Lab Items - Exam 2

7/30/2019 Lab Items - Exam 2

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Microscope Slide Answers : Clues/Question : Actinic keratosis skin biopsy from forehead of 65y/o forest ranger (once, was 55y/o farmer) 2 Actinomycosis lung and liver biopsies obtained from autopsy of 55M w/poor dental h ygiene Acute leukemia Wright-Giemsa stained peripheral blood smear from 24M w/fever, lethargy, and hi gh WBC count. He is anemic and thrombocytopenic. Alcohol abuse two liver biopsies from 55M obtained 3yr apartBitemporal hemianopsia What is the most likely clinical history for this mass that was removed from the sella turcica of a 22M?CD15+; CD30+, CD45- lymph node biopsy from 25M w/cervical lymphadenopathy. Your histologic diagnosis would be confirmed by the following 2CD5/23 co-expression lymph node biopsy from 75M w/cervical lymphadenopathy. Your histologic diagnosis would be confirmed by the followingChronic myelogenous leukemia Wright-stained peripheral blood smear from 49M w/enlarged spleenChronic pyelonephritis kidney biopsy from 55y/o diabetic (once, was 59y/o) 2Coccidioides Immitis lymph node and mediastinal tissue biopsies from a 40M AIDS patient construction worker 2

25F w/lymphadenopathy; biopsy of enlarged axillary lymph nodeCryptosporidium seeberi small intestine biopsy from a 23y/o AIDS patient w/diarrheaCraniopharyngioma mass removed from sella turcica of 5M 2

biopsy from the area of the pituitary glandCytomegalovirus infection 50F renal transplant patient who died of respiratory failure; sample from the colonFibroadenoma breast biopsy from a 42FFollicular hyperplasia 60M w/diffuse lymphadenopathy undergoes biopsy of a cervical (neck) lymph nodeFollicular lymphoma lymph node biopsy from 40M w/diffuse lymphadenopathyGaucher disease 14M w/weakness, fatigue, bone pain, splenomegalyGranuloma The pathology in this lymph node is consistent withHerpes simplex virus esophageal biopsy from 29y/o AIDS patientHisplasmosis bone marrow aspirate from 22y/o bone marrow transplant patient stained w/Gomori Methenamine Silver (GMS)Invasive ductal carcinoma H&E stained breast biopsy from 45F (once, was 42F) 2Leukocyte alkaline phosphatase peripheral blood smear from 60M w/splenomegaly, fever, and shortness of breath. What special stain on a bm aspirate would be most helpful? 2Medullary carcinoma H&E stained biopsy of a thyroid massMEN type IIA 50y/o w/history of parathyroid adenomas and pheochromocytomas presents w/thyroid mass biopsiedMetastatic melanoma lymph node biopsy from 65M w/cervical lymphadenopathy 2

lymph node biopsy from 75M w/an enlarged cervical lymph node; had surgery to remove a cutaneous malignancy 5 years ago.Myeloperoxidase

and Periodic Acid-Schiff (PAS) peripheral blood smear from 30M w/lymphadenopathy, fever, and shortness of breath. What special stains on a bm aspirate would be most helpful?Neuroblastoma biopsy of large abdominal mass removed from 2y/o 2Papillary carcinoma nodule removed from thyroid of a 42F 3

biopsy of a thyroid nodule x2Pheochromocytoma 12M w/headaches, sweating, and tachycardia abdominal mass. The histology of this tumor removed from the right kidney/adrenal area isProcalcitonin biopsy of a thyroid nodule demonstrates deposition ofReactive lymphoid hyperplasia lymph node biopsy from 65M w/cervical lymphadenopathy (once, was 25M. once, was 75M) 3Sarcoidosis spleen removed from 45F w/weight loss, blurred vision, and bilateral hilar lymphadenopathySheehans syndrome biopsy from the area of the pituitary glandSmall cell undifferentiated carcinoma biopsy taken from the central region of the right upper lobeSmall lymphocytic lymphoma 60M w/diffuse lymphadenopathy undergoes biopsy of a cervical (neck) lymph node 2

lymph node biopsy from 65M w/cervical lymphadenopathySquamous cell carincoma biopsy from right upper lobe of lungWilms tumor abdominal mass removed from 2y/o (twice, said a child) 4

biopsy from 2y/o girl w/large abdominal mass

Longer microscope answers 30y/o pregnant female w/pre-ecclampsia The findings in this Wright-Giemsa stained peripheral blood smear are consistent w/which clinical history?32F unable to breastfeed 1 week after an emergent c-section Which clinical presentation correlates most closely to the pathology seen in this pituitary gland biopsy?

