USMLE Step 1 HY Images to Know
look at all the other stuff (squiggly = light pink collagen), we should only see circles (fat) & BM elements Dx = *myelofibrosis* pink bar in middle = spicule of bone
BM
notice empty BM replaced by adipocytes (NO HEMATOPOIETIC ELEMENTS) = *aplastic anemia*
BM shows
spread to *axillary LN* top = normal tissue; bottom = tumor replacing LN -white spaces @ bottom = glands = ADCA (*rmr CA spread via LYMPHATICS*)
BRCA in what tissue
lacunar cells bc now RS cells sit in these "big lakes" Cx of *nodular sclerosing HL* (most common form)
Cx RS Cells
on L = hyper-segmented PMN (> 5 lobes, has 7) on R = macroovalocyte (big RBC, MCV > 100) Dx = *megaloblastic anemia* d/t folate or B12 def
Dx?
Heinz prep showing precipitated Hb (*G6PD def*)
HUH wtf rbc4? cause?
india ink stain: crypto/HIV Pt. with meningitis
ID Cx stain/bug/Pt/Dx
*red (hmrg-ic) infarct* of testicle -d/t re-perfusion & fact tissue is loosely org (allows tissue to hold re-entered blood) -cause: spermatic cord houses thick walled a. and thin v. when cord twists, a. is ok d/t thick wall but v. ruptures easily and the blood from their (that was supposed to exits) instead spills into scrotum
ID again; d/t what 2 things; cause
mucosal *bowel crypts*; at base of crypts are *gut stem cells*
ID circles at bottom; contain what
gangrenous necrosis of L/E in DM Pt.
ID gross path
caseous necrosis (notice white, cottage cheese-like appearance) d/t Tb
ID gross path again
white chalky deposits encircled = peri-pancreatic fat that's undergone *fatty necrosis* via saponification (deposition of Ca++, which gives it chalky white look)
ID gross path again1
candida (know this img)
ID the opportunistic mycoses
discoid rash seen in SLE
ID the rash
looks like a stoma (mouth) think gingivostomatitis -> 1º HSV infxn
ID this smear
pale, wedge shaped infarct of kidney -> *coag necrosis*
ID what's seen; indicates what
jk what cutaneous lesion? borrelia (lyme Dz - Pt was fkn round in the woods); usu Cx lesion is erythema migrans = target sign w/ zone of central clearing but that's actually rarely seen so rmr this
ID whose ass this is
GERD -> *barret's esophagus* (non-K StrSq replaced by non-ciliated columnar epith w/ goblet cells) -> esoph ADCA mucinous columnar epith on surface (asterisk) w/ underlying mixed mucous glands (arrows)
Id Dz (pathophys)
L = b9 adenoma of thyroid R = mal ADCA (disorg growth, hi n:c ratio)
L vs R
R = *reactive hyperplasia in germinal center* (white spaces = *tingle body macrophages* apoptosing dead B-cells that underwent somatic hyper-mut & didn't survive) L = *follicular lymphoma* (increased b-cl2 blocks apoptosis)
LN: L vs R
*fat emboli* (circular spaces = fat cells)
and this
*chipmunk facies* d/t *B-thal major*
and this?
*erythroblast* (immature RBC, lacking cytoplasm, w/ "punched out" nucleolus circled) -can't tell if myeloidblast or lymphoidblast
and vut dis?
notice how many follicles there are thru ENTIRE LN (instead of just cortex; so not simply reactive hyperplasia) = *follicular lymphoma*
another LN; what's interesting? Dx?
notice how T cell has "brain-like lobes" = *cerebriform nuclei* d/t *Sezary Syndrome in Mycosis fungoides*
bad T cell
plasmodium/malaria Tx: chloroquine/Mefloquine
blood smear. Tx?
*prussian blue stain* (stains for Fe) shows iron accum in Mt rings around nuc = *sideroblastic anemia* this is a BM biopsy of erythroblast cells
blue ring indicates what; stain?
lines of Zahn: tells us Pt. had *pre*-mortem clot R = RBC f = platelets + fibrin (clot)
but what diz; what do they tell us
starry sky = Burkitt's Lymphoma blue = the sky, tumor cells white = star, tingible body macrophages that are eating the dead tumor cells that grow so fast they die
classic pic
neurofibromas, so think NFT1
cuatenous lesions are?
