Infectious Disease Pathology p76-89

8/23/2019 Infectious Disease Pathology p76-89

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SPECIAL SILVER STAINS: Warthin Starry, Dieterle Treponema pallidum Legionella Bartonella

For very very small organisms to see, must coatw/silver.

DIRECT FLUORESCENT ANTIBODY STAIN Sputum or respiratory washings Legionella, Bordetella persussis, Herpes virus

and others High specificity/Low sensitivity

The one we do most often is for influenza andparainfluenza

Dieterle/Warthin-Starry Stain: Fluorescent antibody stain: Herpes-infected cells

Shows Treponema pallidum (syphilis)

Bronchopneumonia: Patchy or hit and miss Staphylococcus, GNRs, anaerobes Aspiration with spread through the airways

Bronchopneumonia: Patchy bronchopneumonia:

* = Pneumonia. Bronchopneumonia hit-and-miss spreading through the airways. ANY ORGANISM can causebronchopneumonia, anything can spread through the airways usually think of staphylococci, streptococci, GNRs.

Lobar pneumonia: Involvement of the entire lobe (most of it) The difference is that only a limited # of organisms cause it Streptococcus pneumoniae, Klebsiella

pneumoniae, Haemophilus influenzae Encapsulatedbacteria Aspiration then spread through alveolar walls (pores of Kohn)

Highly specific but

lack sensitivity. If youdo DFA test and itspositive, thats reallygood.

Example: B. pertussis(whooping cough)DFA on sputum

specificity is 99%,sensitivity is only 30%


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Spread through pores of Kohn get complete involvement of a lobe.

Paragonimus westermani: Human lung fluke Granulomatous reaction to

the eggs If you see eggs in lung w/flat

operculum = paragonimus

Aspergillus fumigatus (A. flavus): Opportunistic infection in transplant and hematology/oncology patients More often, patients w/severeneutropenia Narrow, septate hyphae that branch at acute angles (45 degrees or less)

Invasion of arterial wall byAspergillus (PAS):

Aspergillus and Mucor both involve vascular invasion, but we usually associate it more w/Aspergillus.

Mucormycosis (Rhizipomycosis):: Mucorand Rhizopus Diabetic ketoacidosis (DKA), transplant/heme-onc Nasal sinuses, lung, GI tract, brain Rhinocerebral mucormycosis (spread from nasal brain) Morphologic identification or culture Broad irregular ribbon-like hyphae, no septae (aseptate/coenocytic),

right-angle branching Aseptatefungal hyphae (no crosswalls) Branch at 90 degrees (right angles) Diabetics (poorly controlled) and transplantation patients

Narrow hyphae, crosswalls, dichotomous branching.


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Rhinocerebral mucormycosis: Mucor species in a lung biopsy (aseptate hyphae):

Above (left): Cloudy nasal sinus, filled w/organisms and inflammatory cells. Treatment is ALWAYS SURGERY debridement.Above (right): H&E stain very broad, very irregular, no crosswalls. Can see right angle branches in some spots.

Above (left):Mucormycosis in a blood vessel very irregular fragments of the organism.Above (right): Filamentous fungi cut like a pipe (cross-section). Dont confuse w/yeast!

Actinomycosis: Sulfur granules (yellow on gross) Sulfur granules (pink/blue on H&E) Filamentous anaerobic bacteria Gram-positive, acid-fast- negative filamentous bacteria

(Actinomyces) Aspiration Draining fistulas are common People w/poor oral hygiene Non acid-fast anaerobe.

Nocardia is AEROBE, WEAKLY ACID-FAST. Both filamentous, both G+

Gram-positive, filamentousActinomyces2000x sulfur granules can see blue filatmentous organisms.

Colonies of Actinomyces: Colony ofActinomyces in a bronchiole: Actinomyces colonies on H&E Stain:

Yellow sulfur granules H&E Stain Have orange-pinkish rim around them.Fistula extending out of neck of patient Background cells are neutrophils.


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Salpingitis: Inflammation/infection of the fallopian tube. Chlamydia trachomatis Neisseria gonorrhoeae Sterility, ectopic pregnancy

Cervicitis, urethritis, PID (w/inflammation of fallopian tube). More common w/G (because more virulent) can also giveyou other things (sepsis, skin rashes, joint infections) bc it can survive outside cells. C is an obligate intracellularpathogen.

