PreMidterm lab slides review Flashcards by Minh Lam

Mod 4 Slide 30

Mycobacterium leprosy

Tuberculoid leprosy: Th1, granuloma, IL-2, IFN-gamma, well-formed granuloma, no bacteremia,
Lepromatous leprosy: Th2, more severe, lipid-ladened macrophages w bacteria, weak immune system so disorganised granuloma (histo fig.)

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Mod 4 Slide 29

Bartonella Hensliae

Cat scratch disease can affect immunocompetent
necrotizing (non-caseous) of LN; mixed B & T hyperplasia; no Giant cells, stellate-shape

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Lobular: bronchopneumonia, less virulent (staph. aureus, pseudomonas, E. coli, Klebsiella)

diffuse but can coalesce to look similar to lobar

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Lobar: pneumococcal, pores of Kohn, virulent organisms (strep. pneumonia)

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Staph infections: skin mostly

complications: mastitis, endocarditis from IV opiates, bacteremia, osteomyelits, bronchopneumonia
toxin-mediated: Scalded skin, TSS, food poisoning, enterotoxin, tampons

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CMV: inclusion bodies both nucleus & cytoplasm; blindness in AIDS Pt, cottony-wool on fundoscopy; also affects lung

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Rabies: negri bodies, inclusion bodies in cytoplasm only; spread thru neurons

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VZV: inclusion bodes in nucleus, Tzanck smear for HHV 1, 2, 3 showing 3M (multinucleation, marginalized, molding); cowdry type A bodies w halo

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Viral myocarditis: coxsackie viral infections; lymphocyte-mediated, patchy or big sheath necrosis; sx: fever, chest pain

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Rickettsial infections

Epidemic typhus: R. prowazeki w Proteus, transmission: lice; painful hemorrhagic skin nodules; Dx: Weil-Felix; Complications: hepatitis, pneumonia, CNS nodules (typhus nodules)

Rocky MSF: Ricketsia ricketsia, transmission: tick bites in woods of GOAT states, sx: rash moves from centre to periphery, rash on palms & soles, fever, headache, myalgia; more severe CNS & lung involvement; fibrinoid necrosis of vessels (histopath image)

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Candida (monoliasis): oral thrush, vagina, true membrane (easy to scrape off); pseudohyphae on PAS; risk factors: OCT & pregnancy; complications: abscess in kidney, liver, lung, heart

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Cryptococcus: inhaled from pigeon or bat droppings; dissemination likes to go to brain/meningitis, Virchow-Robin perivascular space; India ink, mucicarmine, soap-bubble, latex agglutination,

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Aspergillus: Acute angle pseudohyphae; always opportunistic; 3 types (allergic, colonizing/aspergilloma, invasive); halo sign; dissemination to heart, brain, kidney

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Mucormycosis: non-septate; transmission thru nose -> black necrotic eschar in nose -> lungs & gut; likes to disseminate to brain; vascular invasion

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batman

Histoplasmosis: can infect immunocompetent; transmission: bats & chickens/soil inhalation; sx: similar to Tb; CXR buckshot; budding yeasts from alveolar macrophages

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Pneumocystis jiroveci: HIV+, pneumocystis pneumonia; H&E cotton candy exudate; Silver stain cup cysts exudate; Sx: dry cough (atypical interstitial pneumonia)

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Tubercle requires 3 wks to develop -> cell-mediated immunity; composed of central caseation, giant Langerhans cells, epitheliod cells; no phagocytic activity; mycolic acid; sx: fever (low grade), night sweats/chills, bloody sputum
1o Tb: Ghon lesion in lung parenchyma; 1o complex (Ghon lesion + LN + spread); heals in most people w little caseation; lower part of upper lobe or upper part of lower lobe
1o progressive: large area of lung involved
Miliary Tb: hematogenous spread throughout body
2o Tb: re-infection, HIV+, reactivation; stronger immune response, large caseation at lung apex, cavitation & coughed out; healing & fibrosis in most people.
2o progressive: spread to bronchiole, pleural effusion, empyema, hematogenous spread -> miliary Tb
Complications: PID, Pott’s syndrome, Addison’s, cold abscess, gut ulcers & obstruction, peritonits

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Actinomyces israeli

mouth, dental cavities
Gram +ve anaerobic bacilli,sulfur granules

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lipoma w well-differentianted mature adipocytes, encapuslated, hormone-insensitive

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leiomyoma non-encapsualted, fast-growing, hyperplastic, hormone-responsive

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FAP: exophytic growth called polyps, APC

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Teratoma, 2 germ layers, hair & teeth on ovary; specialised teratoma (struma ovarii Thyroid hormones & carcinoid 5HT & kallikrein)

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hemangioma disorganized growth of endothelial cells

most common tumour of infancy

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Anaplasia

atypical mitosis, irreversible, loss of functional & structural differentiaton
variable size and shape of cell & nucleus, hyperchromatic, incr. nuclear: cytoplasm, proliferation maker ki67, invasion

