AP Questions Part 3 Flashcards
What do each of these classifications of dissecting aortic aneurysm entail?
A) Stanford A
B) Stanford B
C) DeBakey I
D) DeBakey II
E) DeBakey IIIA
F) DeBakey IIIB
A) ascending +/- descending
B) descending
C) ascending and descending
D) ascending
E) descending, extends proximal and distal
F) descending, extends distal
What is the mutation associated with a) AML and b) CML?
A) 15;17 most common, but
8;21 RUNX1 (good prognosis) vs inv3, t(3;3) or t(6,9) poor prognosis
B) 9;22 BCR-ABL1
How do muscle cells differ in atrophy patterns in neurogenic atrophy vs myopathies?
Neurogenic: early polygonal atrophy, nuclear clumping, grouped
Myopathy: round atrophy mixed with hypertrophy, scattered, necrosis/fibrosis, increased nuclei
What are the pertinent IHC for basaloid SCC?
UEA-1+, AE1/3+
But Ber-EP4-, MOC-31-
(Unlike BCC)
What mutation and what variant of PTC is seen with FAP?
APC mutation, cribriform morular variant (which histologically has squamoid metaplasia)
*APC mutation is also in Gardner’s and Turcot
What defines the following categories of AML, NOS: 1) AML with minimal differentiation 2) AML without maturation 3) AML with maturation?
1) <3% of blasts stain for Sudan black or MPO
2) >3% of blasts stain for Sudan black or MPO, <10% granulocytes
3) granulocytes >=10% of blast cells
What mutation is seen in a) adamantinomatous craniopharyngioma and b) papillary craniopharyngioma?
A) beta-catenin
B) BRAFV600E
What mutation is seen in pilocytic astrocytoma, and what IHC is positive?
KIAA1549::BRAF
GFAP+, Olig2+, SOX10+
What is CD5 and CD10 in marginal zone B cell lymphoma?
CD5-, CD10-
What is the difference between dermatofibroma and DFSP?
DFSP is CD34+ and infiltrates adipose tissue
Dermatofibroma is factor XIIIa+
What is Meigs syndrome?
Ovarian fibroma, ascites, right pleural effusion
What is the most common mutation in a) lung adenocarcinomas and specifically mucinous? B) micropapillary lung? C) solid/cribriform with signet cell features?
a) KRAS
B) EGFR
C) ROS1 and ALK
What is the thymoma classification (A, B1, B2, B3, AB, C)?
A: spindled
B1: epitheloid < lymphocytes
B2: epithelioid = lymphocytes
B3: epitheloid > lymphocytes
AB: spindled + lymphocytes
C: carcinoma
What IHC stains for fibromatosis / what part of the cell?
Nuclear beta-catenin
What mutation is seen in In Fragile X Syndrome?
FMR1 methylation from CGG trinucleotide repeat
(Fragile Male)
What excess cell type does granular cell tumor contain? Oncocytoma?
GCC: lysosomes
Onco: mitochondria
What tumors are most specific for calretinin+, inhibin+, melanA+?
Adrenal cortical tumors
What is the specimen type reccommended for urothelial carcinoma DNA ploidy analysis and how should it be collected?
Bladder washings (barbatoge)
Second void of day, 30 mL, delivered within 12 hrs (>12: fix in ethanol)
How to distinguish squamoid eccrine ductal carcinoma from SCC on IHC?
CEA+, EMA+ (typically + in glandular tissue like Adnexal, not squamous), p63
What are the most common materials used as a bullet’s primer (3)? Cartridge?
Bullet: BAL: barium, antimony, and lead
Cartridge: brass (alloy of zinc and copper)
What do you see in histology for gynecomastia?
DUCTAL proliferation with prominent rims of edematous stroma
What is seen on histology with diabetic mastopathy?
Fibrotic/sclerotic stroma and lymphocytic infiltrate of blood vessels and lobules
What are the 3 hormonal breast marker findings in invasive lobular breast carcinoma?
ER+, PR+, Her2- (also E-cad-)
What is the IHC staining for fibromatosis (beta catenin, CD-34, SMA)? How to differentiate from fibromatosis-like metaplastic carcinoma?
Beta-catenin+, CD34-, SMA+
Cytokeratins+ in metaplastic carcinoma
What percentages qualify “MDS with single or multi lineage dysplasia” vs “MDS with excess blasts 1” vs “MDS with excess blasts 2”?
A) blasts in peripheral blood
B) blasts in bone marrow
A) <1% vs 2-4% vs 5-19%
B) <5% vs 5-9% vs 10-19%
What ringed sideroblast percentage/mutation qualifies “MDS with ringed sideroblasts, single lineage dysplasia” vs “MDS with single lineage dysplasia?
> =15% ringed sideroblasts, or >=5% if SF3B1 mutation is present
What tumor is the mutation NR4A3-EWS found in?
Extraskeletal myxoid chondrosarcoma
When is expedited treatment (going straight from cytology/HPV screening to treatment/excision without colposcopy) recommended?
Non-pregnant patients 25+ years old that have HPV+ HSIL, high risk HPV+ patients who have rarely /never screened, or immediate risk of CIN3+ is >60%
What is the defining cell type to remember for each of the following inflammatory lymph node diseases?
