OBJECTIVE:
- Apply your knowledge of basic pathologic processes to interpret clinical history, radiographs, and pathologic findings to understand mechanisms and patterns of cellular and tissue injury and how they relate to disease processes.
CASE 1
(Click here to go to the answers)
Clinical History:
- A 50-year-old man has become increasingly lethargic over the past 3 months. During that time he has had one DUI conviction. On physical examination, his abdomen appears enlarged and there is a fluid wave. He has pitting edema to his knees. He has very mild scleral icterus. A CBC shows that he has a Hgb of 11.1 g/dL with a normal WBC count and platelet count. A review of the peripheral blood smear shows that the RBC's are larger than normal (macrocytosis). Serum chemistries shows sodium 135 mmol/L, potassium 3.7 mmol/L, chloride 96 mmol/L, CO2 23 mmol/L, creatinine 1.3 mg/dL, urea nitrogen 22 mg/dL, glucose 50 mg/dL, total protein 5.5 g/dL, albumin 2.9 g/dL, alkaline phosphatase 40 U/L, AST 65 U/L, ALT 58 U/L, total bilirubin 4.2 mg/dL, and direct bilirubin 3.3 mg/dL.
- Representative images for this patient:
Image 1.1 An abdominal CT scan.
Image 1.2 Gross appearance of the liver.
Image 1.3 Microscopic appearance of the liver.
Questions:
- What form of cellular injury has occurred here?
- How do you explain the physical examination findings?
- How do you explain the CT findings?
- What is the patient's underlying problem?
- Explain the pharmacokinetics of this problem.
|
CASE 2
(Click here to go to the answers)
Clinical History:
- A 45-year-old man of western European ancestry has become progressively more tired for several years. During that time, he has noted that his skin tone seems darker, even though he has spent little time out in the sun. He notes that at the end of the day, he has ankle swelling. He has had increasing joint pain involving multiple large joints (hips, knees, shoulders). His 47-year-old brother has noted similar problems. His younger brother and sister have not. A test for the C282Y mutation is positive in both affected siblings.
- Representative images for this patient:
Image 2.1 MRI scan of abdomen.
Image 2.2 Gross appearance of the liver.
Image 2.3 Microscopic appearance of the liver (Prussian blue stain).
Questions:
- What is the nature of this cellular injury?
- How do you explain his signs and symptoms?
- What is the underlying condition?
- Can you explain why the onset of this condition occurs in the 60's in women?
- Can you suggest a means of treating this condition?
|
CASE 3
(Click here to go to the answers)
Clinical History:
- A 24-year-old man is involved in a motorcycle accident with left lower leg injury and laceration of the popliteal artery. Paramedics arrive at the scene and find that his skin is cool and clammy. His vital signs show pulse 110/min, respirations 24/min, temperature 36.2 C, and blood pressure 70/palpable. On arrival at the hospital his hematocrit is 18%. He is given transfusions of RBC's. His condition remains unstable and his peripheral blood oxygen saturation falls. He requires intubation with mechanical ventilation. The percentage of oxygen is increased to maintain saturations. His lungs become more difficult to ventilate.
- Representative images for this patient:
Image 3.1 CT scan of the chest.
Image 3.2 Gross appearance of the lung.
Image 3.3 Microscopic appearance of the lung.
Questions:
- What is the mechanism for lung injury here?
- Explain the findings.
- What is the resolution for this problem?
|
CASE 4
(Click here to go to the answers)
Clinical History:
- A 35-year-old woman has had increasing malaise for the past week. She has noted that her skin has a yellowish color. She has nausea and sometimes vomits up what she has just eaten. Laboratory testing reveals a normal CBC. Serum chemistries shows sodium 141 mmol/L, potssium 4.2 mmol/L, chloride 90 mmol/L, CO2 28 mmol/L, creatinine 0.7 mg/dL, urea nitrogen 13 mg/dL, glucose 70 mg/dL, total protein 5.8 g/dL, albumin 3.3 g/dL, alkaline phosphatase 39 U/L, AST 578 U/L, ALT 613 U/L, total bilirubin 7.2 mg/dL, and direct bilirubin 4.8 mg/dL. Serologic testing showed hepatitis A virus positive, hepatitis B virus negative, and hepatitis C virus negative.
- Representative images for this patient:
Image 4.1 Microscopic appearance of liver.
Image 4.2 Gross appearance of the eye.
Questions:
- What form of cellular injury is occuring here?
- Explain the physical and laboratory findings.
- What is the outcome for this illness?
- How can you tell if the serology indicates a recent or remote event?
- What agency needs to be notified of this event?
|
CASE 5
(Click here to go to the answers)
Clinical History:
- A 68-year-old woman with a history of diabetes mellitus has the sudden onset of a change in mental status. She is confused and disoriented. She has difficulty moving her right leg. Her vital signs are stable. No new problems develop over the next week, though she has residual difficulty with movement in her leg.
- Representative images for this patient:
Image 5.1 Gross appearance of brain.
Image 5.2 Microscopic appearance of brain.
Image 5.3 CT scan of brain, months later.
Questions:
- What pattern of injury is seen in this case?
- What is the relationship of diabetes mellitus to this process?
- What is the outcome in this casse?
- What is meant by "persistent vegetative state" (PVS) and "brain death" ? Is this patient likely to have either of these conditions?
|
CASE 6
(Click here to go to the answers)
Clinical History:
- Employees for a healthcare company must undergo yearly checkups with a variety of health screening tests. One of these tests is a tuberculin skin test. One employee, a 28-year-old woman who was recently hired, is found to have a positive test. This employee has a physical examination and chest radiograph performed.
- Representative images for this patient:
-
Image 6.2 Gross appearance of lung.
Image 6.3 Microscopic appearance of lesion.
Questions:
- What is the pattern of cellular injury in this case?
- What caused this condition?
- What is the time frame for development of the lesions?
- What are the potential outcomes?
|
CASE 7
(Click here to go to the answers)
Clinical History:
- On routine physical examination, a 49-year-old woman has a "lump" palpable in her left breast. The lesion is irregular, but not fixed to any surrounding structure such as the overlying skin or chest wall. It seems to be about 1 to 2 cm in size. The patient is concerned about this finding, because an aunt died of breast cancer. A fine needle aspirate of the lesion is performed, and a cytopathologist diagnoses the findings. An excisional biopsy of the lesion is then performed.
- Representative images for this patient:
-
Image 7.2 Microscopic appearance of breast
lesion.
Questions:
- What is the cellular process illustrated here?
- What is the significance of this finding?
- What is the significance of the family history?
- What can be done for the patient?
|
|
Return to the
Laboratory Menu.