Microscope Slide Answers: Actinic keratosis Actinomycosis Acute leukemia Alcohol abuse Bitemporal hemianopsia CD15+; CD30+, CD45CD5/23

co-expression Chronic myelogenous leukemia Chronic pyelonephritis Coccidioides Immitis Cryptosporidium seeberi Craniopharyngioma Cytomegalovirus infection Fibroadenoma Follicular hyperplasia Follicular lymphoma Gaucher disease Granuloma Herpes simplex virus Hisplasmosis Invasive ductal carcinoma Leukocyte alkaline phosphatase Medullary carcinoma MEN type IIA Metastatic melanoma Myeloperoxidase and Periodic Acid-Schiff (PAS) Neuroblastoma Papillary carcinoma Pheochromocytoma Procalcitonin Reactive lymphoid hyperplasia Sarcoidosis Sheehans syndrome Small cell undifferentiated carcinoma Small lymphocytic lymphoma Squamous cell carincoma Wilms tumor

Clues/Question: skin biopsy from forehead of 65y/o forest ranger (once, was 55y/o farmer) lung and liver biopsies obtained from autopsy of 55M w/poor dental hygiene Wright-Giemsa stained peripheral blood smear from 24M w/fever, lethargy, and high WBC count. He is anemic and thrombocytopenic. two liver biopsies from 55M obtained 3yr apart What is the most likely clinical history for this mass that was removed from the sella turcica of a 22M? lymph node biopsy from 25M w/cervical lymphadenopathy. Your histologic diagnosis would be confirmed by the following lymph node biopsy from 75M w/cervical lymphadenopathy. Your histologic diagnosis would be confirmed by the following Wright-stained peripheral blood smear from 49M w/enlarged spleen kidney biopsy from 55y/o diabetic (once, was 59y/o) lymph node and mediastinal tissue biopsies from a 40M AIDS patient construction worker 25F w/lymphadenopathy; biopsy of enlarged axillary lymph node small intestine biopsy from a 23y/o AIDS patient w/diarrhea mass removed from sella turcica of 5M biopsy from the area of the pituitary gland 50F renal transplant patient who died of respiratory failure; sample from the colon breast biopsy from a 42F 60M w/diffuse lymphadenopathy undergoes biopsy of a cervical (neck) lymph node lymph node biopsy from 40M w/diffuse lymphadenopathy 14M w/weakness, fatigue, bone pain, splenomegaly The pathology in this lymph node is consistent with esophageal biopsy from 29y/o AIDS patient bone marrow aspirate from 22y/o bone marrow transplant patient stained w/Gomori Methenamine Silver (GMS) H&E stained breast biopsy from 45F (once, was 42F) peripheral blood smear from 60M w/splenomegaly, fever, and shortness of breath. What special stain on a bm aspirate would be most helpful? H&E stained biopsy of a thyroid mass 50y/o w/history of parathyroid adenomas and pheochromocytomas presents w/thyroid mass biopsied lymph node biopsy from 65M w/cervical lymphadenopathy lymph node biopsy from 75M w/an enlarged cervical lymph node; had surgery to remove a cutaneous malignancy 5 years ago. peripheral blood smear from 30M w/lymphadenopathy, fever, and shortness of breath. What special stains on a bm aspirate would be most helpful? biopsy of large abdominal mass removed from 2y/o nodule removed from thyroid of a 42F biopsy of a thyroid nodule x2 12M w/headaches, sweating, and tachycardia abdominal mass. The histology of this tumor removed from the right kidney/adrenal area is biopsy of a thyroid nodule demonstrates deposition of lymph node biopsy from 65M w/cervical lymphadenopathy (once, was 25M. once, was 75M) spleen removed from 45F w/weight loss, blurred vision, and bilateral hilar lymphadenopathy biopsy from the area of the pituitary gland biopsy taken from the central region of the right upper lobe 60M w/diffuse lymphadenopathy undergoes biopsy of a cervical (neck) lymph node lymph node biopsy from 65M w/cervical lymphadenopathy biopsy from right upper lobe of lung abdominal mass removed from 2y/o (twice, said a child) biopsy from 2y/o girl w/large abdominal mass

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Longer microscope answers 30y/o pregnant female w/pre-ecclampsia 32F unable to breastfeed 1 week after an emergent c-section on answer key, this is identified as Sheehans, pituitary infarction 45F who presents w/fatigue and cold intolerance on answer key, this is identified as Hashimotos thyroiditis 5F w/recent history of E. coli diarrhea, fever, decreased urination, and nosebleeds on answer key, this is identified as MHA Elderly patients w/this disorder must be screened for colon cancer on answer key, this is identified as iron deficiency Normal thyroid, 1 normal parathyroid and 1 parathyoid w/decreased fat

