Infection terminology:
Contagious – highly communicable
Subclinical – unapparent; only detected by demonstrating a rise in Ab titer (rising is the most reliable finding) or isolating the organism
Latent state – absence of symptoms until a reactivation occurs
Chronic carrier – organisms continue to grow w/ or w/out producing symptoms in the host
Pandemic – worldwide distribution
Endemic – constantly present at low levels in a specific population and with low incidence of infection
Epidemic – occurs much more frequently than usual
Swelling
In an autopsy, cellular swelling (a commonly observed tissue change, is of little practical diagnostic imporance
Cloudy swelling:
Early degenerative change characterized by increase cytoplamsic granularity & increased size
Swelling of cells due to injury to MBs affecting ionic transfer; causes an accumulation of intracellular water
Shy-drager syndrome (multiple system atrophy)
Rare degenerative condition w/ symptoms similar to Parkinson’s – pt may move slowly, be tremulous, & have shuffling gait
Wiskott-Aldrich syndrome (aka immunodeficiency w/ eczema & thrombocytopenia):
Affects only boys
Characterized by defective B-cell & T-cell functions, Just like SCID mouse
Clinical features – thrombocytopenia w/ severe bleeding, eczema, recurrent infection, & increased risk of lymphoid cancers
Ataxia-telangiectasia:
Inherited disorder that affects many tissues & body systems
Multiple symptoms – telangiectasis (dilation of capillaries), ataxic (uncoordinated) gait, infection prone, defective humoral &
cellular immunity, & increased risk of malignancies
Most obvious symptoms – multiple easily visible telangiectases in the sclera & skin areas such as ear & nose, graying of the hair, & irregular pigmentation of areas exposed to sunlight
Decreased coordination of movement (ataxia) in late childhood
Hyper-IgE syndrome (Job syndrome): -- JOB even got ALLERGIES
Immunodeficiency disorder characterized by very high levels of IgE Ab/s & repeated infections (commonly w/ S. aureus)
Tx – continual administration of Abx
Calcification abnormalities:
Metastatic calcification:
Calcification occurring in nonosseous, viable tissue – stomach, lungs, & kidneys
Cells of these organs secrete acid materials & under certain conditions in instances of hypercalcemia, the alteration in pH seems to cause precipitation of calcium salts at these sites
Occurs particularly in hypercalcemia, hyperparathyroidism & hypervitaminosis D, NOT hypoparathyroidism
Pathologic calcification:
Calcification occurring in excretory or secretory passages as calculi (in tissues other than bone & teeth)
Eggshell calcification:
Thin layer of calcification around an intrathoracic lymph node, usually silicosis, seen on a chest radiograph
Dystrophic calcification:
Deposition of calcium in dying or dead tissues
Occurs in degenerated or necrotic tissue, as in hyalinized scars, degenerated foci in leiomyomas, & caseous nodules
Secondary to disease of affected tissue
NOT associated w/ high blood calcium levels
• Unlike Metastatic Calcification
Calcinosis:
Presence of calcification in or under skin – often associated w/ scleroderma & sometimes dermatomyositis
Staghorn stones:
Occupy renal pelvis & calyces – big stones!
Hematuria:
Blood in urine – should never be ignored!!
