Pathology Final Exam - NBME PDF

Pictures of BM smears and peripheral smears pictures in lectures will be on exam so study them 20 Q’s WBC disorders ​ Infectious leukocytosis - cause is neutrophils ○​ Neutrophils above 65, always bands (Bi-lobed), increase in WBC count, no blasts given - bacterial infec...

Pictures of BM smears and peripheral smears pictures in lectures will be on exam so study them 20 Q’s WBC disorders ​ Infectious leukocytosis - cause is neutrophils ○​ Neutrophils above 65, always bands (Bi-lobed), increase in WBC count, no blasts given - bacterial infection is cause for increase in WBC count ○​ ​ Acute lymphoblastic leukemia - always in children, never occurs above 50 yrs, ○​ fever, cough, shortness of breath, lung infection, followed by anemia, hemoglobin less than 10, platelet count less than 50,000, ○​ WBC count is high and have blasts, cells with large nuclei and scanty cytoplasm (know that it is lymphoblast), ○​ TdT and CD10 is a diagnostic feature, metastasis in brain and testes, patients that have good prognosis = Down syndrome, hyperdiploidy Translocation between 1(12;21). Poor prognosis t(9,22) ○​ ​ Chronic lymphoblastic leukemia - weakness and tiredness, anemia, ○​ history of infection, autoantibodies, jaundice, above 60 yrs, bleeding symptoms, lack of hemoglobins, thrombocytopenia, blast count is low, ○​ smudge cells (irregular border without nucleus; search up picture after). Never occurs below 60  ○​ ​ Follicular lymphoma - middle age woman, female, mass growing around neck, cervical or clavicular, waxing and waning (sometimes small and sometimes big), painless, No interfollicular zone, ○​ Cause = BCL-2 stops/prevent apoptosis t(14,18) ​ Waldenstrom Macroglobulinemia - must be elderly, history of stroke, might have been treated with , ○​ recurrent thrombotic events, immunoglobulins, gamma globulins are increased (IgM), ○​ no lytic lesions, no back pains and calcium levels are normal, only symptoms is recurrent thrombosis, monoclonal gamma spike, creatine levels are normal, no renal symptoms ​ Multiple myeloma - renal pain/ symptoms, bone lesions and hypercalcemia, headache, back pain, lytic lesions shown (pic), increase in creatinine, 3+ urine proteins, ○​ Nephrotic syndrome (lose proteins), dipstick negative - causes = immunoglobulins, edema, Monoclonal spike is IgG, perinuclear halo (pic) ○​ Patient has history of fractures, ○​ Plasma cell neoplasm ○​ Heart problem cause = amyloidosis, increase in lambda chains (light chains), heart problems congestive cardiac failure ○​ ​ Burkitt's lymphoma - Patient migrated from Africa, high fever, jaw swelling,  ○​ in pic you see B cells, macrophages (starry sky appearance), white looking cells with dark backgrounds, C-MYC t(8,14) increase in MYC proteins (tyrosine kinase upregulation) is main cause for genetic mutation, ○​ virus = EBV is cause, ○​ ​ Acute myeloid leukemia - Auer rods (myeloperoxidase is present here) in smear, signs of infection, fever, thrombocytopenia, hemoglobin low, Acute promyelocytic leukemia, t(15,17), bleeding patient, azurophilic granules ○​ PT and PTT prolonged, WBC is high = DIC, ○​ benzene is main cause for this, treat with vitamin A ​ Chronic myelogenous leukemia - WBC count above, 1-2% blasts (large cytoplasm myelocytes, metamyelocytes), elderly patient, ○​ BCR-ABL gene mutation (Philadelphia chromosome) intracytoplasmic tyrosine kinase is cause, t(9,22), thrombocytopenia,  ​ Myelofibrosis - weakness and tiredness, petechial hemorrhages, platelet count low, hemoglobin low, decrease in WBC, teardrop cells, JAK mutation is the cause ○​ aplastic anemia - you see fat here not teardrop cells (that is how you differentiate them cuz they have the same symptoms) ​ Langerhans Cell Histiocytosis - recurrent headaches (pain when touch their skull), rash in head, ○​ drinking too much water, peeing often, calcium levels are high, child, lytic lesions, history of rash on skin and recurrent ear infections, ○​ how to diagnose = Birbeck granules, S-100 and CD1a markers, ​ Tumor