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FATES OF THROMBUS
Fate Definition
Propagation Thrombi accumulate additional platelets and fibrin
Embolization Thrombi dislodge and travel to other sites in the
vasculature
11. HEART
QUESTION ANSWER
HEART FAILURE
67/M, presented with easy fatigability, Left-sided heart
paroxysmal nocturnal dyspnea, and 3-pillow failure
orthopnea. Known case of hypertension, poorly
controlled, for 20 years. What is the type of
heart failure seen in this case?
45/M, known case of COPD, presented with Right-sided heart
decreased sensorium, increased liver span, and failure
lower extremity edema. What is the type of heart
failure seen in this case?
APPENDIX GALLBLADDER
28/M, with initial periumbilical pain shifting to the Acute NON-NEOPLASTIC CONDITIONS
RLQ, with associated fever, anorexia, and vomiting. suppurative 45/F, obese, presented with colicky Chronic calculous
Appendectomy was performed. Biopsy showed PMNs in appendicitis epigastric pain after eating. cholecystitis
muscularis layer. What is the diagnosis? Cholecystectomy was performed. Grossly, (Xanthogranulomatous
28/F, clinically diagnosed with acute appendicitis, Carcinoid, the gallbladder is filled with stones and cholecystitis)
underwent appendectomy. Sections of the appendix appendix the mucosal surface is ridden with
showed congestion, but an incidental finding of sheets multiple yellow pinpoint excrescences.
and nests of uniform cells with scant cytoplasm and Biopsy showed mononuclear infiltrates in
stippled nuclei. Immunohistochemistry: the mucosa with lipid-laden macrophages
Chromogranin and Synaptophysin (+). What is the (cholesterolosis), and prominent
diagnosis? Rokitansky-Aschoff sinuses. What is the
diagnosis?
17. LIVER AND GALLBLADDER
LIVER TUMORS
45/F, managed as a case of chronic Gallbladder
QUESTION ANSWER
calculous cholecystitis is undergoing adenocarcinoma
VIRAL HEPATITIDES
laparoscopic cholecystectomy, but
25/M, with history of eating street foods, Acute Hepatitis A
gallbladder was found to be large, needing
presented with right upper quadrant pain and infection
conversion to open cholecystectomy. Biopsy
jaundice. ALT and AST were elevated; Serology:
showed irregular glands lined by
anti HAV (+); Liver biopsy showed scant portal
dysplastic epithelial cells, invading the
mononuclear infiltrate, predominantly plasma
stroma. What is the diagnosis?
cells, and hepatocyte necrosis and apoptosis.
50/F, presenting with signs of obstructive Cholangiocarcinoma
What is the diagnosis?
jaundice, with dyspnea. CXR: multiple
43/M, with positive HBsAg 7 months prior, still Chronic active
cannon-ball lesions; Abdominal UTZ:
has (+) HBsAg, (-) anti HBs, and (+) HBeAg. ALT Hepatitis B
multiple hepatic nodules. Patient
and AST were elevated; Liver biopsy showed infection
eventually expired. Biopsy of the bile duct
dense portal mononuclear infiltrate, and
showed glands lined by dysplastic
ground-glass hepatocytes. What is the
epithelial cells that invade the stroma.
diagnosis?
What is the diagnosis?
43/M, with anti-HCV (+) for 8 months, Chronic Hepatitis
underwent HCV RNA testing, which turned out C infection
to be positive. ALT and AST were elevated; Liver
biopsy showed dense portal mononuclear
infiltrate, lymphoid follicles, bile duct injury,
and steatosis. What is the diagnosis?
ENDOCRINE PANCREAS
23. ENDOCRINE SYSTEM DIABETES MELLITUS
PITUITARY GLAND
15/M, with polyuria, polydipsia, and polyphagia, Type 1 DM
QUESTION ANSWER
forgot his insulin for a week, presented with weakness
34/F, with galactorrhea and amenorrhea. Pituitary adenoma and increased sleeping time at the ER, and eventually
Imaging showed a pituitary mass, (Prolactin cell expired. Autopsy of the pancreas showed lymphocytic
measuring 2.0 cm. Transsphenoidal adenoma) infiltration of the islets (insulitis). What is the
resection was done. Biopsy showed sheets diagnosis?
of benign-looking pituicytes with sparse
44/F, with polyuria, polydipsia, and polyphagia, Type 2 DM
reticulin network. What is the diagnosis?
presented with a gangrenous foot and high-grade
Based on the case above, if metastases Pituitary carcinoma fever. Patient eventually died of septic shock. Autopsy of
were found in other sites, what would be the pancreas showed amyloid deposition. What is the
the diagnosis? diagnosis?
15/M, with a cranial mass. Biopsy showed Craniopharyngioma Based on the case above, if the patient lived longer, but Diabetic
a lesion that looks like an ameloblastoma. (Adamantinomatous) presented with rising BUN and creatinine, and then nephropathy
What is the most likely diagnosis? eventually died of uremia, and autopsy of the kidney
showed hyaline arteriolosclerosis and nodular
THYROID GLAND glomerulosclerosis (Kimmelsteil-Wilson lesion), what
HYPOTHYROIDISM is the diagnosis?
