Immunopathology

HSR mediated by IgG or IgMo Type II

Cell with receptor for MHC IIo CD4

Function of IL-5o Chemoattractant for eosinophils

Cross-linking of IgEo Degranulation of mast cells

HSR seen in urticariao Type I

Subacute organ transplant rejection (HSR)o Type II

Dry eye, dry mouth, parotid enlargemento Sjogrens

Myasthenia Gravis (HSR)o Type II

Anti-topoisomerase 1o Diffuse scleroderma

ABO transfusion reaction (HSR type)o Type II

Post-strep glomerulonephritiso Type III HSR

Anti-DS DNAo SLE

PPD test HSRo Type IV HSR

Contact dermatitiso Type IV HSR

Cell with receptors for MHC Io CD8

HSR with only lymphocytes involvedo Type IV HSR

Rash, joint pain, oral ulcero SLE

Ag+Ab deposition in tissueso Type III HSR

Anti-Ro and Anti-La (SSA,SSB)o Sjogrens

Antibodies to centromereo Limited scleroderma

Scaly lesion over knuckles with anti-Jo1o Dermatomyositis

Elevated CPK and distal muscle weaknesso Inclusion body myositis

Lacks Ig, defective Btko Bruton’s agammaglobulinemia

Cell depleted in HIVo CD4

Poor response to vaccine, with Giardia infectiono Common variable immunodeficiency

Cleft lip, spasm, history of P. jiroveciio DiGeorge Syndrome

Susceptibility to Neisseria infectiono Terminal complement deficiency (C5-C9)

Transplant with intimal fibrosis of vessels and interstitial lymphocyteso Chronic rejection

Transplant rejection weeks to up to 6 monthso Acute rejection

Receptor for HIV on T cellso CCR5

Viral disease in HIV with CD4 count < 50o CMV

Anti-ribonucleoproteino Mix connective tissue disease

Pneumococcal, staph, haemophilus influenzao Bruton’s agammaglobulinemia

Immunodeficiency with hypocalcemiao DiGeorge Syndrome

Adenosine deaminase deficiencyo Severe combined immunodeficiency

Eczema, petechia, recurrent infectionso Wiskott-Aldrich syndrome

Episodes of edema of face, lips, C1-INH deficiencyo Hereditary angioedema

Transplant rejection with neutrophilic vasculitis and thrombosiso Hyperacute rejection

HIV with CD4 < 200 and pneumoniao Pneumocystis jirovecii

Virus in oral hairy leukoplakiao EBV

HHV-8o Kaposi sarcoma

Skin

Bullous blister, subepidermal not affecting oral cavityo Bullous phemphigoid

Thickened stratum corneum lack of stratum granulosumo Ichthyosis vulgaris

Edema in the intradermal space “spongiosis”o Contact dermatitis

Targetoid lesions on palms of handso Erythema multiforme

Raised lesion dorsum of hands and feet forming a ringo Granuloma annulare

Cyst lined with stratified squamous epitheliumo Epidemal inclusion cyst

Waxy papule with central depressiono Basal cell carcinoma

Eczematous lesion in children < 2 yrs oldo Letter-siwes

Benign histiocytosis Xo Eosinophilic granuloma

IgA against gliadin in dermal papillaeo Dermatitis herpetiforme

Elderly with decrease lipid in skin

o Xerosis Skin lesion associated with asthma

o Eczema Immunofluorescence with linear enhancement on the basement membrane of skin

and scattered in the epidermiso Lupus erythematous

Usually confused with tinea corporiso Ptyriasis rosea

Inflammation of subcutaneous fato Erythema nodosum

Sand paper textureo Actinic keratosis

Basal cell infiltrading dermis with palisading nucleio Basal cell carcinoma

Tennis racket intracytoplasmic structure in electron microscopyo Histiocytosis X

Pruritic rash in patient with malabsorptiono Dermatitis herpetiforme

Mutated BRAF geneo Melanoma

Hyperkeratosis and parakeratosiso Actinic keratosis

Increase in melanine in basal layer of skino Freckles or ephelides

Port wine stain assicated witho Leptomeningeal angiomatosis

S-100 positiveo Melanoma

Darkening pigmentation axilla and neck associated witho Insulin resistance

Neutrophils in stratum corneumo Psoriasis

IgG against desmosomeso Pemphigus vulgaris

Antibodies to what structure in bullous pemphigoido Hemidesmosomes

Lesion appears stuck-ono Seborrheic keratosis

Hyperpigmented lesion on face in women worse with pregnancyo Melasma

Brown macules in elderlyo Benign lentigo

Rete-ridge bridgingo Displastic nevus (BK)

Location of melanoma metastasis to braino Between gray and white matter

Multiple seborrheic keratosis lesions associated witho Adenocarcinoma of stomach

Bullous lesion in skin and oral mucosao Pemphigus vulgaris

IgG against hemidesmosomeso Bullous pemphigoid

WBC, leukemias

Mutation of HAX 1 geneo Kostmann syndrome (agranulocytosis)