lysis syndrome - patient diagnosed with Burkitt’s lymphoma, treated with chemo, after 2 days, ○​ unable to pass urine, creatinine levels are low, hyperuricemia (too much uric acid), hypocalcemia and hyperkalemia is cause of arrhythmia, Transplant rejection: 2 types ​ History of renal transplantation, and after 6 hours, urine output is less than 200mL (low) - renal failure, creatinine levels are high, and within 24 hours (preformed IgE antibodies attacking the endothelial cells causing type II HSR, and fibrinoid necrosis, and causing thrombus in all BVs, and ischemia of the organ, which leads malfunctioning of the organ) ○​ Most occur after 1-2 months (anything after 1 month) ○​ Option 1: cell-mediated CD4 cells, mainly Th2, and Option 2: antibody-mediated CREST syndrome: 1. Limited and 2. systemic ​ History of unable to hold with their hands, and they may have signs of pale (discoloration), and calcifications (nodules on the skin), and difficulty swallowing solid foods (not liquid foods) ​ CD4 T cells, mainly Th1 producing fibrous tissue in the ECM ​ Mostly seen in females above 50 years of age Scleroderma: systemic (generalized) → similar complaints with shortness of breath, creatinine  ​ SLE ○​ Females ○​ 3 main symptoms: Photosensitive rash on face (malar rash), fever or joint pains, blood in urine ○​ Anti ds DNA antibodies and Anti- smith antibodies ○​ If patient has history of giving medication for hypertension and is pregnant and comes in with malar rash and joint pains (drug induced - hydralazine) - this will give Anti-histone antibodies ○​ No renal symptoms for drug induced lupus ​ SCID ○​ X linked and autosomal recessive ○​ Child will have recurrent lung infection (coughing), rash around neck or diaper rash or whitish patches in the mouth - oral or skin candida ○​ Pneumocystis ○​ Upper part of mediastinum is empty - no thymus (thymus shadow) ○​ If child is male = X-linked (IL-7 or IL-2) ○​ If child is female = autosomal recessive (adenosine deaminase deficiency) ○​ Immediately after birth (anything after 6 months = cannot be SCID) ○​ No heart problems ​ X linked Agammaglobulinemia ○​ Occurs after 8 months, coughing shortness of breath ○​ Unable to palpate lymph nodes = lack of germinal centers -- there is no B cells ○​ Recurrent bacterial infections ○​ Male child ○​ Calcium levels normal ○​ Lack of Intracytoplasmic tyrosine kinase (Bruton kinase) Btk ​ DiGeorge syndrome = no parathyroid -- which means calcium levels are low (less than 8) ○​ Occurs before 6 months ○​ Recurrent infections ○​ Absent thymus (thymic absent shadow) ○​ Heart problems ○​ Chromosome 22q11 deletion ○​ TXB1 gene (required for development of branchial arch and great vessels) ​ Wiskott -Aldrich Syndrome ○​ Eczema ○​ Platelet count is low (no petechial hemorrhages though) ○​ Recurrent infection ○​ IgM levels serum are low and IgG is usually normal ○​ WASP protein mutation located on 11.23 ○​ Loss of T lymphocytes in peripheral blood Neoplasia - 60 Qs ​ Colon cancer is most common cause of metastasis (can reach liver) ○​ Type IV collagenase or Matrix Metalloproteinases (cause of metastasis of cancer) ○​ Degrade the BM to move to other parts of the body ​ Liver cancer ○​ Only in liver (tumor growing from hepatocytes or from epithelial) ○​ Alpha fetoprotein normal = growing from epithelial - Polyvinyl Chloride ○​ Alpha feto-protein is elevated = from hepatocytes = Aflatoxin ​ Cervical cancer ○​ Irregular spotting (blood in urine) or post-coital bleeding ○​ HPV 16 and 18 (always!!) ​ Gastric cancer ○​ History of smoking, abdominal pain, weight loss, decreased appetite, ○​ Nitrosamines - most common cause of developing (patient migrated to country) ○​ Supraclavicular lymphadenopathy (Virchow’s node) ​ Poisoning hydrocarbons aniline dyes ○​ Dye industry/ printing industry - used to work ○​ History of passing blood in urine, mass in bladder ○​ Bladder cancer = Transitional cell carcinoma - cause = aniline dyes (naphthylamine) ​ Colon cancer ○​ Cause = APC gene mutation and need to have