USMLE Step 1 HY Images to Know

RICKETS d/t vit D def

-notice femurs bowed out (genu varum)

x-ray of legs of toddler

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

senile plaque in Alzheimer's Dz

β-amyloid protein

MS

-areas of oligodendrocyte loss + reactive gliosis

paraventricular plaques

butterfly glioma in Glioblastoma multiforme

tumor crossing corpus callosum

plasmodium/malaria

Tx: chloroquine/Mefloquine

blood smear. Tx?

candida (know this img)

ID the opportunistic mycoses

looks like a stoma (mouth)

think gingivostomatitis -> 1º HSV infxn

ID this smear

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

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)

(arrow points to intranuc inclusion so u know its virus): CMV

interstitial PNA in transplant Pt.

ecythemic gangrenosum d/t Pseudomonas

necrotic patches in skin in cancer Pt. d/t

spherules containing endospores (coccidio)

fungal

notice acute angles ("V"): aspergillus fumigatus

fungal2

india ink stain: crypto/HIV Pt. with meningitis

ID Cx stain/bug/Pt/Dx

tear drop w/ owl-like face

GIARDIA

recurrent diarrhea d/t protozoan

granuloma (Tb)

-IFN-y

the hell is you lookin at; also what cell responsible for 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

atypical lymphocytes (activated CD8 T cells);

seen in infectious mono (d/t CMV or EBV)

what are these?

Dx?

myeloblasts w/ coarse rod-shaped intra-cytoplasmic granules aka auer rods; think AML

seen in blood smear

neurofibromas, so think NFT1

cuatenous lesions are?

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

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)

keratomalacia (notice thickened/white cells @ bottom) d/t vit A def -> metaplasia in conjunctiva

ocular path; cause

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?

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

pale, wedge shaped infarct of kidney -> coag necrosis

ID what's seen; indicates what

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

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

bright pink stain in wall of blood vessel = fibrinoid necrosis

notice pink stain

apoptotic body (pink Eos cytoplasm (bc it's getting concentrated as cell shrinks) & nuc is smaller)

what's the cell

circled = hepatocytes

big white cells = adipocytes d/t fatty change in liver

liver histo

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

amyloid here has apple-green birefringence

same slide as before placed under polarized light showing what

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

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?

notice how in center there's necrosis & cell death. that makes it caseating granuloma

how is this diff from prev one

mucosal bowel crypts;

at base of crypts are gut stem cells

ID circles at bottom; contain what

E = epidermis, D = dermis

squiggly line = basal layer of dermis that houses SC's

what is this

white scar indicates previous MI

-rmr myocardium is a permanent tissue w/ no regen capacity

what we lookin at doe

-why does this form

L circles = granulation tissue (during wound repair)

R circles = vessels (sprouting capillaries)

squiggly = deposition of collagen via fibroblasts

what this be

keloid

-earlobes of blacks

-T3 collagen

wtf are we looking at here; clin pres; made of

L = b9 adenoma of thyroid

R = mal ADCA (disorg growth, hi n:c ratio)

L vs R

brown so think IHC stain

what stain is this

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

ovarian CA spread to abdominal omentum via body seeding

-aka omental caking

wtf is this

retinoblastoma (Rb TSG needs double hit)

looking at eye. what's circled?

discoid rash seen in SLE

ID the rash

L = normal cells

middle = lymphocytic infiltrate destroying gland = Sjogren's

salivary gland shows

sclerodactyly in scleroderma (CREST)

-notice decreased wrinkles at fingertips bc of tightening of skin (d/t fibrosis)

hand exhibits what

on R = petechiae (pin point bleeds)

on L = ecchymoses (> 1 cm)

purpura > 3 mm

skin bleeds

sheared RBC = schistocyte (helmet cell)

microangiopathic anemia

what cell highlighted; seen in?

lines of Zahn: tells us Pt. had pre-mortem clot

R = RBC

f = platelets + fibrin (clot)

but what diz; what do they tell us

blood vessel occluded by atherosclerotic embolus (white long gaps in middle are cholesterol crystals)

what this

fat emboli (circular spaces = fat cells)

and this

keratin debris in blood vessels = pink cells = amniotic emboli (baby's fetal skin soaking in amniotic fluid)

preg woman

saddle embolus

-embolus has saddled across and knocked out both pulm aa.

my word 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

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?

target cell in HALT: HbC Dz, Asplenia, Liver Dz, Thal

name the cell; found in what Dz's

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?

chipmunk facies d/t B-thal major

and this?

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?

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

nuclear remnant in RBC = howell-jolly bodies d/t splenectomy

wtf rbc? cause?

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?

Heinz prep showing precipitated Hb (G6PD def)

HUH wtf rbc4? cause?

malarial org present w/in RBC's (Plasmodium)

wtf rbc5? cause?

notice empty BM replaced by adipocytes (NO HEMATOPOIETIC ELEMENTS) = aplastic anemia

BM shows

atypical lymphocyte (CD8+ T-cell) in Infectious mono (d/t EBV or CMV); 2nd flashcard of this know this

whart dafuquh

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

erythroblast (immature RBC, lacking cytoplasm, w/ "punched out" nucleolus circled)

-can't tell if myeloidblast or lymphoidblast

and vut dis?

blue dots in meninges = ALL spread to CNS

meninges of child

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

AML type (acute monocytic leukemia)

-monoblasts love to infiltrate gums

masses in gums

smudge cell in CLL (neoplastic prolif of naive B cells)

what's going on top L

notice "hairy" cytoplasmic processes: Hairy Cell Leukemia; Dx by TRAP (get TRAPPED in hair)

what diz be doe? Dx confirm?

notice how T cell has "brain-like lobes" = cerebriform nuclei d/t Sezary Syndrome in Mycosis fungoides

bad T cell

we see a basophil amongst many granulocytes. if basophil ct. increases, think CML

hint top L

ton of platelets; Dx = essential thrombocytosis (backup = iron def anemia)

ton of these; Dx

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

in fibrosed BM, when RBC leaves it gets stretched out = teardrop cell in myelofibrosis

"BM is crying bc it's fibrosed"

weird RBC

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

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?

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

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

RS cell (HL) notice "owl eyes"

what this guy

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

lacunar cells bc now RS cells sit in these "big lakes"

Cx of nodular sclerosing HL (most common form)

Cx RS Cells

MM

punched out lesions on x-ray

rouleaux formation d/t MM (increased protein in serum decreases charge b/w RBC's causing them to clump)

poker chips

tennis racket = birbeck granule = LH cell histiocytosis

hi