Usually caused by kidney & urinary tract disease
Exceptions:
Women – blood may appear to be in urine when it is actually from the va-jay-jay
Men – blood mistaken for urinary bleeding is sometimes a bloody ejaculation due to prostate problems
Children – coagulation disorders (e.g., hemophilia) or other hematologic problems (e.g., sickle cell disease, renal vein thrombosis, or thrombocytopenias) can be underlying reasons for newly discovered blood in urine
Kidney disease following strep throat is a classic cause of hematuria
Hematemesis:
Vomiting of bright red blood – indication rapid upper GI bleeding
Commonly associated w/ esophageal varices (common in alcoholics) or peptic ulcers
Hemoptysis:
Coughing up blood from respiratory tract
Blood-streaked sputum often occurs in minor upper respiratory infections or in bronchitis
Can also be seen in pts suffering from tuberculosis, lobar pneumonia (Diffuse, rusty sputum, S. pneumoniae), or bronchogenic carcinoma (NOT emphysema)
Also can be seen in pts w/ a pulmonary embolism
Hemoptysis is the main symptom of idiopathic pulmonary hemosiderosis (iron in the lungs)
Glucosuria:
Presence of glucose in urine – common in diabetes
Ketonuria:
Presence of ketones in urine – produced by starvation, uncontrolled diabetes, usually Type I, & occasionally alcohol intoxication
Proteinuria:
Presence of protein in urine – usually a sign of kidney disease
Accumulation of endogenous pigments:
Bilirubin
Hemosiderin
Iron containing protein derived from ferritin, which is an iron storage protein
Melanin – formed from tyrosine, synthesized in melanocytes
Increased melanin pigmentation – seen in Addison’s disease
Decrease melanin pigmentation – seen in albinism & vitiligo, and PKU
Histiocytosis X (aka Langerhans Cell Histiocytosis & Differntiated Histiocytosis)
FIXED macrophages
Group of disorders in which histiocytes (scavenger cells) proliferate, esp. in bones & lung, often causing scars to form
Characterized by abnormal increase in # of histiocytes – includes monocytes, macrophages, & dendritic cells
Eosinophilic granuloma:
Most benign form
More common in males ~20 y.o.
May be totally asymptomatic – there may be local pain or swelling
In the mouth, Mn is most likely affected – loose teeth on affected side w/ signs of gingivitis
Letterer-Siwe disease:
Affects infants (< 2 y.o.) – fatal
Child develops a skin rash w/ persistent fever & malaise
Anemia, hemorrhage, splenomegaly, lymphadenopathy, & localized tumefaction over bones are usually present
Oral lesions are uncommon
Hand-Schuller-Christian disease:
Occurs early in life, usually before 5 y.o. – more common in boys
Triad of symptoms – 1) exophthalmos, 1) diabetes insipidus, 3) bone destruction (skull & jaws are affected)
Oral signs – bad breath, sore mouth, & loose teeth
Treatment – radiation & chemotherapy (poor prognosis)
Habermann’s disease:
Is not an example of Histiocytosis X
Sudden onset of a polymorphous skin eruption of macules, papules, & occasionally vesicles w/ hemorrhage
Polymyalgia rheumatica:
Condition causing severe pain & stiffness in muscles of neck, shoulders, & hips
Hydatidiform Mole
A pathologic ovum (“empty egg” – ovum with no DNA) resulting in cystic swelling of chorionic villi and proliferation of chorionic epithelium (trophoblasts)
Most common precursor of choriocarcinoma
High beta HCG
“Honeycombed uterus, cluster of grapes appearance
Genotype of a complete mole is 46, XX and is purely paternal in origin (no maternal chromosomes); no associated fetus
Partial mole is commonly triploid or tetraploid.