KRAS mutation to make it malignant ○​ If there is metastasis then TP53 is problem ○​ Patient above 60, left side of colon ○​ Villous adenomas - Polyp without a stalk ○​ Left sided colon cancer (multiple polyps) ○​ ​ Lynch syndrome (HNPCC) ○​ Young patient ○​ Right sided colon cancer (single mass) ○​ MSH2 or MLH1 ○​ Microsatellite instability ○​ Can get endometrial cancer in females ○​ Runs in family only ​ Id immed conseq of FAP1 gene inactive in cells of develop cancer: ​ Xeroderma Pigmentosum ○​ Rash is sun exposed areas - fungating mass ○​ Squamous cell carcinoma ○​ Young patient ○​ Mismatch repair mutation ​ Acanthosis Nigricans ○​ Dark discoloration around neck - does not itch ○​ Antifungal cream around the neck is not getting better ○​ Gastric cancer is main cause  ​ Tp53 ○​ Multiple cancers in one single family or in the same person = TP53 ○​ ​ Carcinoma of the breast ○​ Lump in breast, mother diagnosed with ovarian cancer = BRCA 1 (either same patient or in family) ○​ If brother has breast cancer and sister has breast cancer = BRCA2 ○​ HER2 cause patient to die faster (poor prognosis in patient with BRCA1 mutation) ​ Neurofibromatosis type 2 ○​ Headache, difficulty seeing, ○​ Hearing loss, mass growing in head, blurring vision ○​ Meningioma or schwannoma diagnosis (psammoma bodies - concentric calcifications) ○​ Merlin mutation ○​ Normally occurs only in brain ​ Lambert Eaton ○​ difficulty getting out of bed and walking, that improves when walking ○​ Associated with Small cell carcinoma of the lung ○​ *Squamous cell carcinoma: only related with hypercalcemia ​ Osteoarthropathy ○​ Elevation of periosteum ○​ Adenocarcinoma of lung ○​ Pain in joint ​ Retinoblastoma autosomal dominant ○​ Autosomal dominant - 50% will develop it ○​ Tumor growing in eye ○​ Family history of osteosarcoma 2 Qs Polycythemia vera: elderly patient, burning sensation in the feet, and itching while showering ​ JAK2 mutation: increased production of RBC ​ Hematocrit greater than 20, and WBC is increased ​ High chance of developing venous thrombus in hepatic or superior mesenteric artery or vein ○​ If hepatic vein involved: hepatomegaly, and ascites (fluid inside the peritoneal cavity) ○​ Generalized abdominal pain (no localized tenderness + no rebound) Iron deficiency anemia: weakness and easy tiredness ​ Look at peripheral smear: hypochromic (pale) microcytic RBCs with central pallor ​ Child less than 6 years: parasites ​ Female between 40-50 years: heavy menstrual period ​ Above 60 years: associated with colon cancer ​ Ferritin levels (low) Sickle cell anemia:  ​ Sequestration crisis (below 3 years of age, hepatomegaly, hypovolemic, anemia, jaundice, and splenomegaly) OR painful crisis (greater than 3 years of age) ​ Must be above 6 months of age, recurrent bone/joint pain, Hb less than 8 ​ Globin chain defect ​ Howard jollie bodies = no spleen - search later Autoimmune hemolytic anemia: if female with history of jaundice, weakness, tiredness, and Hb is low, no history of pains, not taking any medication ​ Peripheral smear: spirochetes via Coomb’s test positive (caused by antibodies - female: lupus IgG-induced) ​ Upper respiratory tract infection: caused by mycoplasma or EBV (virus) ○​ Cause: IgM antibodies Immune thrombocytopenic purpura ○​ Irregular menstrual periods, female ( ○​ Heavy bleeding, platelet count is low (less than 50,000 ○​ PT, PTT is normal ○​ GP2b/3a Thrombotic thrombocytopenic purpura - 5 symptoms are needed ○​ Confusion, irritability, creatinine levels high ○​ Sudden history of confusion, irritability, creatinine levels are high, platelet count is low (40,000), Hemoglobin is low (8), with presence of schistocytes, jaundice ○​ Brain, kidney problems, hemolysis ○​ Creatinine levels above 2 ○​ ADAMTS13 is cause Secondary polycythemia ○​ High altitude, and comes down ○​ Middle age patient ○​ Hemoglobin is very high because he lives high up ○​ Hematocrit is 22 (because of high altitude) ○​ Polycythemia due to high altitude ○​ Cyanotic heart disease Pernicious anemia ○​ Weakness, unable to walk, falling more frequently ○​ Antibodies against parietal cells ○​ B12 deficiency ○​ Neurological defect - associated with anemia = associated with B12 deficiency ​ Check later ○​ Once patient is above 3-6 (after 6 no spleen) ○​ Low Bp, ○​ All sickle cell patient don’t have sleep after 6 years of age ​ Sequestration ○​ all ​ Aplastic anemia ○​ Weakness, tiredness, WBC low, platelet low, Hemoglobin low,  ○​ Fat cells in Bone marrow biopsy ○​ Cause could be viral or drug ○​ Normocytic, MCB normal ​ Hereditary spherocytosis ○​ No coombs tests ○​ Osmolality fragility test ​ Parvovirus B19 ○​ Low reticulocyte count, causing jaundice ○​ Reticulocyte count decrease to 1% (only anemia that reticulocytes less than 2%) ​ Hemolytic uremic syndrome ○​ History of bloody diarrhea or treated for bloody diarrhea ○​ Child, abdominal pain, swelling of feet ○​ No neurological symptoms, ○​ E-coli strain 150-H7 ​ Von Willebrand ○​ Joint swelling, pain, history of joint swelling in family, blood in joint ○​ PTT is prolonged, bleeding time prolonged ​ Factor VII deficiency ○​ PT prolonged ONLY, joint swelling, pain ○​ No petechial hemorrhages ○​ Proconvertin General Pathology ​ Burns ○​ Lose lots of fluids, cytokines produced ○​ Shifting of Intravascular to extravascular fluid space ○​ Increased vascular permeability ○​ Confused, BP is low (cus Increased vascular permeability) ​ Lead poisoning ○​ Working in car parts factory (manufacturing) ○​ Unable to hold things, unable to walk, reflexes decreased, weakness in muscles (neuropathy) ONLY METAL THAT CAUSES NEUROPATHY ○​ Basophilic stippling in peripheral smear - pyrimidine 5’ nucleotidase ○​ ​ Cystic fibrosis ○​ Baby comes with history of respiratory distress ○​ Baby did no pass meconium ○​ Only after passing stool (meconium) is when the baby can be breast fed (if no passing then there is an obstruction) - Hirschsprung or cystic fibrosis ○​ Chloride channels is problem ​ Cystic fibrosis question 2 ○​ Male, BMA low, recurrent lung infection unable to make children  ○​ Vas deferens is absent in cystic fibrosis ○​ Thin build (steatorrhea) cannot absorb fats (patient is malnourished) ○​ Chloride channel is problem (chloride cannot go out of cell in GIT and Chloride cannot come into the skin ) ​ Vitamin A (hypervitaminosis) ○​ Elderly (after 60), history of headache, projectile vomiting, pitting edema ○​ Lumber picture (no meningitis) and CT scan normal ​ Obesity ○​ Hormone stimulating them to eat, From fat = Adiponectin and leptin (satiety) ○​ Ghrelin coming from stomach ○​ GLP an PYY (from small and large intestine) - agonist will help you feel full (suppress appetite once food reaches intestines) ○​ Leptin levels go high in obesity (receptors in brain is problem - not responding to leptin) ​ Malnutrition, protein calorie ○​ Patient always has edema ○​ Living in nursing home, elderly mostly, ○​ Albumin levels low ○​ Fatty liver -enlarged (unable to produce B100) - fat goes to liver but cannot come out because of lack of proteins ​ Mucopolysaccharidosis ○​ Patient has signs of not responding, mental retardation ○​ Clouding of Cornea (Hurler and hunter syndrome) ○​ Sulphate will be accumulated ​ Vitamin D deficiency ○​ Bowing of legs ○​ Renal disease, living in northern part of the world ○​ Normal 25, hydroxy…., low 1,25 hydroxy…. ○​ If 25 present but no 1,25 then kidney is problem ○​ Both low = diet is problem ○​ Swelling of wrist ​ Neural tube defect ○​ Anencephaly, mental retardation ○​ High alpha feto-protein levels are high ○​ Folic acid deficiency ​ Carbon monoxide poisoning ○​ House uses Stove or wood heating process ○​ No respiratory distress ○​ Confused, irritability, SPO2 is normal ○​ Accumulate in hemoglobin (does not allow O2 to release ○​ Oxygen curve to the left, Oxygen binding capacity goes down ○​ Cyt C oxidase defect ​ Fragile X ○​ Patient having difficulty in understanding  ○​ Male child ○​ Mental retardation signs ○​ Testes enlarged ○​ Mothers have menopause at age 35-40 due to ovarian failure (secondary