Elevated leukocyte alkaline phosphataseo Leukemoid reaction

Chemotaxis for neutrophilso LTB4, c5a, IL-8

Leukocytosis in Pertussiso Lymphocytosis

Lukocytosis in allergies and parasiteso Eosinophilia

LNP with proliferation of T cells Paracortical hyperplasia Non-tender LNP with both kappa and lambda chain Benign LNP TDT positive ALL Reed-Sternberg cell Hodgkin’s CD10, CD19, CD20 positive B cells Ulcerating lesions in oropharynx with dark membraning covering them Agranulocytic angina Chemostasis for eosinophils IL-5 Basophillia (condition associated) CML LNP with proliferation of B cells Follicular hyperplasia LNP with increase endothelial cells Reticular hyperplasia (neoplasia associated) Non tender LNP with only kappa chain Malignant LNP Clover leaf cells Adult T-cell leukemia lymphoma CD4, CD3, CD8, CD7 (< 10) Smudge cells CLL Tartrate-resistant acid phosphatase stain Hairycell leukemia t(11,14) Mantle cell lymphoma t(8,14) Burkitt lymphoma Location of sporadic Burkitt lymphoma Iliocecal valve Large B cell lymphoma in immunocompromised microorganism responsible EBV CD4 lymphoma with cloverleave nucleous Adult T cell leukemia/lymphoma Cerebriform nucleous Mycosis fungoide/Sezari syndrome Roleaux formation Multiple myeloma Reed-Sternberg cell

Hodgkin’s lymphoma Reniform nucleous, with cytoplasmic projection, CD11, CD19, CD20 Hairycell leukemia t(14,18) CD19, CD20 Follicular lymphoma B cell lymphoma Chromosome location of cyclin D Chromosome 11 Location of African Burkitt lymphoma Jaw Gene responsible for Burkitt lymphoma c-MYC Large B cell lymphoma primary effusion organism responsible Herpesvirus 8 Organism responsible for adult T cell leukemia lymphoma HTLV1 Chemochine in plasma cell neoplasma with > 30% plasma cell in bone marrow IL-6 Ig inclusion in the cytoplasm and nucleous Waldenstrom macroglobulinemia Hodgkins with best prognosis Lymphcyte rich Hdgkins with worse prognosis Lymphocyte depleted Pawn ball megakaryocytes Myelodysplastic syndrome t(15,17) Acute promyelocytic leukemia Gingival infiltrate Monocytic leukemia (AML) Abnormal retinoic acid receptor Acute promyelocytic leukemia Pseudo-Pelger-Huet cells Myelodysplastic syndrome Plethoric, cyanosis, HTN, and headaches Polycythemia vera Birbeck granule Histiocytosis X Auer rods AML Popcorn cell present, negative for CD15 and negative for CD30 Lymphocyte predominat Hodgkins Most common type of Hodgkin’s Nodular sclerosis Leukemia with CD34, CD15, CD33 AML Deletion of 5q chromosome Myelodysplastic syndrome High WBC and platelets with t(9,22) CML HCT > 60%, high platelet mutation, decrease EPO JAK)-2 mutation Leukemia risk in polycythemia AML Throbbing and burning of hands and feet Essential thrombocytosis

t(9,22) CML

Repiratory

Greenish sputum Myeloperoxidase Squamous metaplasia of pancreas Lack of vitamin A Squamous pearls Squamous cell carcinoma Cause of hypercalcemia in Sarcoidosis Vitamin D like substance Location of Lung Cancer with facial edema Mediastinum Common cause of spontaneous pneumothorax Apical subpleral bleb rupture Pleura Asbestosis Red firm airless, neutrophils, RBC fibrin Red hepatization of pneumonia Sudden SOB, with petechia after fracture Fat embolism Neonate with retinal vascularization to the vitreous Oxygen toxycity Fusobacterium and peptostreptococcus Oropharyngeal aspirate Mechanism of disease in TB (HSR?) Type IV hypersensitivity reaction Pale firm airless, neutrophils, RBC desintegration and fibrin Gray hepatization of pneumonia Lower lobe emphysema AAT Panacinar Shoulder pain, horner Superior sulcus tumor Treatment for small cell lung cancer Chemotherapy Most common lung CA in non smoker Adenocarcinoma Red boggy and heavy lungs Pneumonia congestion phase

GI

Abdominal pain 30 min after eating Ischemic colitis Telangiectasias of skin and mucous membrane and GI bleed Angiodisplasia/osler-weber-randu Black/brown pigment on macrophages in the colon Melanosis coli Diarrhea after antibiotic use with pseudomembranes C. difficile N&V, fever RLQ pain

