USMLE images
Started by Zuhal
60 y/o male presents to your office w/angina on exertion. This is his 3rd visit in the past 2 weeks, the previous two being for pneumonia and a cutaneous S. aureus abscess. He takes no daily medications, and no other history is relevant. Physical examination is notable for scattered petechiae, oral candidiasis, and the finding in the image attached.
Your dx is?
If this is too hard/vague, I'll make it multiple choice
Your dx is?
If this is too hard/vague, I'll make it multiple choice
Attachments
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What tumor is this associated with?
What age range for the patient?
What stain might a pathologist use here?
What am I looking at here? what tissue section is this? I kind of have an idea but I wanna make sure I'm looking at the right thing first?
Yes. Now hone it down a little bit. AML, ALL, CLL, or CML?
almost looks like a gingival hyperplastic response to phenytoin/verapamil.
I am going to guess a leukemia as well.
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Isn't CML the 20-45 y/o and AML is later?
Regardless I think I'm going to join the camp of CLL. Can someone explain the deal with the gingiva?
What tumor is this associated with?
What age range for the patient?
What stain might a pathologist use here?
Pilocytic astrocytoma, I believe those are Rosenthal Fibers
Young'ns
GFAP
just got a uworld question on this.
painful, blue tumor under the fingernail. Name of tumor and what tissue is it derived from?
painful, blue tumor under the fingernail. Name of tumor and what tissue is it derived from?
Check your age ranges in FA
Edit: Just to make it easy and since I have it out, ALL <15, CLL >60, AML ~65, CML 30-60
I would expect CLL to be a much more insidious presentation
I had to look it up bc it was bothering me, so I'm not going to "guess", but you should check out the wiki page - there's an interesting finding for it based on what it's derived from
just got a uworld question on this.
painful, blue tumor under the fingernail. Name of tumor and what tissue is it derived from?
modified smooth muscles of the glomus body?
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Sometimes they describe the typical pt as an obese female pt taking meds for her acne
It is M5 (acute monocytic leukemia). The marker that is absent is one generally associated w/AML
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Interesting - I'd never heard that (or at least have forgotten it from class)
Not sure why you think that's not right, but MPO is what I was looking for
All this info except for the patient presentation is from Pathoma 6.2 fyi
I literally made this question immediately after watching the relevant pathoma - none of this would be at the tip of my tongue ready to recite haha
below is a biopsy of a patient feeling tired... histology shows adrenergic metabolites in lysosomes. what he got?
I know it sounds stupid but is this Gilbert's? Uworld talks about metanephrine metabolites that accumulate in lysosomes is pathognomonic for Gilbert's....
might as well add it for everyone:
This: They are often painful, and the pain is reproduced when the lesion is placed in cold water?
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good call, I totally forgot it was a thing, haha
I had a UW question on this today, haha.
Dubin-Johnson does cause the black liver, and I believe the pigments themselves are the catecholamine metabolites.
Rotor's is more mild and does not cause a black liver.
pg 336 of FA2013
While answering the question in u-world, I initally put Gilbert because of the clinical vignette.. but they gave more infor pointing to Dubin Johnson - black liver - that's why the histological image is a lil darker than normal liver
No; pancreatitis has a more diffuse appearance. reminds me of Christmas lights
Is that a bullet stuck in the rib???
I was going to guess a staghorn calculi but I don't think the kidney is that anterior or medial.
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