Above: Salpingitis. Pus in the lumen.

Abscess w/segmented neutrophils:

Above (left): Staph is known for causing abscesses in the body look for half-full circles (solid on bottom, black on top) = air-fluid level.Above (middle): Brain abscess if it lasts a long time, can get fibrosed around the edges. Anaerobic organisms are most common inbrain abscesses.

Above (right): Abscess with mostly segmented neutrophils

Appendicitis: Neutrophils are easiest to see in the muscle and fat Leukemoid reaction (left shift) is common high granulocyte count. Pyuria due to involvement of the ureter

Neutrophils:

Pus in the finger-likeprojections (fimbriae).


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Pyelonephritis: Most are ascending (post bladder infection) E. coli is most common cause High fever, chills , pain Thyroidization of the kidney seen on H&E-stained sections lots of lymphocytes, protein in the tubules.

Two kinds: most common is ascending (bladder infection travel up ureter to kidney)Descending comes through blood, usually in someone w/endocarditis. If bacteria growing on heart valves, can flip offand make their way down to the glomeruli, where they cause pyelonephritis (usually staph or strep).

Thyroidization:

Lymphocytes that look like C cells (parafollicular cells) Can look around, find a glomeruli

Tubules filled w/protein that look like follicles

Diphtheria: Corynebacterium diphtheriae infection in upper airway. Often in pharynx but sometimes deeper down. C. diphtheriae can be normal flora- do toxin assay for diagnosis of diphtheria Exotoxin destroys myocytes myocarditis can cause a fatal arrythmia heart failure Abscesses in the myocardium

Pseudomembrane: Pseudomembrane:

Pseudomembrane rarely does any damage to the patient except producing the toxin distant sites.Above (right): Two-part toxin-exotoxin that causes the damage

Syphilis: Obliterative endarteritis seen in primary, secondary and tertiary syphilis

inflammation and destruction of the arteries Plasma cells surround vasa vasorum Tertiary- ascending or thoracic aorta is most commonly involved (80%) Treponema pallidum

Chancre on Chest


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Primary chancreSecondary rash + condyloma lataTertiary organism can go to any site in the body. Most often thoracic aorta (ascending) aneurysm (bubbling)

Aneurysm in ascendingaorta: Inflammation in aorta wall: Silver stain:

Plasma cells in the wall. Destruction of elastic tissue.

Tuberculosis: Mycobacterium tuberculosis Communicable person-to-person

Necrotizing granulomas (microscopic) is usual but non-necrotizing granulomas are possible Caseous necrosis (gross) Ghon complex in lung (primary TB) peripheral lesion and central lymph node lesion Apical disease (secondary/reactivation TB)

Necrotizing granuloma:

Granulomas w/necrosis, histiocytes, giant cells, * Large granulomas (hilar lymph nodes)lymphocytes at the periphery. ** Small granulomas (miliary TB)

Lymphadenopathy esp. in hilar/central part of lung

Hilar lymphadenopathy (hilus central part of lung where major vessels/airways enter). Can see this in histo orin TB.Small granulomas everywhere miliary TB (organism erodes into pulmonary artery shower entire lung).

Ghon Complex or Primary Complex:

Ghon Complex:LN and peripheral lesion. Peripheral lesion in

mid-lung fields, some of the organisms travel through lymphaticsto hilar lymph nodes.

TB in the upper lobe-

caseous granulomas

Apical involvement =

reactivation TB. Moreoxygen there. SecondaryTB is more aggressive aggression is immunesystem reacting toorganism: more necrosis,cavitation, lymph nodeproliferation.


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Histoplasma capsulatum: Not communicable Necrotizing granulomas Small (2-3 microns), budding yeast Intracellular

H&E Stain with yeasts ofH. capsulatum: Giemsa stain: GMS (Silver) stain:

Hard to see yeast. Sample from blood. Yeasts inside macrophages pneumocystis is NEVER intracellular

Coccidioides immitis sometimes referred to as Valley Fever California and Arizona Necrotizing granulomas Spherules contain endospores

C. immitis Spherules H&E: GMS (silver) Stain ofC. immitis: PAS Stain ofCoccidioides immitis:

Spherules are BIG. Compare to surrounding inflammatory cells. Endospores are as big as neutrophils.