The findings in this Wright-Giemsa stained peripheral blood smear are consistent w/which clinical history? Which clinical presentation correlates most closely to the pathology seen in this pituitary gland biopsy? This is a biopsy of a thyroid gland. Which clinical history most closely correlates w/the pathology? What clinical history most closely correlates w/the pathology seen in this blood smear? Patient presented w/fatigue, pallor, and dyspnea on exertion; Which statement is true regarding the disorder depicted on this blood smear? This is a biopsy of a thyroid nodule. The biopsy is best described as

Non-Microscope Answers: Acromegaly Actinomycosis Acute leukemia Acute myelogenous leukemia M1 Adenoma (parathyroid) Adenoma (unspecified) AFP ALL Amebiasis Aspergillus Atrophy (unspecified) Basal cell carcinoma Blastomyces dermatitidis Broad based buds are common Bronchopneumonia Burkitt lymphoma Calcitonin Candida albicans Chlamydia trachomatis CMV infection Coagulation necrosis Coccidioides immitis Cryptococcus neoformans Cushings Disease Cushings Syndrome Diabetic kidney Diabetic lesions in pancreas Ductal carcinoma in situ (DCIS) Elevated anti-TSH receptor antibody Endocarditis Entamoeba histolytica Fatty change w/o cirrhosis Fine needle aspirate of mass Follicular hyperplasia Glutamic acid to valine substitution Granuloma Graves disease Growth hormone Hashimotos Disease Hashimoto Thyroiditis Hemochromatosis Hemolytic transfusion reaction Herpes Virus Histoplasma capsulatum Histoplasmosis Hodgkin Disease Hodgkin Lymphoma HPV Hypercalcemia Hyperplasia (adrenal) Langerhans cell histiocytosis Leukocyte alkaline phosphatase Liver w/metastatic carcinoma

Clues/Question: 45M w/pituitary adenoma H&E liver biopsy Which of these 4 photos is most consistent w/a diagnosis of acute leukemia? Which of these 4 photos is most consistent w/a diagnosis of acute myelogenous leukemia (AML, M-1)? 2 parathyroids from the same patient w/hypercalcemia Choose the best description Both of these tumors can be monitored for recurrence during chemo by measuring Wright stain, myeloperoxidase, PAS. Both photos are consistent with H&E, cotton-blue-stained culture Once, said 66F w/a previous history of cavitary TB now presents w/hemoptysis. What diagnosis is consistent w/both of these photos? Choose the best description Gross photo, two micro images of a skin biopsy 4 photographs Which of the following is true regarding the organism depicted in both photos? Lung photograph H&E biopsy of ovary; Biopsy of large abdominal mass Female presents w/thyroid nodule. What substance is most likely to be secreted by this type of tumor? Tongue, gram stain, germ tube test Diagram of an infectious disease outbreak H&E lung biopsies from renal transplant patient Lung specimens H&E-stained biopsy, KOH stain of sputum, cotton-blue stain of culture Once, said 49y/o HIV-infected truck driver just returned from transcontinental trip presents w/fever, cough, chest pain. PAS, GMS, Multicarmine stains of lung biopsy, H&E Low dose Dex no suppression. High dose suppression. (Other choices: normal, adrenal adenoma, lung cancer) Once: A 50M presents w/weight gain, prox musc weakness, and insulin resistance. Which of these 3 photos is consistent w/Cushing Disease? before-and-after endocrinopathy treatment pictures Best description for kidney biopsy picture Both A and B are pancreas biopsies. Correct description for these diabetic lesions: B is type I and A is type II. breast biopsies What abnormal lab values would you expect to find for this patient? 4 photographs are consistent w/a clinical history of After a vacation in Mexico, a 30F has abdominal pain and diarrhea. 3 photos. Which liver is an example of fatty change w/o cirrhosis? Large neck mass, heat intolerance. Next step? enlarged cervical lymph node in a 25M Which of the following defects results in the pathology seen in this picture? Changes present in this lung are consistent with (gross photo, microscopic image) H&E stains, microscopic images of enlarged thyroid What hormone is elevated to cause the condition depicted in these two pictures? photographs H&E stained thyroid biopsies; photos Once: 42F presents w/weight gain and dry skin. Biopsy. Liver Patient w/sudden onset of fever and shortness of breath. This tube of blood was collected 2hr after he received 2 units of packed RBCs. Dx? A 26F undergoes endocervical biopsy after having abnormal uterine bleeding. Pap stain of biopsy. GIemsa, GMS stains of bronchoalveolar lavage 2 GMS stains, PAS stain 4 photos of enlarged cervical lymph node A 20M presents w/generalized lymphadenopathy. Biopsies. Pap smear 2 H&E bone marrow biopsies and x-rays from 70M. You would expect The adrenal on the left side of the picture shows 4 electron microscope images A 40M has a WBC ct of 45,000/L. Given the blood smear below, what diagnostic test would be most helpful in making the Dx? Choose the best decription