Uterine Pathology
Endometriosis
Non-neoplastic endometrial glands/stroma in abnormal locations outside the uterus
Characterized by cyclic bleeding from ectopic endometrial tissue resulting in blood-filled, chocolate cysts
Ovary is most common site
Clinically is manifest by severe menstrual related pain
Often results in infertility
Endometrial Hyperplasia
Abnormal endometrial gland proliferation usually caused by excess estrogen stimulation
Increased risk for endometrial carcinoma
Most commonly manifest clinically by vaginal bleeding
Endometrial Carcinoma
Most common gynecologic malignancy
Peak age is 55-65
Clinically presents with vaginal bleeding
Typically preceded by endometrial hyperplasia
Risk factors prolonged estrogen use, obesity, DM, and HTN
Polycystic Ovarian syndrome
Increased LH due to peripheral estrogen production leads to anovulation
Manifest clinically by amenorrhea, infertility, obesity, and hirsutism
Tx with weight loss, OCPs, gonadotropin analogs, or surgery
Leiomyoma (See “Neoplasm’ section)
Leiomyosarcoma (See “Neoplasm’ section)
Breast Disease
Fibrocystic Disease
Presents with diffuse breast pain and multiple lesions, often bilateral
Bx shows fibrocystic elements
Usually does not indicate increased risk for CA, although it is a risk factor
Histological types
• Cystic – fluid filled
• Epithelial Hyperplasia – Increase in number of epithlelial cell layers in terminal duct lobule, Increase risk for CA
• Fibrosis – Hyperplasia of breast stroma
• Sclerosing – Increased acini and intralobular fibrosis
Benign Tumors
Cystosarcoma phyllodes – large, bulky mass of CT and cysts, breast surface has “leaflike” appearance (“I love Fall”)
Fibroadenoma – most common tumor <25 yrs, small, mobile, firm mass with sharp edges, increases with pregnancy
Malignant Tumors
Comon Postmenopause
Arise from mammary duct epithelium or lobular glands
• Histologic types
♦ Comedocarcinoma – Cheesy consistency of tumor tissue due to central necrosis
♦ Infiltrating ductal – most common carcinoma, Firm, fibrous mass
♦ Inflammatory – lymphatic involvement, poor Px
♦ Paget’s disease – Eczematous patches on nipple
Risk Factors Gender, age, early menarche, delayed first pregnancy, late menopause, family history of 1st-degree relative with breast cancer at a young age, but NOT fibroadenoma or nonhypplastic cysts
Wegener’s Granulomatosis
Characterized by focal necrotizing vasculitis and necrotizing granulomas in the lung and upper airway and by necrotizing glomerulonephritis
Symptoms Perforation of nasal septum, chronic sinusitis, otitis media, mastoiditis, cough, dyspnea, hemoptysis
Findings C-ANCA is strong marker of disease, CXR may reveal large nodular densities, hematuria and red cell casts
Tx corticosteroids nad methotrexate
Alcoholism
Physiologic tolerance and dependence with symptoms of withdrawal (tremor, tachycardia, HTN, malaise, nausea, delirium tremens) when intake is interrupted
Continued drinking despite medical and social contraindications and life disruptions
Ethanol via Alcohol Dehydrogenase and MEOS Acetaldehyde Acetate Acetyl-CoA Increased FAs Fat Liver
• Alcohol Dehydrogenase
♦ Increases NADH/NAD+ ratio, which in turn:
Basically tricks your body into thinking you have energy
Increases Lactate/pyruvate
Inhibitis gluconeogenesis
Inhibits FA Oxidation
Inhibits Glycerophosphate dehydrogenase, leading to elevated glycerophosphate
Complications of Alcoholism
Alcoholic Cirrhosis
• Long term alcohol use leads to micronodular cirrhosis with accompanying symptoms of jaundice,
hypoalbuminemia, coagulation factor deficiencies, and portal hypertension, leading to peripheral edema, ascites, encephalopathy, and neurologic manifestations
Wernicke-Korsakoff Syndrome
• Caused by Vitamin B1 (thiamine) deficiency in alcoholics
• Classically may present with triad of psychosis, ophthalmoplegia, and ataxia
• May progress to memory loss, confabulation, confusion (Irreversible)
• Associated with periventricular hemorrhage/necrosis, especially in mamillary bodies
• Tx with IV Vitamin B1
Mallory-Weiss Syndrome
• DRUNK DUCKS