Blastomyces dermatitidis: Large yeast with Broad-Based Buds Pseudoepitheliomatous hyperplasia mimics (clinically and microscopically) squamous carcinoma in skin and in

the larynx epithelium proliferates, piles up, looks like cancer Inflammation is mixed: histiocytes with giant cells and abscesses with neutrophils ALWAYS starts out as pulmonary infection then is more likely to spread to skin and larynx (lesions look like

cancer)

Pseudoepitheliomatous hyperplasia H&E shows broad-based-budding: GMS (silver) Stain:

Middle figure: Lung. See budding yeast. Not crypto because it has a double ring around it. Cytoplasm shrinks away from cell wall isnot encapsulated.


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Pneumocystis pneumonia: (Pneumocystis cariniipneumonia) or PCP Pneumocystis jiroveci Two forms: cysts and trophozoites Cysts on GMS stain Trophozoites on Giemsa stain

Pneumocystis pneumonia on H&E Stain Alveolar space filled w/bubbly stuff (organisms)

.

Giemsa Stain of BAL: GMS stain:

Cysts Trophozoites Pneumocystis cyst w/ 8 trophozoites. Cysts (cups, targets, grooves)Silver stain see tea cups. No budding, not inside cells just inside

alveolar space.

Cryptococcus neoformans: Variably-sized budding yeast with thick capsule of mucopolysaccharides India Ink stain (poor sensitivity and specificity) Latex agglutination on CSF or serum has high sensitivity and specificity Cryptococcal meningitis 100% fatal if untreated

Similar size to blastomyces, but has very thick capsule.

C. Neoformans in glomeruli (H&E): C. neoformans (GMS): Mucin stain:

Above (middle): Big capsule, huge size variation. Can be as small as histo, as big as blasto. Narrow-based bud.Above (right): Mucin stain can see capsule ofCryptococcus neoformans. Assume if encapsulated yeast, mucin+ = cryptococcus.


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GMS Stain- C. neoformans India Ink:

Chest wall biopsy. Capsule lots of space. C. Neoformans in CSF

Lots of space surrounding do not see a second ring (like blasto, which did not have a true capsule)

Polio: Anterior/motor horns have receptors Paralytic polio occurs in non-vaccinated adults if infected by

the virus

Polio:Anterior horns are destroyed. Best seen on low power

Young children/babies usually dont have receptors on their motorhorns for the virus so if exposed when very young get an

enteritis, get immune, do not get paralytic polio. If you exposed forthe first time when youre older and not immune paralysis.

Entameba histolytica: Flask-shaped ulcers in the colon Erythrophagocytosis- amoebae ingest RBCs; if so, it is E. histolytica

H&E- Flask-shaped ulcer ofE. histolytica: Erythrophagocytosis:

E. histolytica see erythrophagocytosis

Can find ameobaecontaining RBCs erythrophagocytosis.

C. neoformans (latex agglutination +):


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Causes of diarrhea:INVASIVE: NON-INVASIVE:Salmonella and Shigella VibrioCampylobacter CryptosporiudiumMany E. coli GiardiaEntamoebaC. difficile

INVASIVE = SEE RBCs, WBCs IN STOOL.

Strongyloidiasis: Autoinfection- the entire life cycle can occur in humans if they are

immune compromised Association with HTLV-1 infections

Worm that goes through entire life cycle in the body, resulting in hugenumbers of organisms. Will invade lung and cause pneumonia because,as it travels through the lung and poops, it poops out bacteria that causepneumonia.

H&E Stain ofStrongyloides (calcified worm)

Adenovirus: Nucleus only inclusions Cowdry B type in Adenovirus Cowdry A type in Herpes

H&E Stain with Adenovirus inclusions in hepatocyte nuclei

CMV: Enlarged cells Intranuclear (Cowdry B) and cytoplasmic inclusions are present in

some cells

Below: Arrows = CMV-infected cells CMV infection in lung:

Owls eyes in intestines.

Toxoplasmosis: Brain abscess Ring-enhancing lesions Cysts

Toxoplasmosis: Cysts in brain (abscesses)

If you see RBCs and WBCs in stool, means that the organismis invasive and destroying mucosa.

Vibrio makes toxin (thats what does the damage) butdoesnt invade. Cryptosporidium and Giardia coat theintestine but dont invade, so dont see RBCs and WBCs.