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Lobar pneumonia Lung cancer Malignant vs. benign Meningioma Metastatic melanoma Mucor or Rhizopus Multinodular goiter Multiple myeloma

changes present in this lung are consistent with Graph Choose the best description for the two sets of photos answer: A is malignant, B is benign. Gross findings in brain meninges; biopsy obtained during brain surgery Best description for this specimen 49M diabetic Patient presents w/enlarged thyroid and the following nuclear medicine thyroid scan was performed. Dx? 65F w/3-month history of multiple kidney stones. Bone marrow aspirate and X-ray. Once, said 65F w/3mo history of mult kidney stones. Which of the X-rays most likely corresponds to her peripheral blood smear? Mycobacterium tuberculosis dissemination via pulmonary artery Question:What is the most likely etiology for the pathology shown in this specimen? Necrotizing granuloma H&E biopsy Neuroblastoma Which of the 4 photos is consistent w/neuroblastoma? Papillary carcinoma Thyroid mass Parathormone What hormone is elevated to cause the condition depicted in these pictures? Parathyroid hyperplasia What is the most likely finding in a patient w/the disorder evident in this kidney? Both kidneys had the same appearance. Pellagra Adolescent presents w/diarrhea, dementia, and rash seen here. Pheochromocytoma Patient presents w/episodic sweating, intermittent hypertension, headaches, and dizziness. Adrenal mass most consistent with? Plasma cell tumor The disorder in this peripheral blood smear is associated w/which of the following? Pneumocystic jiroveci H&E stain, GMS stained bronchoalveolar lavage (BAL) Pretibial myxederma and exophthalmos A 45F presents w/diffusely enlarged thyroid. Which clinical features are most specific for the disorder exemplified in the photo? Promyelocytic leukemia (M3) Wright-Giemsa peripheral blood smear photos; once: 30M undergoes BM aspiration this photo is a Wright stain twice, answer was Acute myelogenous leukemia M3 Prostate hyperplasia; bladder hypertrophy Prostate hyperplasia vs. carcinoma Choose the best answer to describe these prostate photos: A is hyperplasia, B is carcinoma. Rheumatic heart disease Heart biopsy Right-sided heart failure Which liver specimen would you expect to see in a patient w/right-sided heart failure? Schistocytes This child has H. influenza sepsis. What would peripheral blood smear show? Sickle cell anemia Which of the following X-rays is consistent w/sickle cell anemia? Spleen The RBCs shown on this peripheral blood smear are indicative of dysfunction of what organ? Stool exam for occult blood These blood smears are from a 75 anemic male who has lost 50lb during the past year. What test to order? once, answer was Rectal exam and stool for occult blood Streptococcus Pneumoniae Lung specimen Syphilis Photo t(14;18) What is the translocation responsible for the disorder depicted on these 2 photos? Teratoma ovary specimen Tertiary syphilis Changes seen in the heart and aorta Thalassemia Which of the following X-rays is consistent w/thalassemia? Thiamine (Vitamin B1) deficiency Illustrations Toxoplasmosis A 21y/o HIV patient presents w/seizures. Head MRI and biopsy. Treponema pallidum Darkfield preparation, Warthin-Starry stain both of genital ulcers Type IV Hypersensitivity What hypersensitivity pattern is described by the diagram? Ulcers 2 photos Vitamin B12 deficiency Patients past med history significant only for an unknown abdominal surgery. Presents w/two weeks of difficulty walking. Peripheral blood smear Once, question was Which of the following photographs is consistent w/Vit B12 deficiency? Vitamin C deficiency Robbins illustrations Vitamin D deficiency photos Wilms tumor Tumor is removed from abdomen of young child. Which of the 4 photos is consistent w/Wilms tumor?

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