PreMidterm lab slides review Flashcards
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.)
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
Lobular: bronchopneumonia, less virulent (staph. aureus, pseudomonas, E. coli, Klebsiella)
diffuse but can coalesce to look similar to lobar
Lobar: pneumococcal, pores of Kohn, virulent organisms (strep. pneumonia)
Staph infections: skin mostly
complications: mastitis, endocarditis from IV opiates, bacteremia, osteomyelits, bronchopneumonia
toxin-mediated: Scalded skin, TSS, food poisoning, enterotoxin, tampons
CMV: inclusion bodies both nucleus & cytoplasm; blindness in AIDS Pt, cottony-wool on fundoscopy; also affects lung
Rabies: negri bodies, inclusion bodies in cytoplasm only; spread thru neurons
VZV: inclusion bodes in nucleus, Tzanck smear for HHV 1, 2, 3 showing 3M (multinucleation, marginalized, molding); cowdry type A bodies w halo
Viral myocarditis: coxsackie viral infections; lymphocyte-mediated, patchy or big sheath necrosis; sx: fever, chest pain
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)
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
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,
Aspergillus: Acute angle pseudohyphae; always opportunistic; 3 types (allergic, colonizing/aspergilloma, invasive); halo sign; dissemination to heart, brain, kidney
Mucormycosis: non-septate; transmission thru nose -> black necrotic eschar in nose -> lungs & gut; likes to disseminate to brain; vascular invasion
batman
Histoplasmosis: can infect immunocompetent; transmission: bats & chickens/soil inhalation; sx: similar to Tb; CXR buckshot; budding yeasts from alveolar macrophages
Pneumocystis jiroveci: HIV+, pneumocystis pneumonia; H&E cotton candy exudate; Silver stain cup cysts exudate; Sx: dry cough (atypical interstitial pneumonia)
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
Actinomyces israeli
mouth, dental cavities
Gram +ve anaerobic bacilli,sulfur granules
lipoma w well-differentianted mature adipocytes, encapuslated, hormone-insensitive
leiomyoma non-encapsualted, fast-growing, hyperplastic, hormone-responsive
FAP: exophytic growth called polyps, APC
Teratoma, 2 germ layers, hair & teeth on ovary; specialised teratoma (struma ovarii Thyroid hormones & carcinoid 5HT & kallikrein)
hemangioma disorganized growth of endothelial cells
most common tumour of infancy
Anaplasia
atypical mitosis, irreversible, loss of functional & structural differentiaton
variable size and shape of cell & nucleus, hyperchromatic, incr. nuclear: cytoplasm, proliferation maker ki67, invasion
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
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