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H&E Stain of brain biopsy with Toxoplasma: Cysts ofT. gondiiin brain- H&E Stain:

Encysted forms w/bradyzoites. If causing active infection in the lung/other sites, will see tachyzoites that look likebananas.

Hepatitis: Lymphocytes in the portal zones Loss of hepatocytes Cirrhosis

Chronic Hepatitis: Hepatocytes w/inflammatory cells. Chronic Hepatitis: Plasma cells, lymphocytes.

Get lots of lymphocytes (viral infection) inflammation around the bile ducts/artery/vein.

Leftover Infectious Disease Test Qs: Couldnt find a good place for these in the notes some are review from Micro.

Test q: Petechiae of skin, progressing to necrosis of finger tips, nose and ear lobes, suggests infection by: Meningococci.

Test q: Which of the following poses the lowest risk for person-to-person spread to physicians, nurses, or laboratorians? Anthrax (Other choices:Smallpox, Plague, Viral hemorrhagic fever)

Test q:A 22F suffers a tick bite on a hike in southern Indiana. She develops fever w/a total-body rash that includes palms of her hands. Biopsy of therash shows thrombosed blood vessels. Swollen endothelial cells contain tiny dots on Giemsa stains. Diagnosis? Rickettsia rickettsii.

Test q:A 32M professional football player (not a quarterback) presents with a history of spider bite on his back. The site is now ulcerated, painful, anderythematous. The patient has fever of 102F. You would expect a Gram stain of the tissue to show: Gram-positive cocci in clusters.

Test q:A 56M presents w/ulcers and mucocutaneous lesions around his nose and mouth after a trip to South America. A skin biopsy shows ameboidmicroorganisms and mixed inflammation. Erythrophagocytosis is not present. Gram stain and GMS (silver) stains show no microorganisms.Diagnosis? Balamuthia mandrillaris.


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All Other Test Qs:

Review questions from years past:

Test q: On a routine visit to the physician, an otherwise healthy 51y/o man has a BP of 150/95mmHg. If the patients hypertension remains untreatedfor years, which of the following cellular alterations will most likely be seen in the myocardium? Hypertrophy. REPEATED x3Test q:As the human female ages and gives birth to children, the endocervical epithelium changes from columnar to squamous. This change is called:Metaplasia.

Test q:A long-time male cigarette smoker exhibits replacement of bronchial glandular mucosa by benign squamous cells. This change is called:Metaplasia.

Test q: Mature squamous epithelium in bronchial lining is an example of: Metaplasia

Test q: The apple core appearance of colon cancer on x-rays and inversion of the nipple in breast cancer are both due to: Desmoplasia.

Test q:A 72y/o woman is admitted to the hospital in an obtunded condition. Her temp is 37*C, pulse is 95/min, respirations are 22/min, and BP is

90/60mmHg. She seems to be dehydrated and has poor skin turgor. Her serum glucose level is 872 mg/dl. Urinalysis shows 4+ glucosuria, but noketones, protein, or blood. Which of the following factors is most important in the pathogenesis of this patients condition? Insulin resistance (Otherchoices were: HLA-DR3/HLA-DR4 genotype, Autoimmune insulitis, Severe depletion of cells in islets, Virus-induced injury to cells in islets.)Test q:A child is born w/a single funct ional copy of a tumor suppressor gene. At the age of 5, the remaining normal allele is lost through mutation. As aresult, the ability to control the transition from G1 to S phase in the cell cycle is lost. Which of the following neoplasms is most likely to occur?

Retinoblastoma

Test q: The following tumors are known for being invasive but generally NOT metastatic: Glioblastoma multiforme and basal cell carcinoma.

Test q: The nuclear proteins Rb and p53 are gene products for: Tumor suppressor genes.

Test q:A 40y/o woman who was recently in an automobile accident noticed a firm mass in the upper-outer quadrant of her right breast. A mammogram2mo ago was normal. Which microscopic description is most consistent w/the clinical history? Giant cells and foamy macrophages.

Test q: The most important property of a tumor that determines malignant potential is: Metastasis.Test q: A 69y/o man has had difficulty w/urination for the past 5 years. A digital rectal exam reveals that the prostate gland is palpably enlarged to aboutwice normal size. A transurethral resection of the prostate is performed, and the microscopic appearance of the prostate chips obtained is that oflarge glands lined by 2 cell layers and with intervening stroma. Which of the following pathologic processes has most likely occurred in the prostate?