ovarian failure) ​ Vit K deficiency ○​ Baby comes with bleeding from umbilical cord, bloody urine or stools, nose, etc ○​ Bleeding baby that was born within 10 days - 2 weeks ​ Marfan syndrome ○​ Dislocation of lungs (upward outward) ○​ Signs of vision defect (myopia) ○​ Tall male, 6’4, shortness of breath ○​ Aortic root dilation, aortic regurgitation ○​ Cystic medial necrosis ​ Ehler-Danlos Syndrome ○​ Recurrent dislocation (joint slipping out when lifting it) ○​ Skin is elastic/ stretchy ○​ Easy bruising (multiple different stages of healing wounds), poor wound healing ○​ Type 5 collagen is problem ​ Down syndrome ○​ Protrusion of tongue ○​ Shortness of breath, heart failure, atro-ventral septal defect (AVD) right atrium and left ventricle ​ Id target protein of anti apoptotic drug ○​ 2 diff mechanism:Hormone withdrawals and radiation ○​ Patient comes with history of lung and prostate cancer (after 2 months PSA level gone down) ○​ Radiation induced apoptosis: BCL-2 (radiation) will decrease and Cyt C is released/ increased, breakdown of DNA through caspase 3 (180 bp), NO INFLAMMATION ○​ Chemo drug: Tumor cell size decrease, BCL-2 will decrease, increase Cyt. C, the cell goes into apoptosis ​ Necrosis ○​ Patient has history of trauma, left sided abdominal pain, trauma to spleen, coagulative necrosis ○​ Decrease blood supply to the organ → always goes into coagulative necrosis except the brain ○​ Cell architecture remains the same without nucleus, muscle enlarged, caused by infarction ○​ Myocardial infarction as well can lead to coagulative necrosis ​ Neurogenic atrophy ○​ Injury to leg, nerve injury, history of stroke, unable to move leg cause of paralysis, ○​ neurogenic atrophy → irreversible ○​ If fracture, atrophy is = lack of using the muscle  ○​ Autophagy, Ubiquitin-protease pathway ○​ BCL-2 decrease ○​ If use pin = nerve ○​ If use cast = non use of muscle ​ Cardiomegaly hypertensive ○​ Hypertension, concentric hypertrophy, Ejection fraction preserved, parallel ○​ ​ Squamous metaplasia ○​ Occurs in patient who have hisorty of smoking ○​ Tracheobronchial ​ Liver injury ○​ Liver can regenerate ○​ If liver goes into infarction or ischemia → coagulative necrosis ​ Neuronal ischemia ○​ Hemiplgeic, not a able to move ○​ Hemiplegia ○​ Liquefactive necrosis, cyst formation but no scar tissues (cuz no fibroblasts) ​ Infarction myocardial - put picture later ○​ First 24 hrs = no cells ○​ 2-3 day = neutrophils ○​ 4-6 = macrophages ○​ 7+ = fibroblasts and angiogenesis and fibrous tissue formation - Fibroblast growth factor ○​ Type 3 collagen ​ ID mediator of acute inflammation causing pain ○​ Patient comes with infection, coughing, shortness of breath, right sided lobar pneumonia or bronchopneumonia ○​ Cut, red and swollen ○​ Need to detect bacteria through Toll like receptors (first one to detect the bacteria in infection) ○​ Dilate blood vessels = histamine ○​ Bradykinin = pain and edema ○​ Redness = histamine ○​ Prostaglandin E2 (causes fever) and Leukotriene B4 (recruit neutrophils) ​ Bronchopneumonia ○​ IV drug abuser or alcoholic ○​ Fouls smelling sputum ○​ Low grade fever (below 101) = Lung abscess (if pneumonia it is high grade fever) ○​ After neutrophils, Macrophages come in ​ Pneumonia, Bacterial margination ○​ First step: of inflammation is margination ○​ Second step: Selectins = next expression for rolling ○​ Third step: Integrins = stick on ○​ C5a makes them to migrate to injury site ​ Perforation duodenum ○​ Macrophages and lymphocytes (CD4) is cause for developing perforation (ulcer) ○​ Long term complication of chronic gastritis ○​ Peritonitis ​ Sepsis ○​ Patient comes with history of sudden acute high fever, BP low, ○​ Shortness of breath, admitted for pneumonia ○​ Pain in passing urine ○​ BP 80/40 ○​ Main cause of septic shock = gram negative lipopolysaccharide → trigger release of IL-1 (activate complement without antibody) ​ Wound Healing ○​ Cut, clot , then neutrophils come in, then angiogenesis occurs (Fibroblast growth factor), ○​ Platelet