*Auer rods in AML* rmr Auer rods are crystal aggregates of MPO, which are only prod by MYELOblasts -also notice it's large w/ punched out nucleolus = blast
for 2nd time; notice thin rod
spherules containing endospores (coccidio)
fungal
notice acute angles ("V"): aspergillus fumigatus
fungal2
sclerodactyly in scleroderma (*CREST*) -notice decreased wrinkles at fingertips bc of tightening of skin (d/t fibrosis)
hand exhibits what
tennis racket = *birbeck granule* = LH cell histiocytosis
hi
we see a basophil amongst many granulocytes. if basophil ct. increases, think *CML*
hint top L
Gaucher's cells in *Gaucher's Dz* (lysosomal storage Dz); macrophage looks like crumpled tissue paper
histo of macrophage
foam cells (stored w/ fat) in *niemann pick Dz*
histo of macrophage 2
notice how in center there's necrosis & cell death. that makes it *caseating granuloma*
how is this diff from prev one
double refractive walls w/ broad based budding so think Blasto (focus on L pic); in great lakes, ohio, miss river
iD this fungi in lungs
notice how fungi is HIDING in macrophage, so Histoplasma
id this fungus in i-c Pt. (BM)
congo red stain identifying *amyloid* deposition around blood vessel in extra-cellular space (small red dot in middle of box) -*Alz*
identify what's around blood vessel -classic Dz
(arrow points to intranuc inclusion so u know its virus): CMV
interstitial PNA in transplant Pt.
circled = hepatocytes big white cells = adipocytes d/t *fatty change in liver*
liver histo
*retinoblastoma* (Rb TSG needs double hit)
looking at eye. what's circled?
AML type (acute monocytic leukemia) -monoblasts love to infiltrate gums
masses in gums
blue dots in meninges = *ALL* spread to CNS
meninges of child
saddle embolus -embolus has saddled across and knocked out both pulm aa.
my word what is this
2 Ig monomers: J in middle = J chain; SC = secretory component secretory *IgA*: found in colostrum (also tears, saliva, mucus)
name the Ig; primarily found in
*target cell in HALT*: HbC Dz, Asplenia, Liver Dz, *Thal*
name the cell; found in what Dz's
L = *coagulative necrosis* of kidney glomeruli notice on R you see blue nuc, but not on L; also gen shape of L histo is preserved even w/o nuc d/t coag of cellular proteins
necrosis type
ecythemic gangrenosum d/t Pseudomonas
necrotic patches in skin in cancer Pt. d/t
circle = bone in sk. mm. = *myositis ossificans* (portion of sk. mm. becomes bone d/t inflm via trauma) confused for *osteosarcoma* but notice how adjacent bone is normal and is distinct from circular lesion so you know new bony mass is not growing off of long bone but rather sk. mm.
notice circle in sk. mm. -confused for?
bright pink stain in wall of blood vessel = *fibrinoid necrosis*
notice pink stain
*keratomalacia* (notice thickened/white cells @ bottom) d/t vit A def -> metaplasia in conjunctiva
ocular path; cause
*MS* -areas of oligodendrocyte loss + reactive gliosis
paraventricular plaques
LVHT hypertrophy bc cardiac myocytes have no stem cells to undergo hyperplasia, like sk. mm., can only undergo hypertrophy. notice L (HT) vs R (normal)
pathologic process involved
rouleaux formation d/t *MM* (increased protein in serum decreases charge b/w RBC's causing them to clump)
poker chips
keratin debris in blood vessels = pink cells = *amniotic emboli* (baby's fetal skin soaking in amniotic fluid)
preg woman
MM
punched out lesions on x-ray
tear drop w/ owl-like face GIARDIA
recurrent diarrhea d/t protozoan
L = normal cells middle = lymphocytic infiltrate destroying gland = *Sjogren's*
salivary gland shows
amyloid here has *apple-green birefringence*
same slide as before placed under polarized light showing what
myeloblasts w/ coarse rod-shaped intra-cytoplasmic granules aka *auer rods*; think *AML*
seen in blood smear
on R = petechiae (pin point bleeds) on L = ecchymoses (> 1 cm) purpura > 3 mm
skin bleeds
granuloma (Tb) -IFN-y
the hell is you lookin at; also what cell responsible for this?
ton of platelets; Dx = *essential thrombocytosis* (backup = iron def anemia)
ton of these; Dx
butterfly glioma in *Glioblastoma multiforme*
tumor crossing corpus callosum
in fibrosed BM, when RBC leaves it gets stretched out = *teardrop cell in myelofibrosis* "BM is crying bc it's fibrosed"
weird RBC
atypical lymphocyte (CD8+ T-cell) in Infectious mono (d/t EBV or CMV); 2nd flashcard of this know this
whart dafuquh
broad pink bands of fibrosis cut LN into "nodules" = *nodular sclerosing HL* (most common form) sclerosing = hard, bc all this fibrotic tissue
what abt this LN
atypical lymphocytes (activated CD8 T cells); seen in infectious mono (d/t CMV or EBV)
what are these? Dx?
