits
Type II Membranoproliferative GN Deposits
Only C3 deposits
AKA dense deposit disease
Focal Segmental Glomerulosclerosis Deposits
IgM & C3 deposits
Cold Agglutinins
Seen in atypical pneumonia (mono, mycoplasma)
It is IgM Ab w/ specificity for I Ag on adult RBCs
Scrofula
TB in the lymph nodes
Aspirin-Asthma Triad
Nasal polyps, allergic rhinitis, bronchoconstriction
Ferruginous Bodies
Hemosiderin (pigment w/ Fe3+) covered fibers that have been phagocytized by macrophages
Pancoast Tumor
Sx: Ulnar nerve pain & Horner’s syndrome, hoarse voice
Fatty Degeneration
Made up primarily of triglycerides
MCC: alcoholism, leads to cirrhosis
Associated w CCl4-
Cloudy swelling
Failure of cellular Na pump
Seen in fatty change of liver and in hydropic (vacuolar) degneration of the liver
Hydropic degeneration
Severe form of cloudy swelling
seen w/ hypokalemia incuded by vomiting/diarrhea
Liquefactive Necrosis
Rapid enzymatic breakdown of lipids
Seen commonly w CNS lesions
Seen in suppurative infection= pus formation
Coagulation Necrosis
Result of sudden ischemia
Seen in organs w end arteries (limited collateral circ)= heart, lung, kidney, spleen
Caseating Necrosis
Combination of both coag & liquefaction nec
Seen w/ M. Tb and Histoplasma capsulatum infection
Fibrinoid Necrosis
Seen in the walls of small arteries
Assoc. w/ malignant HTN, polyarteritis nodosa, immune-mediated vasculitis
Fat Necrosis
Result of lipase actions liberated from pancreatic enzymes
Seen w/ acute pancreatitis–> saponification results
Hemoptysis
Blood in sputum
Pulmonary Embolism
Most commonly thrombus from deep vein of lower extremity
-Virchow’s triad
Phlebothrombosis
-venous blood clot forms independently of inflamm. of vessel
From: a vein of lower extremities, a pregnant uterus, in CHF, bed ridden pt.
As a complication in a pt w pancreatic Ca due to inc. blood coagulability
Saddle Embolus
Embolus lodged in a bifurcation of pulmonary trunks
Inc. in RV strain= RV & RA dilate= acute cor pulmonale
Paradoxical Embolism
R to L shunt allows a venous embolism to enter arterial circulation
Patent foramen ovale or Atrial Septal Defect
Tuberculoid Granuloma
Collection of macrophages w/o caseation
Seen w/ sarcoidosis (non-caseating); syphilis; Brucellosis; Leprotic infections
Cellulitis
Spreading infection due to strep.
-inflammation of connective tissue, dermsi, subcut
PSA
Prostate specific antigen=elevated in prostate Ca
Controversial training measure
Elevated 5HT
In cases of metastatic carcinoid
Tx: w methysergide (5-HT antagonist)
Elevated alpha-Feto Protein (AFP)
Seen in:Hepatocarcinoma
Neural tube defects
CEA
Carcinoembryonic Antigen= elevated in colon CA
Chromosome 13
Retinoblastoma
Chromosome 11p
Wilms’ tumor of the kidney
Vinyl Chloride
Associated w/ Angiosarcoma of the liver
Agent Orange
Contains dioxin
Implicated as a cause of Hodgkin’s disease, non-Hodgkin’s lymphoma & soft tissue sarcomas
Parasites & CA
Schistosoma haematobium= Urinary bladder CA risk
Schistosoma mansoni= colon cancer risk
Aspergillus flavus= potent hepatocarincogen
Ochronosis
Inherited form: Alkaptonuria= black urine
Error in tyrosine metabolism due to homogentisic acid (oxidize tyrosine)
Involving intervertebral discs= ankylosing spondylitis= poker spine
See dark urine, sclera, tendons, cartilage
Lead poisoning
Acid fast inclusion bodies Inc urinary caproporphyrin Anemia: microcytic/hypochromic Stippling of the basophils Gingival line & lead line in bones on X-ray Mental retardation
Heroin OD, clinically
Massive pulmonary edema w/ frothy fluid from the nostrils
Fetal Alcohol Syndrome
Small head, small eyes, funnel chest, ASD, mental deficiency, hirsutism
Atypical mycobacterium
