CIS Questions Flashcards
60yo woman underwent right radical mastectomy w/radiation for adenocarcinoma of the breast 10yrs ago. She developed lymphedema of her right arm. You should check for which complication
a. Diabetes insipidus
b. Epidermolysis bullosa
c. Kaposi sarcoma
d. Liposarcoma
e. Osteosarcoma
e. Osteosarcoma
60yo woman underwent right radical mastectomy w/radiation for adenocarcinoma of the breast 10yrs ago. She developed lymphedema of her right arm. 2 yrs after developing her secondary malignancy (osteosarcoma) she presents for routine follow-up. Where are you most likely to find metastasis of the secondary tumor?
lungs
which of the following genes is most frequently in sporadic osteosarcoma?
a. INK4a
b. Rb
c. TP53
d. MDM2
e. CDK4
b. Rb
21yo male w/u/l hip pain of 6 mo and lately his back has become very stiff. No meds. ROS unremarkable. PE shows limitation in back movement and chest expansion. Serologic markers for RA are negative. Your best presumptive dx is…
a. Ankylosing spondylitis
b. Gonorrheal arthritis
c. Lyme disease
d. Osteoarthritis
e. Primary gout
a. Ankylosing spondylitis
21yo male w/u/l hip pain of 6 mo and lately his back has become very stiff. No meds. ROS unremarkable. PE shows limitation in back movement and chest expansion. Serologic markers for RA are negative. what other organ/s might be effected?
a. Eye
b. Lungs
c. GI tract
d. Heart
e. Bladder
a. Eye
21yo male w/u/l hip pain of 6 mo and lately his back has become very stiff. No meds. ROS unremarkable. PE shows limitation in back movement and chest expansion. Serologic markers for RA are negative. what other disease process shares an association with the same HLA as ankylosing spondylitis, and can involve the conjunctiva
a. Enteric associated arthritis
b. Psoriatic arthritis
c. Reactive arthritis
d. Infectious arthritis
c. Reactive arthritis
45yo male has painful, rapidly enlarging mass of his femur. Radiograph and cross section of his resected femur are seen in pics (similar to pics on slide 17 of lect 1). Whats the most likely dx?
a. Chondrosarcoma
b. Enchondromatosis
c. Giant cell tumor
d. Osteogenic sarcoma
e. Paget’s disease
a. Chondrosarcoma
45yo male has painful, rapidly enlarging mass of his femur. Radiograph and cross section of his resected femur are seen in pics (similar to pics on slide 17 of lect 1). 1. from which of the following preexisting tumors might a chondrosarcoma arise?
a. Enchondroma
b. Osteosarcoma
c. Osteoblastoma
d. Chondroblastoma
e. Osteoid osteoma
a. Enchondroma
40yo woman present with lower back pain. Hx of multiple enchondromas in hands and feet along w/soft tissue hemangiomas. CT of spine shows a destructive process of the sacrum. Biopsy shows malignant chondrocyte and hyalinized matrix. Most likely dx?
a. Lyme disease
b. Maffucci syndrome
c. Ollier disease
d. Reiter syndrome
e. Sjogren’s syndrome
b. Maffucci syndrome
68 yo man fell off ladder trapping leg between it, portion of bone is protruding through the skin and X-ray shows multiple bone fragments in superior tibiral region. What terms best describe this fracture?
Compound and comminuted
44yo renal dialysis pt develops swollen knees. Arthrocentesis shows 5000 neutrophils and a few RBCs, protein level is increased, you examine fluid under polarized light and see needle-shaped crystals. Your findings are most suggestive of crystals formed of what?