on answer key, this is identified as Sheehans, pituitary infarction45F who presents w/fatigue and cold intolerance This is a biopsy of a thyroid gland. Which clinical history most closely correlates w/the pathology?

on answer key, this is identified as Hashimotos thyroiditis5F w/recent history of E. coli diarrhea, fever, decreased urination, and nosebleeds What clinical history most closely correlates w/the pathology seen in this blood smear?

on answer key, this is identified as MHAElderly patients w/this disorder must be screened for colon cancer Patient presented w/fatigue, pallor, and dyspnea on exertion; Which statement is true regarding the disorder

on answer key, this is identified as iron deficiency depicted on this blood smear?Normal thyroid, 1 normal parathyroid and 1 parathyoid w/decreased fat This is a biopsy of a thyroid nodule. The biopsy is best described as


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Non- Microscope Answers : Clues/Question : Acromegaly 45M w/pituitary adenoma Actinomycosis H&E liver biopsy Acute leukemia Which of these 4 photos is most consistent w/a diagnosis of acute leukemia? 2 Acute myelogenous leukemia M1 Which of these 4 photos is most consistent w/a diagnosis of acute myelogenous leukemia (AML, M-1)? Adenoma (parathyroid) 2 parathyroids from the same patient w/hypercalcemia Adenoma (unspecified) Choose the best description 3 AFP Both of these tumors can be monitored for recurrence during chemo by measuring ALL Wright stain, myeloperoxidase, PAS. 3 Amebiasis Both photos are consistent with 2 Aspergillus H&E, cotton-blue-stained culture 2

Once, said 66F w/a previous history of cavitary TB now presents w/hemoptysis. What diagnosis is consistent w/both of these photos? Atrophy (unspecified) Choose the best descriptionBasal cell carcinoma Gross photo, two micro images of a skin biopsyBlastomyces dermatitidis 4 photographsBroad based buds are common Which of the following is true regarding the organism depicted in both photos?Bronchopneumonia Lung photographBurkitt lymphoma H&E biopsy of ovary; Biopsy of large abdominal mass 2Calcitonin Female presents w/thyroid nodule. What substance is most likely to be secreted by this type of tumor?Candida albicans Tongue, gram stain, germ tube testChlamydia trachomatis Diagram of an infectious disease outbreakCMV infection H&E lung biopsies from renal transplant patient 2Coagulation necrosis Lung specimensCoccidioides immitis H&E-stained biopsy, KOH stain of sputum, cotton-blue stain of culture 2

Once, said 49y/o HIV-infected truck driver just returned from transcontinental trip presents w/fever, cough, chest pain.Cryptococcus neoformans PAS, GMS, Multicarmine stains of lung biopsy, H&E 3Cushings Disease Low dose Dex no suppression. High dose suppression. (Other choices: normal, adrenal adenoma, lung cancer) 2

Once: A 50M presents w/weight gain, prox musc weakness, and insulin resistance. Which of these 3 photos is consistent w/Cushing Disease?Cushings Syndrome before-and-after endocrinopathy treatment pictures 3Diabetic kidney Best description for kidney biopsy picture 2Diabetic lesions in pancreas Both A and B are pancreas biopsies. Correct description for these diabetic lesions: B is type I and A is type II.Ductal carcinoma in situ (DCIS) breast biopsies 3Elevated anti-TSH receptor antibody What abnormal lab values would you expect to find for this patient? 3Endocarditis 4 photographs are consistent w/a clinical history ofEntamoeba histolytica After a vacation in Mexico, a 30F has abdominal pain and diarrhea. 3 photos.Fatty change w/o cirrhosis Which liver is an example of fatty change w/o cirrhosis?Fine needle aspirate of mass Large neck mass, heat intolerance. Next step?Follicular hyperplasia enlarged cervical lymph node in a 25MGlutamic acid to valine substitution Which of the following defects results in the pathology seen in this picture?Granuloma Changes present in this lung are consistent with (gross photo, microscopic image) 2Graves disease H&E stains, microscopic images of enlarged thyroid 2Growth hormone What hormone is elevated to cause the condition depicted in these two pictures? 2Hashimotos Disease photographs 2Hashimoto Thyroiditis H&E stained thyroid biopsies; photos 3