M. kansasii & M. avium intercellulare
Cold Abcesses
Liquified TB lesions similar to pyogenic abcesses but lacking acute inflammation
Actinomyces Isrealli
Farmers Infection Lumpy jaw (from chewing grain) & PID (IUD) but most common is due to saprophyticus
Congenital Syphilis
Saddle nose, Saber shin, Hutchinson’s teeth, nerve deafness, interstitial keratitis
Warthin-Finkeledy Cells
Reticuloendotheial giant cells on tonsils, lymph nodes, spleen
Seen w Rubeola (measles) due to paramyxovirus
Diphylbothrium latum
Tapeworm infection causing megaloblastic anemia by consuming large amt of B12 in host
Acutea Bacterial Endocarditis
Staph aureus, Beta hemolytic strep, E. coli
Common among IVDA and diabetics
Subacute Bacterial Endocarditis
alpha hemolytic Strep (S. viridans)..usually in pt w preexistig heart/valve problem
Mitral Insufficiency
Rupture papillary muscle
Left Anterior Descending Branch
Branch of the left coronary artery
Highest freq. of thrombotic occlusion
MI= anterior wall of LV, esp. in apical part of interventricular septum
Left Circumflex Branch
Branch of LCA
Occlusion= MI of posterior/lateral wall of LV
Dissecting Aneurysm
False aneurysm: splitting of the media of the aorta
Usually w long hx of severe HTN, also seen w/ familial hyperlipidemia, athersclerotic disease, Marfan’s
Zones of medical necrosis +/- slit-like cysts=medical cystic nec. of Erdheim–> autosomal dom, aka familal thoracic aortic aneurysm
Cor Pulmonale
RV strain due to pulmonary HTN, associated, associated w/ RV hypertrophy
Acute Cor Pulmonale
Sudden RV strain due to massive PE
Bronchopneumonia
Lobular rather than lobar
Common causes: S. aureus, P. aeruginosa, Klebsiella, E. coli,
Abcess formation is common
Lobar pneumonia
Community acquired= Strep pneumo infection (5% due to Klebsiella)
Red hepatization= day 1-3 of pneumonia
Gray hepatization= 3-8 of untxed pneumonia
Complications: pleural effusion, atelectasia, fribrinous pleuritis, empyema, fibrinous peridcarditis, otitis media
Bronchiectasis
Permanent dilatation of the bronchi– predisposed by chronic sinusitis & post-nasal drip
supparation associated
Lower lobe> upper lobe
Cold Agglutinins
- Usually IgM, autoimmune hemolytic anemia
Found in mycoplasma pneomonea, mono, CLL
Panlobular Emphysema
A1AT deficiency associated
Inc. Elastase= Inc compliance in the lung
Bulla
Associated w/ emphysema= “Bleb” = outpouching …may rupture and cause spontaneous pneumothorax
Farmer’s Lung
Due to micropolyspora faeni (thermophilic actinomyces)
Type III hypersensitivity pneumonitis
Bagassosis
Hypersensitivity pneumonitis
Due to M. vulgaris (actinomycetes) from moldy sugar cane
Silo-Filler’s Disease
Due to NO2 inhalation from nitrates in corn
G6PD deficiency
Enzyme in pentose phosphate shunt…regens NADPH
Sex-linked chronic hemolytic anemia w/o challenge or after eating fava beans/oxidative stress
Heinz bodies appear on RBCS, bite cells seen
Elevated HbF
Seen in Sickle Cell Anemia
Multiple Myeloma
Lytic lesions of flat bones (“salft & pepper” lesions”) …vertebrea, ribs, skull
Hypercalcemia, Bence-Jones Protein Casts
“CRAB”
Hodgkin’s Disease
Malignant neoplasm of the lymph nodes causing: pruritis, fever= can mimic EBV/acute infections
Reed-Sternberg cells
Polyarteritis Nodosa
Immune complex depostion on vessel walls
Medium/small vessel vasculitis
Hep B Ag association (30% of pt.s)
Can see fever, abd. pain, dec. weight, HTN, muscle aches
Sprue
Celiac disease due to gluten-induced enteropathy= small intestine villi blunted
High titers of anti-gliadin Abs & IgA levels
Regional Enteritis
AKA Crohn’s disease
Association w/ arthritis; uveitis; erythema nodosum
Whipple’s Disease
Caused by bacterium Tropheryma whipplei (actinomycetes).