Uric acid
Male pt with hyperuricemia and possible gouty arthritis. You notice he persistently bangs his head against the wall. What does he have a deficiency of?
a. 25-hydroxy vit D
b. Amido-phosphoribosyltransferase
c. Hypoxanthine-guanine phosphoribosyl transferase
c. Hypoxanthine-guanine phosphoribosyl transferase
10yo boy w/hx of multiple fractures over the yrs, shorter than his peers, PE shows small misshapen blue-yellow teeth and curvature of the spine, whats the most appropriate dx?
a. Achondrogenesiss I
b. Achondrogenesis II
c. Osteogenesis Imperfecta III
d. Osteogenesis Imperfecta II
e. Osteomalacia
f. Osteopetrosis
c. Osteogenesis Imperfecta III
17yo high school football player w/pain in right leg, X-ray shows a 1 cm shaprly demarcated radiolucent lesion in the tibia surrounded by dense sclerotic bone, no FH of cancer, what is the pain caused by?
a. Excess production of prostaglandin E -> this is an osteoid osteoma
b. Excess production of leukotriene E4
c. Excess production of IL-6
a. Excess production of prostaglandin E -> this is an osteoid osteoma
17yo high school football player w/pain in right leg, X-ray shows a 1 cm shaprly demarcated radiolucent lesion in the tibia surrounded by dense sclerotic bone, no FH of cancer. Pain can be controlled with:
a. Opioids
b. Aspirin
c. Corticosteroid
b. Aspirin
52yo female with joint pain and swelling in hands for 3 mo, significant morning stiffness and increasing fatigue, she’s able to continue her work as a transcriptionist and says she begins to feel better by midday. Left untreated, the pt may develop:
radial deviation of the wrists and ulnar deviation of her fingers -> this is a presentation of RA
52yo female with joint pain and swelling in hands for 3 mo, significant morning stiffness and increasing fatigue, she’s able to continue her work as a transcriptionist and says she begins to feel better by midday. which of the following could also be found in this pt?
a. Joint mice
b. Subchondral cyst
c. Fibrillation
d. Ankyloses
e. Morning stiffness
f. TNF
d. Ankyloses
e. Morning stiffness
f. TNF
**A-C are characteristics of osteoarthritis
60yo woman with inc hat size and generalized bone pain, PE shows hearing loss but no masses are found, CMP shows a markedly elevated alk phos w/normal serum levels of Ca and Pi, biopsy performed and shown. Dx?
Paget’s disease
60yo woman with inc hat size and generalized bone pain, PE shows hearing loss but no masses are found, CMP shows a markedly elevated alk phos w/normal serum levels of Ca and Pi, biopsy performed and shown and a dx of Paget’s disease was made. 10yrs later.. section of bone shows a mosaic pattern of lamellar bone with prominent osteoid seams, most likely to have which additional finding?
a. 24hr urine cortisol elevated
b. Radiography shows a Codman triangle
c. Radiography shows a diffuse radiolucency
d. Skin biopsy shows a thin dermis
e. Compression fractures of the spine
e. Compression fractures of the spine
what malignant tumor/s might develop in a pt with pagets disease?
a. Giant cell tumor
b. Fibrosarcoma
c. Osteosarcoma
d. Chondrosarcoma
e. Liposarcoma
b. Fibrosarcoma
c. Osteosarcoma
12yo boy w/sickle cell presents w/bone pain in right humerus, after 4 days of pain meds hes still in pain and has a fever, Hgb and Hct are stable and WBC slightly elevated, bone scan shows an area of inflammation in th ehumerus, which organism is most likely the etiology?
salmonella
40yo man with arm in sling, had suffered a gunshot wound to R upper arm during deer hunting season when his drunk friend mistook him for a stag. Hes been nursing this injury for several mo w/out seeking medical care, he went through a period of purulent material accompanied by small “brunchy bits” oozong from the wound, the crunchy bits were most likely:
sequestrum
67yo man w/PSA of 12.2, results of transrectal biopsy confirm adenocarcinoma, what is most likely to develop if the disease is left untreated?