• Longitudinal lacerations at the gastroesophageal junction caused by excessive vomiting with failure of LES relaxation that could lead to fatal hematemesis
A Quick Review on Pathology Findings
Argyll-Robertson Pupils
Constricts with accommodation but is not reactive to light, pathognomonic for Tertiary syphilis
Think ARP Argyll-Robertson Pupil, Accommodation Response Present
Amyloidosis
Primary seen with multiple myeloma or Wadenstrom’s macroglobulinemia
Secondary can cause nephrotic syndrome in kidney, Apple-green birefringement on Congo Red stain
Alzheimer’s disease associated with Beta-amyloid deposition in the cerebral cortex
Islet cell amyloid deposition characterisitic of DM Type II
Aschoff Body
= Granuloma with Giant cells are also found with Anitschkow’s cells (activated histiocytes) in Rheumatic Heart Disease
• Think 2 RHussians Rheumatic
Auer bodies
Cytoplasmic inclusions in granulocytes and myeloblasts
Primarily seen in Acute Myelocytic Leukemia -- Ambulance
Casts (in Urine)
RBC glomerular inflammation, ischemia, or malignant HTN, Bladder Cancer
WBC casts inflammation in renal interstitium, tubules and glomeruli, Acute cystitis
Hyaline casts often seen in normal urine
Waxy casts Seen in chronic renal failure
ESR (Sed Rate)
Nonspecific test that measures acute-phase reactants
Dramatically increased with infection, malignancy, CT disease, with pregnancy, inflammatory disease, anemia
Decreased with Sickle cell anemia, polycythemia, CHF
Hyperlipidemia signs
Atheromata Plaques in blood vessel walls
Xantheloma Plaques or Nodules composed of lipid-laden histiocytes in the skin, especially the eyelids
Tendinous Xanthoma Lipid deposit in the tendon, especially Achilles,
Familial Hypercholesterolemia
Corneal arcus Lipid deposit in cornea, nonspecific (arcus senilis)
Psammoma bodies
Laminated, concentric, calcific spherules seen in
• Think PSaMMoma Papillary adenocarcinoma of thyroid, Serous papillary cystadenocarcinoma of ovary, Meningioma, Malignant Mesothelioma
RBC Forms
Biconcave Normal
Spherocytes Hereditary Spherocytosis, Autoimmune hemolysis
Elliptocyte Hereditary Elliptocytosis
Macro-ovalocyte Megaloblastic anemia, marrow failure
Helmet cell, Schistocyte DIC, traumatic hemolysis
Sickle cell Sickle cell anemia
Teardrop cell Myeloid metaplasia with myelofibrosis
Acanthocyte Spiny appearance in abetalipopreteinemia
Target cell Thalassemia, liver disease, HbC
Poikilocytes Nonuniform shapes in TTP/HUS, microvascular damage, DIC
Burr cell TTP/HUS
HLA-B27
Think PAIR Psoriasis, Ankylosing spondylitis, Inflammatory bowel disease, Reiter’s syndrome
Virschow’s (sentinel) node
Firm Supraclavicular lymph node, often on left side, easily palpable, also known as jugular gland
Presumptive evidence of malignant visceral neoplasm (usually stomach)
Random Qs All of the following should be HIGHLIGHTED YELLOW
Bacteria surviving in CO2
Capnophiles or Anaerobics -- think????
Tran has another Q stating Anaerobics need CO2 to grow
Retrovirus causes what in infants????
Pneumonia, T-cell leukemia????
Mushroom Toxins
The recent answer was some Alpha-amanitin Toxin
Ehler-Danlos Syndrome
a group of inherited generalized connective tissue diseases characterized by overelasticity and friability of the skin, hypermobility of the joints, and fragility of the cutaneous blood vessels and sometimes large arteries, due to deficient quality or quantity of collagen;
the most common is inherited as an autosomal dominant trait; some recessive cases have hydroxylysine-deficient collagen due to deficiency of collagen lysyl hydroxylase, and two tentatively ascribed to X-linked inheritance.
• Also associated with Berry Aneurysms
What does CD stand for??
Not compact disc, but Cluster of Differentiation
They are surface molecules that are recognized by specific types of antibodies
CD 4 and CD 8--- Ring a bell?
Respiratory Burst
The rapid release of SUPEROXIDE anion when PMNs come in contact with bacteria
Throat Cancer
Most are squamous cell carcinomas – Just like Skin and Esophagus
Oral Cancer
Occurs on the side of the tongue
Tracheomalacia
Trachea collapsing
Noma
Gangrenous disese of the mouth and cheeks