Intestinal lipodystrophy= malabsorption syndrome
Kulchitsky Cells
Neural crest cells from which carcinoids arise in the bronchi, GIT, Pancreas
Ulcerative Colitis
Inflammatory disease of the colon w/ inc. colon CA incidence
Crypt abcess in the crypts of Lieberkuhn
Pseudopolyps when ulcers are deep
No transmural involvement
Vaginal adenosis
Women exposed to DES (diethylstilbesterol) in utero before 18th week of pregnancy
Some develop clear cell adenocarcinoma of vagina & cervix (usually < 30 yo)
Scirrhous Carcinoma
Infiltrating ductal carcinoma w/ fibrosis– most common type of breast carcinoma
Hofbauer Cells
Lipid laden macrophages seen in villi of Erythroblastosis Fetalis (hemolytic disease of the newborn)– seen w maternal IgG crossing placenta
Retinopathy of Prematurity
aka Retrolental fibroplasia
blindness in premies due to high supplemental O2 concentration…leads to free radical injury
IgA deficiency
Genetic cause
Pt has recurrent infection & diarrhea w/ inc repiratory tract allergy & autoimmune disease
If given blood w IgA–> develop severe anaphylaxis
Primary Sjogrens
Autoimmune– HLADR3 associated
Sx:Dry eyes & dry mouth, arthritis. Inc risk of B cell lymphoma.
Secondary Sjogrens
RA, SLE< or systemic sclerosis associated
HLA-DR4 associated
LDH1& LDH2
Myocardium
LDHI > LDH2–> MI
LDH3
Lung Tissue
LDH4 & LDH5
Liver cells
Keratomalacia
Severe Vit A deficiency. See Bitot’s spot in the eyes= gray plaques= thickened, keratinized conjunctiva
Metabisulfite Test
Suspending RBCS in a low O2 content sol’n
Can detect Hemoglobin S, which sickles in low O2
Microangiopathic Hemolytic Anemia
Can be due to HUS and TTP
See helmet cells
Wright’s Stain
Stain for Burkitt’s lymphoma
Mononucleosis
Due to EBV infection (CMV possible)
If mono is txed w ampicillin, thinking that it is a strep pharyngitis, a rash will occur
T(8:14)
Burkitt’s lymphoma translocation
c-myc oncogene overexpression
T(9:22)
Philadelphia chromosome, translocation of CML= abl/bcr gene formation
Langerhan Cell Histiocytes
Dendritic cells of skin & mucosa
Birbeck granules present tennis racket shape
Langerhans cell histiocytosis subtypes:Letterer-Siwe disease, Hand Schuller Christian Disease, Eiosinophilic Granuloma
Myeloid Metaplasia
Alkaline Phosphatase elevated/normal (compared to low in CML)
Anemia; splenomegaly; platelets> 1 mill= extensive extra-medullary hematopoiesis
Multiple Myeloma
Weakness, weight loss, recurrent infections, proteinuria, anemia, proliferation of plasma cells in BM= plasma cell dz
Serum M protein spike…most often IgG or IGA light chain
Hypercalcemia…lytic bone lesions
T(14:18)
NHL Lymphoma= bcl2 proto-oncogene overexpression seen w/ follicular lymphoma
Focal Segmental Glomerulonephrosis Exs
IgA focal GN= Berger’s disease, SLE, PAN, Henoch-Schonlein purpura
Nephrotic Syndrome Exs
Focal (segmental); membranous GN, lipoid (minimal change) GN, membranoproliferative GH, Hep B, Syphilis, pencillamine
Schistosoma Haematobium
Infection is associated w/ squamous cell CA of the bladder (most common bladder Ca in transitional cell type)
associated w portal HTN due to intrahepatic obstruction
Penicillin Resistant PID
PID usually due to N. gonnorhea, but if unresponsive to penicillin think of bacteroides cause
Duret Hemmorrhages
Severe ↑ in ICP w/ downward diplacement of cerebellar tonsils into Foramen Magnum causing acompression on the brainstem w/ hemorrhaging into the pons & midbrain Nearly always associated w/ death due to damage to the vital centers in these areas
Hypertensive Hemorrhage
Predilection for lenticulostriate arteries= putamen& internal capsule hemorrhages
Cerebral Embolism