*splenic rupture d/t EBV induced mono* (causes spleen to enlarge, now more susceptible to rupture thru capsule) -we tell Pt. to avoid contact sports for 1 yr bc any light contact with spleen can cause this
what are ur eyes seeing right now plz spk thru lips -viral cause? -Tx
interstitial space during acute inflm -bottom corner circles = vessels so you know we're outside of them -smaller circles above = *PMN's* -empty circles = fluid building up in tissue = *edema*
what are we seeing here
chronic inflm L - lymphocyte R - plasma cell
what can you tell by presence of cells
sheared RBC = *schistocyte (helmet cell)* microangiopathic anemia
what cell highlighted; seen in?
notice "hairy" cytoplasmic processes: *Hairy Cell Leukemia*; Dx by *TRAP* (get TRAPPED in hair)
what diz be doe? Dx confirm?
E = epidermis, D = dermis squiggly line = basal layer of dermis that houses SC's
what is this
*Iron Def Anemia*: -lymphocyte nuc & RBC size should be same so as reference you can tell RBC size small -also notice spectrum of RBC exists (bc this first has normocytic anemia b4 microcytic) -also increased central pallor = hypochromic
what is this and how can you tell
*granuloma* (notice rim of lymphocytes around epithelioid histiocytes); it's *non-caseating* bc each of the histiocytes (small circles) has their nuc present so it's not yet necrotic like caseating
what is this? how can u tell?
*LN* -Cortex = B-cells (hyerplasia in RA, early HIV) -Paracortex = T-cells (all viral) -Medulla, site of sinus histiocytosis (reactive hyperplasia to cancer)
what lymphoid tissue is this
brown so think IHC stain
what stain is this
blood vessel occluded by *atherosclerotic embolus* (white long gaps in middle are cholesterol crystals)
what this
L circles = *granulation tissue* (during wound repair) R circles = vessels (sprouting capillaries) squiggly = deposition of collagen via fibroblasts
what this be
*RS* cell (HL) notice "owl eyes"
what this guy
white scar indicates previous *MI* -rmr myocardium is a permanent tissue w/ no regen capacity
what we lookin at doe -why does this form
*smudge cell in CLL* (neoplastic prolif of naive B cells)
what's going on top L
*apoptotic body* (pink Eos cytoplasm (bc it's getting concentrated as cell shrinks) & nuc is smaller)
what's the cell
it's larger and has a bluish tinge (d/t increased RNA in cytoplasm) = *reticulocyte* (baby RBC)
what's weird abt this RBC?
*HS* (smaller than avg *RBC w/ no central pallor*) -range of size d/t fact that oldest cells lose more membrane (smaller RBC than newer ones)
what's wrong w/ cells here
massive expansion of hematopoiesis in new parts of bone to make new RBC's (d/t increased loss) Dx = *B-thal MAJOR* or *SCA* forming *"CREW CUT"* -> sk. deformities -> *chipmunk facies*
why does skull look like that; Dx; sequelae?
*keloid* -earlobes of blacks -T3 collagen
wtf are we looking at here; clin pres; made of
*ovarian CA* spread to abdominal *omentum* via *body seeding* -aka *omental caking*
wtf is this
*SCA*: banana shaped RBC d/t polymerization of HbS in low O2, dehyd, acidosis
wtf rbc2? cause?
*HbC crystal* d/t glutamic acid to *LYSINE* (C for LyCn) mut
wtf rbc3? cause?
*bite cells* in *G6PD def*
wtf rbc4? cause?
*malarial* org present w/in RBC's (*Plasmodium*)
wtf rbc5? cause?
nuclear remnant in RBC = *howell-jolly bodies* d/t *splenectomy*
wtf rbc? cause?
*RICKETS* d/t vit D def -notice femurs bowed out (genu varum)
x-ray of legs of toddler
senile plaque in Alzheimer's Dz
β-amyloid protein