a. Acute tubular necrosis
b. Chronic pyelonephritis
c. Gram negative bacteremia
d. Osteoblastic vertebral lesions
e. Stromal sarcoma
d. Osteoblastic vertebral lesions
1yo female w/leukocoria (white reflex), cream colored mass fills orbit, micro exam shows calcifications and small round blue cells arranged in rosettes, whats true of this condition?
a. Diffuse spread through retina w/out formation of a mass is a common feature
b. Its uncommon for this tumor to metastasize to bone marrow
c. Most cases of this tumor are hereditary due to germ line mutations in a tumor suppressor gene on 13q14
d. Pts with the hereditary form of this tumor have an inc risk fo developing osteosarcoma
e. Rosettes seen microscopically are identical to those seen in neuroblastomas
d. Pts with the hereditary form of this tumor have an inc risk fo developing osteosarcoma
Rickets is characterized by which of the following?
a. Collagen synthesis do
b. Failure of bone mineralization
c. Failure of bone remodeling
d. Failure of osteoid formation
e. Reactive bone formation
b. Failure of bone mineralization
65yo woman has developed kyphosis over the last 15yrs, she fractures ankle while getting out of bathtub, which of the following would be a major risk factor for her condition?
a. She has low serum phosphorus or cortisol
b. She is African American or Hispanic
c. She took SSRI for 20yrs
d. She used to play contact sports and still lifts weights
e. She was vegan or anorexic in high school
e. She was vegan or anorexic in high school
5yo child’s mother says he walks funny and seems to fall down a lot and need help getting up, has slight lordosis and prominent calf muscles, skeletal muscle biopsy performed, what lab test confirms dx?
Immunohistochemical staining for dystrophin
30yo white woman with .8cm, painless, firm, tan papule on lower leg, it has inc slightly over time and it is an area of prior trauma, doc notes that the lesion dimples inward when he compresses it laterally, biopsy shows spindle cells surrounded by hyalinized collagen bundles which stain positively for factor XIII, dx?
Benign fibrous histiocytoma -> AKA dermatofibroma
26yo mal who lives near the Appalachian trail in Maryland develops rash on back, its targetoid with serpiginous border, 6 wks later he develops pain in shoulders and knees, he can barely walk or raise his arms above his head, most likely cause of his joint pain is an infection with:
spirochete -> this is lyme disease
25yo male comes to office bc of mole, doesn’t remember ever noticing before and hasn’t noticed any recent changes, dx?
Benign melanocytic nevus
biologic behavior of suspicious nevi is most dependent on:
presence of a vertical growth phase
28yo HIV positive male w/pneumocystis jiroveci pneumonia and respiratory distress, after initiation of therapy, he develops numerous lesions like those seen here, symmetrically distributed over his arms and trunk, which of the following drugs is responsible for the development of these lesions?
Sulfamethoxazole -> sulfa drugs commonly contribute to erythema multiforme
22yo male presents w/abrupt onset of high fever, chills, HA and petechial rash, within mins you narrow the causative agent down to a member of Rickettsia, what additional pieces of info would make you favor rickettsia rickettsia over rickettsia prowazekki?
Petechial rash initially began on his extremities and then spread toward his trunk
6yo girl develops blotchy, reddish-brown rash on face, trunk and proximal extremities over 3 days, .2 to .5cm ulcerated lesions are prominent on oral mucosa, she has generalized LAD and a cough with productive sputum, what infection does she have?
a. Mono
b. Mumps
c. Rubella
d. Rubeola
e. Varicella
d. Rubeola -> AKA measles (measles has ulcerated lesions, this is key; pay attention to what causes ulcerated vs targetoid vs flat lesions)
52yo man develops generalized exfoliative erythroderma, blood smear shows numerous CD4 cells with lobulated nuclei, whats the correct dx?
a. Anaplastic large cell lymphoma (ALK1 +)
b. CML after successful treatment
c. Sezary syndrome
d. Extranodal marginal zone B-Cell lymphoma
e. Precursor T cell acute lymphoblastic leukemia
c. Sezary syndrome -> nuclei described as lobular or
54yo male who had a liver transplant 2 yrs ago present with skin tumor, immunosuppressed individuals are at most risk for developing which one?
a. Atopic dermatitis
b. SCC
c. Seborrheic keratosis
d. Psoriatic arthritis
b. SCC -> HPV 5&8
immunosuppressed pts are at most risk for developing SCC due to which HPV strains?