6/M, with mental retardation, short stature, Cretinism Based on the second case, if the patient lived, but Diabetic
coarse facial features, protruding tongue, presented with progressive deterioration of visual retinopathy
umbilical hernia, and history of maternal acuity, and retinal workup showed neovascularization
hypothyroidism. What is the diagnosis? and cotton-wool exudates, what is the diagnosis?
34/F, with profound weight gain, deepening of Myxedema
voice, and nonpitting edema. Skin biopsy PANCREATIC NEUROENDOCRINE TUMORS
showed accumulation of matrix substances, Parameter Insulinoma Gastrinoma
such as glycosaminoglycans and hyaluronic Clinical Hyperinsulinism Hypergastrinemia
acid. What is the diagnosis? syndrome Whipple Triad Zollinger-Ellison
THYROIDITIDES 1. Hypoglycemia (<50 syndrome
35/F, with thyroid enlargement. Total Hashimoto mg/dL) 1. Pancreatic islet
thyroidectomy was done. Biopsy showed thyroiditis 2. Neuroglycopenic cell tumor
lymphoid follicles scattered throughout the symptoms 2. Hypersecretion of
parenchyma with Hurthle cell change. What is 3. Relief upon parenteral gastric acid
the most likely diagnosis? glucose administration 3. Severe peptic
35/F, with a history of viral URTI, complained of De Quervain ulceration (may
anterior neck pain and sudden thyroid thyroiditis occur in jejunum)
enlargement. Total thyroidectomy was done. Location Pancreas Gastrinoma triangle
Biopsy showed granulomatous inflammation. Biologic Usually benign Usually malignant
What is the diagnosis? behavior
GRAVES DISEASE Gross and May recapitulate normal pancreatic islets; even
36/F, with proptosis, pretibial myxedema, and Graves Disease histology malignant tumors can be encapsulated; amyloid
modest thyroid enlargement. TSH is low and deposition (in insulinomas)
FT4 is high. Total thyroidectomy was done.
Biopsy showed diffuse hyperplasia with ADRENAL GLANDS
pseudopapillary structures and moth-eaten ADRENAL CORTEX
colloid. What is the diagnosis?
34/M, obese with moon facies, purple Cushing syndrome
GOITERS abdominal striae, and dorsocervical secondary to cortisol-
45/F, with an anterior neck mass. Total Colloid goiter fullness (buffalo hump). 24-hour urine secreting adrenal
thyroidectomy was done. Cut sections show a cortisol is increased. Plasma ACTH is adenoma
single nodule. Biopsy showed follicles distended decreased. Imaging showed a right adrenal
by abundant amount of colloid. What is the mass. Biopsy showed cells resembling
diagnosis? normal zona fasciculata. What is the
Based on the case above, if cut sections show Multinodular diagnosis?
multiple nodules, and biopsy showed multiple goiter Based on the case above, if plasma ACTH is Cushing disease
nodules distended by colloid, as well as nodules increased, and imaging showed bilateral (Cushing syndrome
forming pseudopapillary structures, what is the adrenal hyperplasia, and cranial MRI secondary to ACTH-
diagnosis? showed a pituitary mass, what is the secreting pituitary
Based on the case above, if the patient presented Plummer diagnosis? adenoma)
with hyperthyroidism, and the histologic syndrome 45/F, presented with weakness and Conn syndrome
diagnosis is still multinodular goiter, what is the treatment-resistant hypertension. Plasma (Primary
clinical diagnosis? aldosterone is elevated. Plasma renin is hyperaldosteronism
TUMORS decreased. Imaging showed a left adrenal secondary to
38/F, with an anterior neck mass. Total Papillary mass. Biopsy showed cells resembling aldosterone-secreting
thyroidectomy was done. Biopsy showed carcinoma normal zona fasciculata with adrenal adenoma)
papillary fronds lined with atypical thyrocytes spironolactone bodies. What is the
with Orphan Annie nuclei and Psammoma diagnosis?
bodies. What is the diagnosis? 6/F, with ambiguous genitalia, presented Congenital adrenal
Based on the case above, if grossly there is only Follicular with fever, cough and colds, with hyperplasia, salt-
one nodule observed, and biopsy showed sheets adenoma hypotension and hypoglycemia. Cortisol wasting type
of benign-looking thyrocytes without capsular and aldosterone levels are decreased.
or vascular invasion, what is the diagnosis? Plasma renin is increased. Serum sodium is
Based on the second case, if capsular and Follicular low, and potassium is high. Imaging showed
vascular invasion were observed, what would carcinoma bilateral adrenal hyperplasia. What is the
be diagnostic? diagnosis?
UVEA
Inflammation of the tissues that comprise the Uveitis
uvea (iris, ciliary body and choroid)
Most common intraocular malignancy Metastases to uvea
Most common primary intraocular Melanoma
malignancy in adults
OPTIC NERVE
Swelling of the optic nerve head; can be Optic nerve edema
unilateral or bilateral (papilledema); usually
caused by nerve compression (unilateral) and
increased ICP (bilateral)