Hyperplasia.

Test q: Angiogenesis in tumor cells is stimulated by: VEGF.

Test q: Degradation of ECM Type IV collagen in metastasis is due to the action of: Metalloproteinases.

Test q:A 26F has a lump in the left breast. On phys exam by the physician, there is an irregular, firm, 2cm mass in the upper inner quadrant of the

breast. No axillary adenopathy is noted. A fine-needle aspirate of the mass shows carcinoma. The patients 30y/o sister was recently diagnosedw/ovarian cancer, and 3 years ago, her maternal aunt was diagnosed w/ductal carcinoma of the breast and had a mastectomy. Which of the following

genes is most likely to have undergone mutation to produce these findings? BRCA1 (DNA repair gene).

Test q:A 40M has been taking daily insulin injections for the past 25 years. When he does not arrive at work, a friend visits his house and finds him onthe floor in an obtunded state. He is taken to the hospital by ambulance. On admission to the hospital, he cannot be aroused. He is afebrile, with apulse of 90/min, resp 17/min, and BP 90/60 mmHg. Lab studies show a Hbg A1c concentration of 8.9%, serum glucose level of 11 mg/dL, and serumosmolality of 295 mOsm/kg. Urinalysis shows 4+ ketonuria w/a specific gravity of 1.010. Which of the following statements best characterizes these

findings? He is in poor glycemic control and has had an insulin overdose. (Other choices: He is in good glycemic control but has developedketoacidosis; He is in poor glycemic control and is not taking his insulin; He is in good glycemic control but has not eaten food recently; He is in poorglycemic control and has developed a hyperosmolar coma.)

Test q:A 23F receiving corticosteroid therapy for an autoimmune disease has an abscess on her upper outer right arm. She undergoes minor surgeryto incise and drain the abscess, but the wound heals poorly over the next month. Which of the following aspects of wound healing is most likely to be

deficient in this patient? Collagen deposition. (Other choices: Re-epithelization; Fibroblast growth factor elaboration; Serine proteinase production;Neutrophil infiltration)

Test q: Which of the following are labile cells? Gastric columnar epithelial cells. (Other choices: Cardiac muscle fibers, Hepatocytes, Fibroblasts,Smooth muscle cells)

Test q: The most common paraneoplastic syndrome is: Hypercalcemia.

Test q: Which best characterizes a post-mortem clot? Chicken fat appearance.

Test q: In an experiment, peripheral blood T lymphocytes are collected and placed in a medium that preserves their function. The lymphocytes areactivated by contact w/antigen and incubated for several hours. The supernatant fluid is collected and is found to contain a substance that is a major

stimulator of monocytes and macrophages. Which of the following substances is most likely to stimulate these cells? Interferon-.

Test q:At autopsy, a patients liver shows marked stasis of blood in the central veins. Lung shows congestion of capillaries and pink, acellular mater ialin the alveoli. What is the most likely cause of these findings? Left heart failure.

Test q:A 50y/o woman saw her physician af ter noticing a mass in the right breast. Physical exam showed a 2cm mass f ixed to the underlying tissues


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and three firm, nontender, lymph nodes palpable in the right axilla. There was no family history of cancer. An excisional breast biopsy was performed,and microscopic exam showed a well-differentiated ductal carcinoma. Over the next 6mo, additional lymph nodes became enlarged, and CT scans

showed nodules in the lung, liver and brain. The patient died 9mo after diagnosis. Which of the following molecular abnormalities is most likely to befound in this setting? Amplification of the ERBB2 (HER2) gene in breast cancer cells

Test q:A 68F suddenly lost consciousness and, on awakening 1 hour later, she could not speak or move her right arm and leg. Two months later, ahead CT scan showed a large cystic area in the left parietal lobe. Which of the following pathologic processes has most likely occurred in the brain?Liquefactive necrosis. REPEATED x2

Test q:A 30y/o woman sustained a traumatic blow to her right breast. Initially, there was a 3cm contusion that resolved within 3wk, but she then felt afirm lump that persisted below the site of the bruise 1mo later. What is the most likely diagnosis for this lump? Fat necrosis

Test q:A 61y/o woman has felt a lump in her breast for the past 2mo. On phys exam, there is a firm 2cm mass in the right breast. An excisional biopsyspecimen of the mass shows carcinoma. Immunoperoxidase stains for matrix metalloproteinase-9 are performed on the microscopic tissue sectionand show pronounced cytoplasmic staining in the tumor cells. Which of the following characteristics is most likely to be predicted by this marker?

