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PATHOLOGY NOTES DR. GOLJAN SYSTEMIC PATH — EEE Note: This material is copyrighted. All rights reserved, GOLJAN HIGH YIELD NOTES FOR USMLE STEP 1° Note: This material is copyrighted. All rights reserved. No part of this publication may be reproduced in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without permission in writing from the publisher (Edward F. Goljan, M.D.) Abbreviations commonly used: AD = autosomal dominant, AR = autosomal recessive, COD = cause of death, Dx ~ diagnosis, MC = most common, MCC = most common cause, PaO; oxygen in arterial blood, PB = peripheral blood, Rx = treatment, Sa0. blood, SXR = sex-linked recessive artial pressure of ‘oxygen saturation of arterial Systemic Pathology RBC disorders ‘© Peripheral blood pictures on USMLE: 1. hypersegmented neutrophit- folste/B,, deficiency 2. microcytic hypochromic cells A. RBCs that have increased pallor can be assumed to be microeytic B, iron deficiency C. anemia of chronic disease (ACD) D. thalassemia E. _ sideroblastic anemia sickle eells~ sickle cell anemia not trait have sickle cells in the peripheral blood 4. target cells A. bullseye B. alcoholic liver disease CC. hemoglobinopathy spherocytes- A. _no-central area of pallor B. ~ congenital spherocytosis C. ABO hemolytic disease of newborn 6. tear drop- A. myelofibrosis B. thalassemias 7. Howell Jolly bod; pleen surgically removed or dysfunctional spleen as in HbSS disease, 8. _platelet— small, red, anucleate cell 9. lymphoeyte- black dot with a thin rim of eytoplasm 10, Auer rod~myeloblast with immature nucleus and splinter-like structures in the eytoplasm 11. atypical lymphocyte— ‘A. big cell with abundant sky blue cytoplasm B, _ infectious mono/CMV /toxoplasmosis/viral hepatitis/phenytoin 12. eosinophil ‘A. large red granules that do not cover the nucleus: same color as RBCs B. type hypersensitivity C. invasive helminthic infections Note: This materi is copyrighted. All rights reserved. 13. basophil- A. _ large purple granules that do cover the nucleus: granules darker than RBCs B. _ myeloproliferative diseases 14. rouleau~ RBCs with stack of coins effect: increased ‘sedimentation rate 15, _schistocytes— A. fragmented RBCs seen in microangiopathic hemolytic anemias B. thrombotic thrombocytopenic purpura C. hemolytic uremic syndrome D. DIC 16. reticulocyte A. special supravital stain: thin filaments represent RNA B. increased in: (1) hemolytic anemias 2) 5-7 days after blood loss, 3) after Rx of iron deficiency (4) Byy/folate deficiency 17, Heinz bodies— A. special stain: large blue inclusions with involvement of the RBC membrane B, G6PD deficiency 18. coarse basophilic stippling~ A. routine stain: persistent B. Pb poisoning ‘Bone marrow pictures on USMLE* megaloblastic marrow— A. all the cells appear big due to large, immature nuclei: e.g., giant band neutrophils B. _ B,2/folate deficiency 2. mayslofibrosis=marrow is composed of fibrous tissue: large cells represent megakaryocytes 3. aplastic:anemia~ empty marrow with predominantly fat, and islands of lymphocytes 4. multiplemyeloma— plasmablasts with bright blue cytoplasm, eccentric ‘huclei, perinuclear halo 5. ringed sideroblast— A. Prussian blue stain for iron: ring of blue around the nucleus of a normoblast B. _ indicate a defect in heme synthesis: sideroblastic anemias due to alcohol, pyridoxine, Pb poisoning, Exythropoiesis: 1. definition- ‘A. production of RBCs in the bone marrow B. dependent on erythropoietin (EPO) synthesized in the kidneys 2. stimuli for EPO- A. low PaO: hypoxemia B. anemia <7 gm/dL C. left shifted oxygen dissociation curve (ODC) 3. peripheral blood (PB) reticulocytes— A. manifestation of EPO stimulated marrow B. reticulocytes require 24 hours to become mature RBCs C. reticulocytes have RNA filaments: identified with supravital stains

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