A) Cat scratch disease
B) Toxoplasmosis
C) kikuchi’s syndrome
D) Kimura’s disease
E) autoimmune lymphoproliferative syndrome
A) necrosis/neutrophils
B) epithelioid histiocytes
C) necrosis/histiocytes with crescent shaped nuclei
D) eosinophils
E) plasma cells
What type of genetic changes is Comparative genomic hybridization useful for and how does it work?
Gain or loss of DNA
Reference DNA is fluorescently labeled one color, test subject DNA is labeled another color. If signal from test DNA is stronger/same color, it means gain of DNA. If signal from reference DNA is stronger, loss of DNA.
What are the main differences between parosteal and periosteal osteosarcoma?(grade, location)
Parosteal: low grade, metaphysis on back of knee
Periosteal: intermediate/high grade, diaphysis of femur/tibia
How do you calculate, a) MCV b) MCH c) MCHC?
a) MCV = Hct / RBC count
b) MCH = Hgb / RBC count
c) MCHC = Hgb / Hct x 100
What is the mutation associated with MALT lymphoma?
API2-MLT
Which IHC marker is most commonly positive in mycosis fungoides?
CD4
What is salpingitis isthmica nodosa and what do you see on histology?
Diverticular disease of the Fallopian tube associated with infertility, ectopic pregnancy
- see smooth muscle hypertrophy / fibrous tissue and underlying normal glandular epithelium
What is the most common glycogen storage disease and what is deficient?
Von Gierke’s disease, glucose-6-phosphatase deficiency
(Hypoglycemia, lactic acidosis, hyperlipidemia, hyperuricemia)
What is a hierarchical database vs a flat file database vs a relational database?
Hierarchical: parent-child tree-like model
Flat file: single table without primary key (ie spreadsheet)
Relationship: most widely used, data in tables and each row has unique primary key, can relate to another table through key
What are two IHC that are positive in endometriosis? What mutations are common in endometriosis associated with clear cell carcinoma?
CD10+, IFITM1+
ARID1A, ER, PR mutation with their loss
How do the following stain for CD5, CD10, CD23?
A) mantle cell lymphoma
B) CLL
C) follicular lymphoma
A) CD5+
B) CD5+, CD23+
C) CD10+
What 4 stains are positive for Ewing sarcoma/PNET and what is the mutation?
CD99+, NSE+, SYN+, PAS+
11;22 FLI1-EWS mut
What is the difference in IHC between primary Paget’s disease and secondary Paget’s (with underlying carcinoma)?
Primary: GCDFP+, CK20-
Secondary: GCDFP-, CK20+
(Note: Both are CK7+ while SCC is CK7-, CK5+)
What is the most common form of glomerulonephritis?
IgA nephropathy (Berger disease)
What mutation is most commonly seen in a) invasive PTC, follicular type and b) noninvasive PTC, follicular type?
A) BRAF
B) RAS
Spindle cell lesion that is CD117+, DOG1+, CD34+, vimentin+? What is the treatment?
GIST
Tyrosine kinase inhibitors, ie Gleevec
What mutation is seen with hereditary leiomyomatosis and renal cell cancer? What is the inheritance?
Fumarate hydratase, autosomal dominant
(Reed’s syndrome)
What conditions are fundic gland polyps associated with? What is mutated?
FAP, Zollinger-Ellison syndrome, tuberous sclerosis, PPI use
Beta catenin (APC)
What stain is positive in angiomyolipoma?
HMB45
What tumors have TFE3 rearrangement?
Alveolar soft part sarcoma, PEComa, MiT family RCC, epithelioid hemangioendothelioma
What 2 conditions is follicular cervicitis most commonly associated with?
Chlamydia infection, post-menopausal atrophy
What 3 mutations are most common in GIST?
KIT, PDGFRA, and SDH-deficient (last is most common in Carney syndrome)
What mutation is common in epithelioid hemangioma?
FOS/FOSB
A) What kind of placental membrane most commonly leads to twin twin transfusion syndrome?
B) What kind has highest rate of twin loss?
A) Monochorionic diamniotic
B) mono mono
Which of the following systems are for EMR transfers, medical terms, imaging, lab data:
A) SNOMED
B) LOINC
C) DICOM
D) HL7
A) medical terms
B) lab data
C) imaging
D) EMR
What’s the difference between an f test, t test, and chi square test?
F test measures variability between 2 tests/treatments(F for fluctuation)
T test examines difference between means of 2 groups
chi square test measures categorical variables (not numerical)
What syndrome encompasses hemihypertrophy, macroglossia, hypoglycemia, and “blastomas” of childhood?
Beckwith-Wiedemann syndrome
What syndrome encompasses Wilms tumor, gonadal dysgenesis/gonadal blastoma, and nephropathy from diffuse mesangial sclerosis, and what mutation is seen?
Denys-Drash syndrome
WT-1 mutation
What does WAGR syndrome entail?
WT-1/Wilms tumor
Aniridia
GU malformation
Retardation
Which of the 4 classic melanocytic markers are positive in granular cell tumor?
S100+, SOX10+
(melanA and HMB45 are negative)
What mutation is seen in mesenchymal chondrosarcoma?
HEY1-NCOA2
(“HEY” stop “mesen” with my “COA”L)
ChondrOsarcomA)
What mutation do tropomyosin kinase inhibitors target, and what are some examples of tumors with those mutations?
ETV6-NTRK
Congenital infantile fibrosarcoma, congenital mesoblastic nephroma, AML, glioblastoma, some lung and breast cancers