Invasiveness.

Test q:A property of the initiator family of carcinogens is: Chemicals that damage genes.

Test q: Direct acting carcinogens are: Weak carcinogens.

Test q:A 44F has a right breast mass. Grossly, multiple blue-dome cysts are present. These gross changes suggest: Fibrocystic disease.

Test q: Which of the following histologic features seen in breast biopsies place the patient at increased risk for ductal carcinoma? Ductalpapillomatosis.

Test q:A 45F receives 4wk treatment for mastitis of the right breast. Biopsy shows invasive carcinoma w/ lymphatic invasion. Initial therapy in this caseis: Chemotherapy.

Test q: Which of the following breast carcinomas has the poorest prognosis? Metaplastic carcinoma. (Other choices: Tubular carcinoma, Mucinouscarcinoma, Medullary carcinoma, Adenoid cystic carcinoma)

Test q:A breast biopsy shows Indian-file growth pattern of the tumor cells. In other areas, a targetoid growth pattern is seen. Diagnosis: Lobularcarcinoma.

Test q:A 50M long-time smoker has a biopsy of a right central lung mass. The right mainstem bronchus is not obstructed. The tumor shows highnucleus-to-cytoplasm ratio and nuclear molding. Neither squamous nor glandular differentiation are present. Treatment of the patient would include:Chemotherapy.

Test q: The left breast of a 39y/o female is slightly enlarged compared w/the right. The skin overlying this breast is thickened, reddish-orange, and

pitted. Mammography reveals a 3cm underlying density. A fine-needle aspirate of this mass reveals carcinoma. How is the gross appearance of theleft breast best explained? Lymphatic obstruction.

Test q:A 50M experienced an episode of chest pain 6hr before his death. A histologic section of left ventr icular myocardium taken at autopsy showed a

deeply eosinophilic-staining area w/loss of nuclei and cross-striations in myocardial fibers. There was no hemorrhage or inflammation. Which of thefollowing conditions most likely produced these myocardial changes? Coronary artery thrombosis.

Test q: Which of the following is associated w/hereditary nonpolyposis colon cancer (HNPCC)? Inability of DNA mismatch repair genes (mutation)to correctly repair damaged DNA.

Test q:A 48y/o woman notices a lump in her left breast. On phys exam, the physician palpates a firm, non-movable, 2cm mass in the upper outerquadrant of the left breast. There are enlarged, firm, nontender lymph nodes in the left axilla. A fine-needle aspiration biopsy is performed, and the cells

present are consistent w/carcinoma. A mastectomy w/axillary lymph node dissection is performed, and carcinoma is present in two of eight axillarynodes. Which of the following factors is most likely responsible for the lymph node metastases? Increased laminin receptors on tumor cells

Test q:An epidemiologic study investigates the potential cellular molecular alterations that may contribute to the development of cancer in a population.Data analyzed from resected colonic lesions show that changes are occurring that demonstrate the evolution of a sporadic colonic adenoma into aninvasive carcinoma. Which of the following best describes the mechanism producing these changes? Malignant transformation involves

accumulation of mutations in protooncogenes and tumor suppressor genes in a step-wise fashion.

Test q:A 70y/o woman reported a 4mo history of a 4kg weight loss and increasing generalized icterus. On phys exam, she is afebrile, and her blood

pressure is 130/80mmHg. An abdominal CT shows a 5cm mass in the head of the pancreas. Fine-needle aspiration of the mass is performed. Onmolecular analysis, the neoplastic cells from the mass show continued activation of cytoplasmic kinases. Which of the following oncogenes is mostlikely to be involved in this process? RAS

Test q: Prevention of lethal squamous cell carcinoma in patients suffering from xeroderma pigmentosa requires:Avoiding sunlight,

Test q: A 67M developed increasing shortness of breath over a three day period. His neighbor drove him to the ED where a CXR revealed fluffypulmonary infiltrates, a partially calcified, rounded density in the right upper lobe, and bilateral pleural effusions. Aspiration of some of the pleural fluidshowed a specific gravity of 1.006. Of the following the effusion is most likely due to: Congestive heart failure. (Other choices: Lung cancer,

