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Edward Goljan, M.D. 2002 HIGH YIELD NOTES PATHOLOGY & = —_USMLE pictures: sec handout describing high yield pictures in Robbin's Sixth edition = USMLE hematology pictures not in Robbins: * supravital stain showing reticul filaments, © coarse basophilic stippling in Pb poisoning, » x-ray with density in ict RNA poisoning, « ringed sideroblast, * acute progranulocytic leukemia lots of Auer rede aoa tig’, DIC, « gross of non-Hodgkin's lymphoma encircling trachea and arch vessels wenn et them, + micro of B cell follicular lymphorna, » multiple myeloma marrow with plaeme ale urine, + Reed-Sternberg cell, * apple green birefringence of amyloid, » back of hand of elderly patient with senile purpura, + arms of elderly patient with multiple bruises~ probably abuse midbrain with yellow discoloration of kemicterus, + fetus with hydrops fetal i 2 — USMLE cardiovascular pictures not in Robbins: » xanthelasma, » Achilles tendon xan pathognomonic of familial hypercholesterolemia, » turbid supranate (chylomicrons) and inffanate (VLDL), « stasis dermatitis of lower leg~ sign of decp venous thrombosis, « Osler-Weber-Read discase— telangiectasia on fingers and mucous membranes, + spider telangiectasia, « lymphedema post mastectomy, * Kaposi's sarcoma, « micro of small vessel vasculitis with fibrinoid necrosis, « thromboangiitis obliterans, * patient with Henoch-Schénlein purpura, * gross of renovascular hypertension due to atherosclerosis, * capillary hemangioma on the face of a newbom, « Sturge Weber~ port wine nevus in trigeminal nerve distribution, « gross and micro of pulmonary edema, « coronary artery+ * identify platelet thrombus, + fibrofatty plaque, + dystrophic caleification, © atherosclerosis (empty slits), + section through ascending aorta~ what part dilated with postductal coarctation? proximal aorta, « rupture of posteromedial papillary muscle in an AMI, * rupture of anterior wall of LV in an AML, + ruptured interventricular septum in patient with an acute myocardial infarction rupture occurs in site of coagulation necrosis and leads to right heart failure, © mural thrombus in an AMI, « fibrinous pericarditis, « old AMI with scar tissue on anterior wall- do not confuse with a pale infarct, « valve vegetations- * MV vegetations in rheumatic fever: along the lines of closure of the valve, * infective endocarditis: see destruction of valve, + marantic vegetations on MV: * similar in appearance to rheumatic fever, + Hx of colon cancer or ulcerative colitis, + Libman Sacks endocarditis: occur on MV in patients with SLE, + gross of mitral valve « prolapse, * micro of myocardium with lymphocytic infiltrate~ coxsackie myocarditis © — USMLE respiratory pictures not in Robbins: « x-ray with spontaneous pneumothorax (tracheal shift to side of the pneumothorax) or tension pneumothorax (tracheal shift to contralateral side), « gram stain of Streptococcus pneumoniae, * x-ray or gross of lobar pneumonia, * gram stain of filamentous gram positive bacteria— Actinomyces or Nocardia (partially acid fast), « micro of macrophage with Histoplasma yeasts, « gross of cavitary apical lesion of TB~ possible acid-fast stain of organisms, + micro of a macrophage with acid-fast bacteria— TB, * micro of broad based bud of Blastomyces, « micro of wide-angled non-septate hyphae of Mucor, « gross of lung abscess, + micro of non-caseating granuloma in sarcoidosis, « gross of Hamman-Rich honeycomb lung, * x- tay of classic COPD, + gross of main-stem primary lung cancer 7 2 USMLE gastrointestinal pictures not in Robbins: + patient with Herpes simplex, + exudative tonsillitis, hairy leukoplakia, « thrush with or without gram stain of pseudohyphae and yeasts, « gross of two tongues with leukoplakia— one tongue is squamous dysplasia and the other is invasive cancer (look for asymmetry of tongue), « lower lip with squamous cancer, + Peutz-Jeghers lips, « patient with mixed tumor of parotid, « gross or barium study of Zenker's diverticulum, * gross of esophageal cancer~ think squamous if mid-esophagus or adenocarcinoma if distal esophagus, * X° ray of classic small bowel obstruction with air-fluid levels and step-ladder effect, + gross of intussusception in a child, * micro of absent ganglion