from MI w/ mural thrombis, or atrial fib thrombi= marantic thrombi; L-sided bacterial endocarditis; paradoxical embolism w a septal defect
Neurosyphilis
Tabes Dorsalis= Dec joint position sensation, dec pain sensation, Argyl Roberston pupils
Syphilitic Meningitis
Paretic neurosyphilis
5p deletion
Cri du Chat: mental retardation, small head, wide set eyes, low set ears, cat like cry
Trisomy 13
Patou’s: small head & eyes, cleft lip & palate; many fingers
Acute cold agglutination
Abs to I blood group Ag. Mediated by IgM ABs
Complication of EBV or mycoplasma pneumonial infections
Chronic Cold Agglutination
Assoicated w/ lymphoid neoplasms. See agglutination & hemolysis in tissue exposed to cold IgM Abs
RBC Osmotic Fragility
Hereditary spherocytosis
Non-Hodgkin’s Lymphomas
Small lymphocytics: low grade B cell lymphoma of the elderly. Related to CLL
Follicular lymphoma: low grade B cell lymphoma of the elderly. T(4:18) bcl2 oncogene
Large Cell
Lymphoblastic: high grade T cell lymphoma of kids progressing to T-ALL
Small Non cleave= Burkitt’s= high grade B cell lymphoma. EBV infection assoc. “starry sky” histo appearance. T(8:14) c-myc proto-oncogene. Related to B-ALL
Singer’s Nodules
Benign laryngeal polyps associated w/ smoking & overuse of the voice
Paraseptal Emphysema
Associated w/ blebs (large subpleural bullae) that can rupture and cause pneumothorax
Superior Vena Cava Syndrome
Obstructed due to bronchogenic carcinom. Causing swollen face & cyanosis
Betel Nuts
AKA Areca nut, chewed in South Asia
Associated w oral cancer
Fundal (Type A) Gastritis
Antibodies to Parietal cells; pernicious anmia; autoimmune disorders
Antral (type B) Gastritis
Associated w H. pylori infection. 90% of duodenal ulcers have this bacteria present
Primary Biliary Cirrhosis
Autoimmune origin: see in middle aged women, anti-mitochondrial Abs
Sx: jaundice, itching, hypercholesterolemia (can see cutaneous xanthomas)
Acute Pancreatitis
Elevated pancreatic enzymes= fat necrosis saponification.-> hypocalcemia, inc serum amylase
Severe epigastric pain, prostration, radiation to the back
Pain radiating to back
Chronic pancreatitis
Complete hydatidiform mole
No embryo. Paternal DNA only…46XX
Partial hydatidiform mole
Embryo. 2 or more sperm fertilized 1 ovum. Triploidy/tetraploidy occurs
Cold Nodules
Hypoplastic goiter nodles that do not take up radioactive iodine. (vs. hot nodules do)
Acidophils
From anterior pituitary (adenohypophysis)
Mammatrophins= prolactin
Somatotrophins= GH producing
“GPA”
Basophils
From anterior pituitary (adenohypophysis)
Thyrotrophins= TSH
Gonadotrophins= LH& FSH
Corticotrophins= ACTH
Lacunar Strokes
Small/focal aa occlusions. Purely motor or sensory
Sensory= thalamic lesion
Motor= internal capsule
CSF of Bacterial Meningitis
↓ Glucose; ↑ Protein; ↑ Neutrophils; ↑ Pressure
CSF of Virla Meningitis
Normal Glucose; +/-↑ Protein; ↑ Lymphocytes
Marble Bone Disease
Osteopetrosis: Albers-Schonberg Disease= inherited disorder. inspite of inc bone density many fractures due to dec osteoclast activity
C5a
complement factor chemoattractant– Involved in chemotaxis (for neutrophils)
C3b
complement factor involved in opsonization
Anaphylotoxins
C3a and C5a (mediate Histamine releasefrom basophils & mast cells)
Vasoactive mediators
Vasoconstriction: TxA2; LTC4; LTD4; LTE4; PAF
Vasodilation: PGI2; PGD2; PGE2; PGF2α; Bradykinin; PAF
↑d Vascular Permeability: Hist.; 5HT; PGD2; PGE2; PGF2α; LTC4; LTD4; LTE4; Bradykinin; PAF
Platelet Aggregation
ADP; Thrombin; TxA2; collagen; Epinephrine; PAF
Platelet Antagonist
Prostacyclin (PGI2)
Intrinsic Pathway– coag
F XII(Hagman): follow w PTT
Extrinsic Pathway– Coag
F VII: follow w PT