Pneumonia w/pleural involvement, Rupture of the thoracic duct into the pleural cavity, and Tuberculosis w/pleural involvement)

Test q: Spontaneous venous thrombosis and migratory thrombophlebitis are most characteristic of: Adenocarcinoma of the pancreas. (Other choices

Chronic cholecystitis; Acute hemorrhagic pancreatitis; Islet cell tumor; Parathyroid hyperplasia)

Test q: A 79F, previously healthy, feels a lump in her right breast. The physician palpates a 2cm firm mass in the upper outer quadrant. Nontender


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right axillary lymphadenopathy is present. A lumpectomy w/axillary lymph node dissection is performed. Microscopic exam shows that the mass is aninfiltrating ductal carcinoma. Two of 10 axillary nodes contain metastases. Flow cytometry on the carcinoma cells shows a small aneuploid peak and

high S-phase. Immunohistochemical tests show that the tumor cells are positive for estrogen receptor, negative for ERBB2 (HER2/neu) expression, andpositive for cathepsin D expression. Which of the following is the most important prognostic factor for this patient? Presence of lymph nodemetastases.

Test q:A patient presents to the ER w/jaundice. Routine lab studies show that both the total and direct bilirubin are elevated, the alk phosphatase is 6xthe upper limit of normal, and both the ALT and AST are within the reference ranges for these enzymes. These results would be most consistent with:

Obstructive jaundice.

Test q: Which of the following malignant tumors most commonly metastasizes to the liver? Adenocarcinoma of the colon (Other choices: Renal cell

carcinoma, Prostate adenocarcinoma, Glioblastoma multiforme [Astrocytoma grade IV], Osteosarcoma)

Test q: The best initial lab test to order if you are evaluating a patient for autoimmune disease is: Antinuclear antibody (ANA).

Test q:A 45F presents w/a painful, swollen lef t breast. Peau dorange is present, the nipple is retracted, and the skin is dimpled. These changes areconsistent with: Inflammatory carcinoma.

Test q: All of the following increase risk for breast cancer in women EXCEPT: Oral contraceptives (Other choices: Obesity, Atypical hyperplasia,BRCA1, BRCA2)

Test q:All of the following are seen in fibrocystic disease of the breast EXCEPT: Cribriforming. (Other choices: Microcalcification, Cystic change,Apocrine change, Epithelial hyperplasia)

Nutrition section from years past:

An epidemiologic study observes increased numbers of respiratory tract infect ions among children living in a community in which most families are at the

poverty level. The infectious agents include Streptococcus pneumoniae, Haemophilus influenzae, and Klebsiella pneumoniae. Most of the childrenhave had pneumonitis and rubeola infection. The study documents increased rates of keratomalacia, urinary tract calculi, and generalized papulardermatosis in these children. A deficiency of which of the following vitamins is most likely to be present in these children? Vitamin A. REPEATED x2

A 3y/o child has had a succession of respiratory infections during the past 6 months. On phys exam, the child appears chronically ill, listless, andunderdeveloped. He is 50% of ideal body weight and has marked muscle wasting. Lab findings include Hgb of 9.4 g/dL, hematocrit 27.9%, MCV

75m3, platelet count 182,000/mm

3, WBC count 6730/mm

3, serum albumin 4.1 g/dL, total protein 6.8g/dL, glucose 52 mg/dL, and creatinine 0.3 mg/dL.

Which of the following conditions is most likely to explain these findings? Marasmus.

Children suffering from Kwashiorkor often fail to recover when proper nutrition is returned to their diet due to:intestinal atrophy.

The malnutrition seen in severe burn patients is similar to that seen in: Kwashiorkor.

Which vitamin supplement can be used to lower LDL and Triglycerides and increase HDL? Niacin.

Over the past year, a 55F has had worsening problems w/memory and the ability to carry out tasks of daily living. She has had watery diarrhea for the

past 3mo. Phys exam shows red, scaling skin in sun-exposed areas. The deep tendon reflexes are normal, and sensation is intact. Which of the

following is the most likely diagnosis? Pellagra.

Infectious Disease Pathology p76-89

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Transcript of Infectious Disease Pathology p76-89