Once: 42F presents w/weight gain and dry skin. Biopsy.Hemochromatosis Liver Hemolytic transfusion reaction Patient w/sudden onset of fever and shortness of breath. This tube of blood was collected 2hr after he received 2 units of packed RBCs. Dx?Herpes Virus A 26F undergoes endocervical biopsy after having abnormal uterine bleeding. Pap stain of biopsy.Histoplasma capsulatum GIemsa, GMS stains of bronchoalveolar lavageHistoplasmosis 2 GMS stains, PAS stain 2Hodgkin Disease 4 photos of enlarged cervical lymph node 2Hodgkin Lymphoma A 20M presents w/generalized lymphadenopathy. Biopsies.HPV Pap smear 2Hypercalcemia 2 H&E bone marrow biopsies and x-rays from 70M. You would expectHyperplasia (adrenal) The adrenal on the left side of the picture shows 2Langerhans cell histiocytosis 4 electron microscope images

Leukocyte alkaline phosphatase A 40M has a WBC ct of 45,000/ L. Given the blood smear below, what diagnostic test would be most helpful in making the Dx?Liver w/metastatic carcinoma Choose the best decription


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Lobar pneumonia changes present in this lung are consistent withLung cancer GraphMalignant vs. benign Choose the best description for the two sets of photos answer: A is malignant, B is benign. 2Meningioma Gross findings in brain meninges; biopsy obtained during brain surgery 4Metastatic melanoma Best description for this specimenMucor or Rhizopus 49M diabeticMultinodular goiter Patient presents w/enlarged thyroid and the following nuclear medicine thyroid scan was performed. Dx?Multiple myeloma 65F w/3-month history of multiple kidney stones. Bone marrow aspirate and X-ray. 4

Once, said 65F w/3mo history of mult kidney stones. Which of the X-rays most likely corresponds to her peripheral blood smear?Mycobacterium tuberculosis dissemination via pulmonary artery Question:What is the most likely etiology for the pathology shown in this specimen?Necrotizing granuloma H&E biopsyNeuroblastoma Which of the 4 photos is consistent w/neuroblastoma?Papillary carcinoma Thyroid mass 3Parathormone What hormone is elevated to cause the condition depicted in these pictures? 2Parathyroid hyperplasia What is the most likely finding in a patient w/the disorder evident in this kidney? Both kidneys had the same appearance.Pellagra Adolescent presents w/diarrhea, dementia, and rash seen here.Pheochromocytoma Patient presents w/episodic sweating, intermittent hypertension, headaches, and dizziness. Adrenal mass most consistent with?Plasma cell tumor The disorder in this peripheral blood smear is associated w/which of the following? 2Pneumocystic jiroveci H&E stain, GMS stained bronchoalveolar lavage (BAL) 2Pretibial myxederma and exophthalmos A 45F presents w/diffusely enlarged thyroid. Which clinical features are most specific for the disorder exemplified in the photo?Promyelocytic leukemia (M3) Wright-Giemsa peripheral blood smear photos; once: 30M undergoes BM aspiration this photo is a Wright stain 3

twice, answer was Acute myelogenous leukemia M3Prostate hyperplasia; bladder hypertrophyProstate hyperplasia vs. carcinoma Choose the best answer to describe these prostate photos: A is hyperplasia, B is carcinoma. 2Rheumatic heart disease Heart biopsyRight-sided heart failure Which liver specimen would you expect to see in a patient w/right-sided heart failure?Schistocytes This child has H. influenza sepsis. What would peripheral blood smear show?Sickle cell anemia Which of the following X-rays is consistent w/sickle cell anemia?Spleen The RBCs shown on this peripheral blood smear are indicative of dysfunction of what organ?Stool exam for occult blood These blood smears are from a 75 anemic male who has lost 50lb during the past year. What test to order? 3

once, answer was Rectal exam and stool for occult bloodStreptococcus Pneumoniae Lung specimenSyphilis Photot(14;18) What is the translocation responsible for the disorder depicted on these 2 photos? 3Teratoma ovary specimenTertiary syphilis Changes seen in the heart and aortaThalassemia Which of the following X-rays is consistent w/thalassemia? 2Thiamine (Vitamin B1) deficiency Illustrations 2Toxoplasmosis A 21y/o HIV patient presents w/seizures. Head MRI and biopsy.Treponema pallidum Darkfield preparation, Warthin-Starry stain both of genital ulcersType IV Hypersensitivity What hypersensitivity pattern is described by the diagram?Ulcers 2 photosVitamin B12 deficiency Patients past med history significant only for an unknown abdominal surgery. Presents w/two weeks of difficulty walking. Peripheral blood smear 4

Once, question was Which of the following photographs is consistent w/Vit B12 deficiency?Vitamin C deficiency Robbins illustrations 2Vitamin D deficiency photosWilms tumor Tumor is removed from abdomen of young child. Which of the 4 photos is consistent w/Wilms tumor?

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Lab Items - Exam 2