Appendicitis Cause of appendicitis Fecalith obstruction Hematochezia with LLQ pain in an elderly person Diverticular disease Premalignant polyps Adenomatous Hypokalemia, chronic secretory diarrhea?polyp? Villious adenoma Mutation leading to familial adenomatous polyposis APC gene mutation Multiple polyps at young age, with osteomas and teeth anomaly Gardner syndrome Multiple polyps in young patient with brain tumor Turcot syndrome DNA mismatched reapair gene Nonpolyposis colorectal cancer or lynch synd. Multiple hamartomatous polys and freckles in the lips Peutz-Jeghers syndrome Causes adenomatous polyp formation APC gene Causes growth of adenomatous polyp KRAS mutation Converts adenomatous polyp to cancer P53 mutation Most common location of colon cancer Rectosigmoid area Symptoms of left sided colon cancer Pencil thin stools Symptoms of right sided colon cancer Symptoms of anemia Tumor of the appendix with elevated 5-hydroxyindolacetic acid levels Carcinoid tumor Fistula in colon Crohns disease Bird beak Achalasia Swelling of the eye lid Achalasia Painful hematemesis Mallory Weis tear Painless hematemesis and cirrhosis Esophageal varices Elongation of the lamina propria Esophagitis Esophagus with columnar epithelium and goblet cells Barrett’s esophagus, intestinal metaplasia Rapidly progressive dysphagia initially to solids only Esophageal cancer Dysphagia to solids only on patient with gerd Adenocarcinoma of the esophagus Keratin nests and pearls SCC Dysphagia to solids in a patient with GERD and weight loss Adenocarcinoma of the esophagus

Newborn with projectile vomiting which is non bilious Pyloric stenosis Hyperplasia of foveolar mucous cell epithelium Ménétrier disease Multiple ulcers and diarrhea Zollinger-Ellison/Gastrin producing tumor Ulceration not extending beyond the muscularis mucosa of stomach Gastric erosion Ulceration extending beyond the muscularis mucosa in the stomach Gastric ulceration Loss of parietal cells hyperplasia of G cells in the antrum Atrophic gastritis, autoimmune gastritis, type A Diarrhea, flushing and bronchospasm location of tumor Appendix or terminal ilium Diarrhea flushing and bronchospasm indicates what about tumor Metastasis Chronic epigastric pain, gastritis and B12 deficiency Perniciious anemia, autoimmune gastritis Gastric intraepithelial cells and submucosal plasma cells H pylori IBD with p-ANCA Ulcerative colitis Lesser trelat Gastric carcinoma Ulcer with heaped up margins Gastric carcinoma Linitis plastic Diffuse gastric carcinoma Ovarian tumor poorly differentiated, bilateral and loaded with mucous Krukenberg tumor, metastasis from gastric cancer Currant jelly stools Intussuception Absence of Auerback plexus Achalasia Absence of Auerback and Meisner plexus Hirschsprungs disease Villious atrophy and flatterned epithelium Celiac sprue Foamy macrophages in lamina propria with positive PAS stain Whipple’s disease Enterocytes with clear cytoplasma normal villous architecture Abetalipoproteinemia Newborn with delayed meconium passage, greenish vomiting and abdominal

distention Hirschsprung’s disease Paneth cell metaplasia on left colon and granulomas Crohn’s disease Overexpression of NFkB Inflammatory bowel disease Early p53 mutation late APC mutation Colon cancer related to IBD Chronic inflammatory diarrhea, no granulomas, uniform involvement Ulcerative colitis IBD with ASCA Crohn’s disease

Gallbladder and Billary Gallstones in patients with malabsorption Cholesterol gallstone Black stones indicate Hemolysis RUQ pain, radiating to shoulder, failure to visualize gallbladder Calculous cholecystitis Calcification of the wall of the gallbladder Chronic cholecystitis Lipid laden macrophage in the lamina propria of the gallbladder Cholesterolosis Type of gallbladder cancer Adenocarcinoma Gallstones patient taking triglyceride medication Cholesterol gallstone Radiopaque gallstones Bilirubin stones/black stones/ Rokitansky Aschoff Chronic cholecystitis Fever chills abdominal pain and jaundice Ascending cholangitis Strawberry appearing gallbladder Cholesterolosis Risk for gallbladder cancer Cholelithiasis Risk for bile duct cancer Chlonorchis (Opisthorchis) sinensis Primary sclerosing cholangitis

Liver Substance responsible for alcoholic hepatitis Acetaldehyde Cirrhosis, ataxia, cardiomyopathy, RTA 2 Wilson’s disease Mutation of ATP7B on chromosome 13 Wilson disease PiZZ genotype Alpha-1 antypripsin deficiency C282Y mutation Hemochromatosis Cirrhosis with basal ganglia atrophy Wilson’s disease Liver with positive Prussian blue stain Hemochromatosis Twisted rope like appearance in hepatocytes are called Mallory bodies, multiple liver disease Mutation of HFE gene on chromosome 6 hemochromatosis Excess copper excreted where Bile Causes type II RTA Wilson’s diseas Rhodamine and orsein stain

Copper stains Cirrhosis, diabetes and bronze color of skin Hemochromatosis Child with URI receives ASA develops coma what is the cause Reyes syndrome