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invasive cervical squamous cell carcinoma: occurs at transformation zone (CE -\> SE), keratin pearls

Gastric adenocarcinoma: intestinal type (H. pylori) & familial type (E-Cadherin, FGF-R); most common in lesser curvature; lymphatic spread to Virchow node; spread to ovary -\> Krukenberg tumour

Krukenberg tumour: bilateral, mucin-secreting, signet rings, CEA marker, sx: dyspenuria

Carcinoma of endometrium: HNPCC, \> 55 YO, dysmenorrhea, Cowden’s syndrome (PTEN), hemorrhage, necrosis in uterus

Wilm’s Tumour: Africa-American, most common childhood tumour; 5% anaplastic (p53); cystic degeneration, hemorrhage, necrosis; aborted tubules; assoc WAGR (Wilms, Aniridia, Genital ab, Retardation), Denys-Drash (WT1 gonadal dysgensis), Beckman-Wiedemann (WT2 organomegaly), sx: hematuria & ab mass

Compression: pneumothorax, trachea dev Away Resorption: complete airway obstruction, trapped air spread to pores of Kohn, trachea dev Towards Contraction: fibrosis -\> inability to fully expand

ARDS: aka Diffuse Alveolar Damage often refractory to O2 therapy, bilateral pulm. infiltrates due to hypoxemia-\> patchy atelectasis Direct Etiopath: Emboli, O2 tox., Pneumonia, Apsiration, Drowning, Inhalation injury Indirect Etiopath: Sepsis, Trauma w shock, Acute pancreatitis, Burns severely, Transfusion of blood, Uremia, Drugs Prolonged: fibrosis & honey comb lung

Emphysema: sknny, pink puffers, barrel chest, hyperinflated lungs, moth-eaten, flat diaphragm, CXR, alpha-AT1 (PIZZ), incr. MMP, decr. TGFB, smoker's centriacinar, panacinar

GC hyperplasia, seromucinous gland hypertrophy, mucus, hyperemia, swelling, edema, no EOS, VQ mismatch, blue bloaters, ascites, R. heart failure, distended neck veins, Reid index close to 1,

Asthma: Atopic type I H, IL-4 -\> IgE -\> M/B; IL-5 -\> EOS; patchy necrosis, hyperinflated lungs; Drug-induced asthma -\> Cox drugs -\> overproduction of LT CDE -\> bronchoconstrict; squamous hyperplasia, Leiden-charcot crystals, Curschmann spiral mucus, FEV1 \<30%; assoc. w Churg-Strauss & Status asmaticus

Birbeck granules in histiocytes of Pulmonary Langerhans Cell Histocytosis (PLCH)

Bronchiectasis: not 1o disease, permanent dilation due to obstruction or infection from tumour, Kartagenner, CF, foreign body, immunodef. states, necrotizing pneumonia (Klebsiella, Staph. aureus); squamous metaplasia in brionchiole, complications: cor pulmonale, amyloidosis

M\>F, smokers \>60 YO, cobble-stone pleural surfaces; cystic spaces lined by type II P, crackles, cyanosis, cor pulmonale

African-American, hilar LN, Sjogren, Parotidis, Uveatis, granulomatous disease (non-necrotizing), Type 4 H -\> CD4+ Th1 -\> IL-2 & IFN-gamma; anergy to skin tests w Candida/PPD; Schaumann & asteroid bodies; night sweats

Atypical (interstitial) pneumonia: alveolar space clear, scattering of lymphocytes

Lung abscess: pneumonia, Wegener, Churg-Strauss, LYG; assoc. w clubbing; mixed aerobe & anaerobe -\> Staph. Aureus & Bacteroides fragilis

cardiogenic non-cardiogenic: ARDS, high altitidude, pulm embolism, neuogenic hemosiderin-ladened macrophages; heart failure cells

PE Virchow’s Triad; occurs when 60% total pulm vasculature obstructed death from acute cor pulmonale or shock (5%) Risk factors: immobility, surgery, severe trauma, congestive heart failure, OCT, Disseminated malignancies, hypercoagulability

2o assoc w restrictive lung disease and some obstructive lung disease, mitral valve stenosis medium muscular aa -\> intimal & medial hypertrophy -\> onion skinning small aa -\> medial hypertrophy & plexiform lesions

Diffise Alveolar Hemorrhage syndromes: Wegener's and Goodpastures classic presentation necrotizing granulomas in upper and lower RT vasculitis of small & medium vessels w necrotizing granulomas renal damage in form crescentic glomerulonephritis chronic sinusitis pneumonitis w nodules and cavitations ulcer in oropharynx fever, myalgia, joints, neuritis

Signet ring adenocarcinoma: ALK

adenocarcinoma in-situ: smokers, men, central necrosis, assoc w hypercalcemia paraneoplastic syndrome; complication: resorption atelectasis; Etiopath: ALK, KRAS, EGF-R

squamous cell carcinoma: smokers, men, central, keratin pearls & tadpoles, G1 intercell bridges, G3 no intercell bridges; spread to hilar LN;