derived growth factor, Tumor growth factor Beta (TGF-B) will stop angiogenesis ○​ Produce type 3 collagen (Vit C and copper,.. oxidase) ○​ To convert to type 1 from type 3 = need zinc ○​ Type 1 collagen (comes in with help of zinc) ​ Embolism,amniotic fluid ○​ Patient must be delivery that baby (does not occur when patient is having abortion) ○​ Sudden irritability, confusion, bleeding from IV line or vagina, no fever ○​ DIC ○​ Squamous cells need to be in embolism ​ Anaphylactic shock ○​ Bee sting or taken something ○​ Difficulty swallowing, generalized rash, shortness of breath ○​ Itching, low BP ○​ IgE is cause → Type 1 hypersensitivity ​ Urethral oligohydramnios ○​ Respiratory distress (hypoplasia of lungs) in full term baby (38 weeks) ○​ Patient has deformities in legs, flat face (lack of amniotic fluid in uterus) ○​ No kidney or polycystic kidney; absent ureter; or urethra (fibrosis in posterior urethral wall is narrowed) ○​ Urine not coming out ​ Carbon tetrachloride ○​ Dry cleaning industry ○​ Jaundice, right sided abdominal pain, elevated liver enzymes, hepatomegaly ○​ Cause = produces ROS, (do not have glutathione peroxidase or superoxide dismutase) ​ Tuberculosis skin test- hypersensitivity ○​ Type 4 hypersen with CD4 Th1 cells which produce IFN-gamma → Macrophages come in  ○​ Low grade fever with night sweaters, coughing ​ Hemolytic disease of newborn ○​ Baby borns, hemoglobin low (8), baby has jaundice, Indirect bilirubin must be higher than direct bilirubin (will give you total bilirubin and direct not indirect so just do the math) ○​ Mother is O and baby is A or AB = ABO incompatibility ○​ Mother is O and baby O then look at Rh. If mother is RH- and baby is positive Rh = Rh incompatibility ​ Exposure, radiation ○​ Lymphocytes is most affected by radiation ○​ Injury to any organ - first cell that dies within hours = lymphocytes ​ Mumps encephalitis ○​ Child comes with high fever, sore throat, testicular pain, parotitis, ○​ Myalgia, jaw swelling, confusion, irritability ○​ Mumps is major cause of encephalitis in child with testicular pain, jaws swelling ​ Herpes zoster ○​ One half of face (forehead and cheek), vesicles, high fever, does not cross the midline ○​ Immunocompromised or taking medication ○​ Reactivation of chickenpox (already present in trigeminal ganglia) ​ Infectious mononucleosis , ruptured spleen, ○​ High fever, maxillary lymphadenopathy ○​ Lymphocytes with little cytoplasm, without granules = atypical lymphocytes ○​ Cause is EBV ○​ Splenomegaly ○​ Avoid contact sports cuz of enlargement of spleen, there is high chance of splenic rupture - 2 weeks prior of this infection, patient had upper respiratory infection ○​ ​ Immunization, Hepatitis Bs Abs ○​ High fever, ○​ Know the surface antigens in Hepatitis B (look at table in lecture) ○​ Window period means no Antibodies being produced ○​ ​ Pneumococcal, pneumonia ○​ Lobar pneumonia (one sided) ○​ Community acquired (always in one single lobe) ​ Actinomycosis ○​ Jaw swelling, leaking pus from jaw, past 2 months, not painful ○​ Sulfur granules in pus ○​ Osteomyelitis ​ Toxic shock syndrome ○​ Patient will have weakness, confusion, joint pain, low bp (80/40) ○​ High fever  ○​ Cause: superantigens (cross linking between APC and ….) → excessive cytokine release ​ HIV infection ○​ Patient has less than 500 CD4 count ○​ Oral thrush (whitish mouth rash), difficulty swallowing ○​ Less than 200 = lung infection, IV drug abuser, (interstitial pneumocystis jirovecii) ○​ Less than 100 (brain always involved) but above 50 (multiple ring enhancing lesions = toxoplasmosis ○​ Less than 50 CD4 Single lesion (either in temporal or frontal lobe) = CNS lymphoma ​ Malaria ○​ Always have history of travel (visiting from African or Asian continent) ○​ Fever is cyclic ○​ Ring forms of malaria parasite in RBC in peripheral smear (look at pic in lecture) ​ Schistosomiasis ○​ Coming from African country, bloody urine, painless, RBC there, but WBC is less than 5 ○​ Dipstick shows no nitrates or proteins = no infection