Pathology Notes

Waterhouse Frederichsen syndrome   Updated: 06/21/2022 © Jun Wang, MD, PhD General features Adrenal insufficiency Due to bilateral/unilateral adrenal hemorrhage Associated with bacterial or viral infection   Commonly associated with meningococcal infection  Other associated pathogens include Haemophilus influenzae Pseudomonas aeruginosa Escherichia coli Streptococcus pneumoniae Pathogenesis Clinical presentations Sudden onset Nonspecific presentations: headache, fever, weakness, abdominal/flank pain, anorexia, etc Signs of shock : Tachycardia, hypotension, etc Abdominal rigidity or rebound tenderness If associated with meningococcemia: petechial rash , purpura fulminans, other neurological abnormalities Key Laboratory findings Features of Disseminated intravascular coagulation Leukocytosis Hyponatremia and hyperkalemia: Mineralocorticoid deficiency Hypoglycemia: glucocorticoid deficiency Elevated : ACTH, renin Decreased : Aldosterone, glucocortico

Shock Updated: 08/08/2022 © Jun Wang, MD, PhD General features Cell/tissue hypoxia Due to circulatory failure Life threatening Reversible at early stage only Need to initiate therapy immediately while rapidly identify underlying etiology Treat underlying etiology Stages Compensation : Perfusion of vital organs maintained Decompensation : Hypoperfusion and lactic acidosis Irreversible : Permanent cell/tissue damage, organ failure, usually leads to death Classification Distributive : Relative hypovolemia due to pathological redistribution of intravascular volume, usually resulted from excessive vasodilation Systemic inflammatory response syndrome Septic shock Neurogenic shock Anaphylactic shock Drug and toxin-induced shock Endocrine shock Cardiogenic : Cardiac malfunctioning associated critical reduction of pumping capacity Cardiomyopathic Arrhythmic Mechanical Hypovolemic : Absolute hypovolemia due to loss of intravascular volume, usu

Practice questions Ib answers, female genital tract Pathology of vulva, vagina and cervix © Jun Wang, MD, PhD 1. A. Thick white vaginal discharges are suggestive of candida infection , that can be confirmed by wet mount preparation with identification of fungal pseudo hyphae, as seen in this case. Chlamydia trachomatis is probably the most common type of STD. However, there is no specific morphological changes for chlamydia infection. Gonorrhea usually has purulent discharges with Gram negative diplococci, but not pseudohyphae. Herpes infection is characterized by multinucleation, chromatin margining with ground glass appearing nuclei, as well as molding of nuclei, with marked neutrophilic infiltration. Human papillomavirus infection will cause cervical intraepithelial neoplasia , endocervical adenocarcinoma in situ , and most of cervical carcinomas , with presence of koilocyte , or neoplastic glandular or squamous cells, but not pseudohyphae. 2. D. Yellow-green m