Small cell carcionoma of lung: smokers, paraneoplastic syndrome, spread to mediastinal LN, cytology shows nuclear moulding; Etiopath: pRB, p53, 3p deletion, TTF, rim and dot stain

Carcinoid: Flushes & cyanosis, episodic diarhhoea, cramps, asthma attacks, Kulchitsky cells, paraneoplastic, no nuclear moulding, fibrovascular stroma polypoid growth

mesothelioma: malignancy of pleura; assoc w asbestos

hamartoma: benign disorganized growth of collagen, cartilage, endothelial cells (hemangioma)

breast, colon, prostate cancer metastasis to lung multinodule = metastatic

Acute congestion: R. heart failure, Budd-Chiari syndrome Chronic congestion: nutmeg liver, centrilobular necrosis

Thrombosis Etiopath: Virchow’s triad Endothelial injury: atherosclerosis, HPT, bacterial toxins, homocystinuria, high cholesterol, cigarette smoking, myocarditis Hypercoaguability: Factor V (most common), Antithrombin III, Factor C & S; OCT, Trousseau, cardiac failure, trauma/burns Blood flow: turbulence, platelets, aneurysm, DVT Thrombosis tyoes: arterial thrombi (pale, opposite flow), venous (red, takes shape of vessels), lines of Zahn

Fat embolism: trauma to bone, death, yellow sputum, thrombocytopenia, anemia, DIC, neuro (irritibality, restless, delirium, coma)

Bone marrow embolism: vigorous CPR, not a cause of death

Atherosclerotic emboli: IEL intact, IEL intact, angioplasty, clot buster meds, needles

Infarct: ischemic coagulative necrosis, torsion, hypoperfusion, hemorrhage, vasculitis Pale infarct: arterial occlusion, end-organ, heart, spleen, kidney (solid organs)

Red infarct: collateral circulation, lungs (soft organs w tissue space)

Hyaline arteriosclerosis: HPT or diabetes casuing chronic stress

Hyperplastic arteriosclerosis: onion-skinning, acute & severe, malignant HPT

Monckeberg’s Medical Calcific Sclerosis: incidental finding, no clinical significance

Giant cell arteritis: non-caseating Granulomas, \>50 YO, assoc. polymyalgia rheumatica

assoc HBV, HCV, cryptoglobulins, bowel infarcts,

Wegener’s Granulomatosis: C-ANCA, necrotizing triad: URT/LRT, vasculitis (small & med), type IV H, renal, 40 YO M

Buerger’s: smokers, claudication, Reynaud’s, microabscess

AAA: Risk factor -\> HPT, younger Pt w Marfan’s

Syphilitc aneurysms: Destruction of T. media, occurs in tertiary phase of syphillis -\> Pt will be have rx for syphillis; Sx: dyspnea, cough, difficulty swallowing, pain from rib erosions; endarteritis of vasa vasorum; aortic regurg, cor bovinum

Aortic Dissection: risk factor 40 YO M, intimal tearing 2/3 innner, 1/3 outer, pseudolumen, pain radiating to back; complication: tamponade, transverse myelitis

Calcific Aortic: Ca2+ deposit behind valves, extend into sinus of valsalva/aortic sinus

MVP: mitral regurg & CHF, infective endocarditis, ventricular arrhythmias

Rheumatic heart disease: Strep infection -\> type II H, 3rd world country; irregular thickening & calcifiation of leaflets, often w fusion of commissures and chordiae tendinae; fibrosing repairs -\> mitral valve regurg \> murmurs (listen to apex), bilateral rales, joint pains, dyspnea, Aschoff bodies & Anitschkow cells

Infective endocarditis: : vegetations are bulky leading to ring abscess (perivalvular), and rapid valve destruction; Acute IE -\> destructive & fulminant on nl heart; SubAcute IE -\> low virulence on abnl heart - splinter hemorrhages - clubbing is a sign of hypoxia

infections: Coxsackie B virus, Chagas disease, fungal (immunodef.)

Hypertrophy: defective filling -\> diastolic dysfunction; beta-myosin defect (familial AD) Restrictive: diastolic dysfunction due to another cause Dilated: systolic dysfunction due to dystrophin defect, alcohol/B12 def. -\> cirrhotic liver, EF\<25% -\> edema ARVC: thin RV -\> R. heart failure

Tetralogy of Fallot: PROVEN, cyanotic, blue baby, squat to build up LV pressure boot-shaped hear.

VSD: pansystolic murmur; assoc. w Tri 21, 18, 13; Sx: Pulm. HPT -\> Eisemenger (irreversible) -\> cyanotic

ASD: asx, pulm HPT -\> ASD -\> paradoxical emboli; assoc. Tri. 21; S2 splitting

Pericarditis: assoc. w Uremia/Renal failure; Beck’s Triad (distended neck v, muffled heart sounds, decr. CO) hemorrhagic pericarditis: pericardial tumour & tb