5 & 8
30yo man developed lesions on upper lip 5yrs ago, whats most likely
a. Apocrine sweat gland malignancies
b. Benign tumors of eccrine sweat ducts
c. Familial neoplasms of the hair follicle
d. Pores infected by P. Acnes
e. Sites of HPV infection
c. Familial neoplasms of the hair follicle
Angiofibromas associated with what condition?
Tuberous sclerosis
28yo female presents for yearly obgyn exam. Multiple verrucous plaques are visible in the vulvar and perineal areas, biopsy of one lesion shows cells with nuclear atypia and perinuclear halos, pt most likely has
a. Condyloma acuminatum
b. Condyloma lata
c. Extra-mammary pagets disease
d. Lichen simplex chronicus
e. LGV
a. Condyloma acuminatum
55yo woman with dysphagia, ptosis and diplopia, thorough eval for malignancy is negative, what is most consistent with these sx?
Myasthenia gravis -> Abs to Ach receptor
adolescent girl with hx of vertigo and hearing loss, CT scan reveals b/l masses at cerebellopontine angles, dx?
schwannoma
mutations in the gene product merlin, located on chr 22 are strongly correlated with this clinical setting
schwannoma
48yo woman on hemodialysis for CKD reports inc loss of sensation in legs for 3 yrs, on PPE symmetrical dec sensation over both LE’s w/no dec in strength or abnormalities of gait, what is most likely to produce these findings?
DM
65yo female w/ itchy rash for few mo, lesions first appeared as red swollen plaques on abd and flexor aspects of forearms, PE shows urticarial plaques, as well as large bullae on abd and thighs, skin biopsy shows positive direct immunofluorescence test for IgG anti-BM antipodies, most likely dx
bullous pemphigoid
20yo female w/severe HA, signs of weakness of left face and slurred speech, which of the following viruses has not been implicated as a cause of this condition?
a. HSV
b. Herpes zoster
c. EBV
d. CMV
e. Norovirus
e. Norovirus -> A-D can all present with sx of Bell’s Palsy and are particularly common among teenagers
25yo with severe muscle cramps, currently being treated w/Abx for UTI, erythematous papulovesicular rash, urine shows + leukocyte esterase, 3+ Hgb, but no intact RBCs are seen, what type of inflammatory rxn?
Type 4 hypersensitivity -> this is eczema
25yo with severe muscle cramps, currently being treated w/Abx for UTI, erythematous papulovesicular rash, urine shows + leukocyte esterase, 3+ Hgb, but no intact RBCs are seen. Now he no longer has UTI sx but still has muscle cramps, her CK is markedly elevated, most likely dx?
a. Pompe DIsease
b. Von Gierke Disease
c. McArdle DIsease
d. Lysosomal glucosidase deficiency
e. G6P deficiency
c. McArdle DIsease
What familial/genetic syndrome has inc risk of basal cell carcinoma?
9p22 -> nevoid basal cell carcinoma syndrome (Gorlin) -> AD mutation
75yo female in nursing home wit large blisters on thighs, lower abd and groin, biopsy reveals non acantholytic subepidermal blister, dx?
a. Dermatitis herpetiformis
b. Bullous pemphigoid
c. Epidermis bullosa
d. Pemphigus foliaceus
b. Bullous pemphigoid
Lamotrigine reaction is characteristic of what condition?
Stevens-johnson syndrome
Epidermodysplasia verruciformis is assoc with what infection?
HPV-5