cells in rectal biopsy in Hirschsprung’s, *Note: This material is copyrighted. All rights reserved. Edward Goljan, M.D. 2002 i o jodysplasia in cecum, * gross of carcinoid tumor (yellow c. ! sen pte ce a ott cern tobiliary/pamcreas pictures not in Robbins: * eyes with jaundice. « ee tal cee tan eee ey eet eae | phagocytosis,» gross of liver echinococcosis, « gross or micro of obstructive jaundice Hees green, look for stone in common bile duct, » Kayser-Fleische ring in Wilson's disease ven’ | total copper is low, ceruloplasmin is low, and free copper is high, » patient with Dupmreen contracture, + xray showing calcifications in the pancreas in chronic pancreatitis, © meee pancreatic cancer of head of pancreas USMLE genitourinary pictures not in Robbins: + casts in urine~ hyaline (fuzzy and round borders) vs waxy (sharp borders), RBC cast, renal tubular cast, fatty cast with Maltese rose cclls in urine~ WBCs, RBCs, + crystals in urine uric acid, calcium oxalate, cystine crystals, « horseshoe Kidney, * gross or x-ray of duplicated ureter, + gross of bilateral polyeysicladney discasc in a child, * gross of adult polycystic disease with or without brain with thes © subarachnoid bleed (ruptured berry aneurysm) or intracerebral bleed (hypertensive bleed), « linear immunofluorescence- think Goodpasture's syndrome, * lumpy bumpy IF— think ype I immunocomplex glomenalonephritis, « EM pictures fusion of podocytes in lipoid nephrosis, subepithelial deposits (post-streptococcal, membranous), subendothelial (type IV. SLE, membranoproliferative), * micro of nodular glomerulosclerosis in DM look for hyaline ancriolosclerosis of afferenvefferent and pink balls in mesangium, "Christmas ball” disease, micro of ischemic ATN- look for coagulation necrosis of tubular cells, « picture of kidney and show where Hg or Pb damages— proximal tubule, « gross of staghom calculus, « gross or micro or renal infarction— look for pale, sunken areas on the cortex and coagulation necrosis, & gross of benign nephrosclerosis— granular appearing cortical surface, * gross of malignant hyperteasion— look for petechial lesions on surface of the kidney, * micro of foreign body giant cell reaction in tubules BJ protein reaction in multiple myeloma, « gross of prostate hyperplasia— bulging nodular surface with occlusion of the urethra, * patient with Klinefelter’s— look for signs of feminization, « patient with testicular feminization looks like a woman but they will give history of blind vaginal pouch, * gross of renal adenocarcinoma~ yellow mass with hemorthage, yellow mass extending up the inferior vena cava USMLE gynecology pictures not in Robbins; * Herpes genitalis with or without a Tzanck prep showing multinucleated squamous cells with intranuclear inclusions, « condyloma acuminata— looks like a fern, HPV 6/11, ¢ Chlamydia- cell with vacuole in the cytoplasm containing an elementary body, # cervix or penis with thick exudate of GC with or without gram stain showing gram negative diplococei in polys, « clue cell of Gardnerella vaginalis— squamous cell covered by bacteria, « primary syphilitic chancre on penis or labia~ + painless, + if painful look for Hemophilus ducreyi, « picture of lymphogranuloma venercum— C. trachomatis subtype, papules with draining sinus from nodes, lymphedema, * Candida— cottage cheese discharge with or without gram stain of Pscudohyphae and yeasts, * squamous cell carcinoma of vulva— large ulcer on labia, * gross of cervical cancer, « micro of squamous dysplasia, « woman with hirsutism- * increased testosterone indicates ovarian origin, + increased DHEA-sulfate indicates adrenal cortex origin, * ovary with blood in cyst— endometriosis, * gross of ruptured tube (small embryo) from ectopic pregnancy, © ‘goss of follicular cyst, * gross or micro of serous cystadenocarcinoma of ovary- look for Psammoma bodies, * micro of signet ring cells with mucin in ovaries~ Krukenberg tumor from Stomach metastasis, © gross of abruptio placenta, * micro of choriocarcinoma- look for multinucleated cells representing syncytiotrophoblast and clear cells representing cytotrophoblast, « ‘&0ss of fibrocystic change, * patient with Paget's disease of nipple, « patient with inflammatory carcinoma of the breast with peau du orange appearance