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MED4 ACP > CNS pathology > Flashcards

CNS pathology Flashcards

1
Q

MC cause and type of head injury

A

Falls
Deacceleration injury

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2
Q

What is raccoon eye and Battle sign? What do they indicate respectively?

A

Raccoon eye: periorbital ecchymosis ==> anterior cranial fossa fracture
Battle sign: retromastoid ecchymosis ==> petrous temopral bone fracture

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3
Q

Glasgow Coma Scale (associated mortality)

A

= assessment of impaired consciousness level in response to defined stimuli to determinen severity of head injury

Eye opening response (4): spontaneous –> to speech –> to pain –> none

Verbal response (5): orientated –> confused –> inappropriate words –> incomprehensible sounds –> none

Motor response (6): obey commands –> localization to pain –> normal flexion to pain –> abnormal flexion to pain –> extension to pain –> none

> =14: minor severity (0.4%)
9~13: moderate severity (5%)
<=8: severe severity (45%)

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4
Q

Types of skull fractures (4)

A

Linear fracture
Depressed fracture
Basilar fracture
Diastatic fracture

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5
Q

Types of brain parenchymal injury

A

Contusion (coup or countercoup)
Laceration
Diffuse axonal injury

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6
Q

Types of brain traumatic vascular injury (which is MC?) (What are the vessels involved?)

A

Epidural haematoma: middle meningeal artery
Subdural haematoma (MC): bridging vein between dura & arachnoid membrane
Cerebral / contusional haematoma: intracerebral vessels

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7
Q

Difference in CT between epidual and subdural haematoma

A

lens-shaped, limited by suture lines
crescent-shaped, cross suture lines

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8
Q

Involvement of which spinal level will lead to respiratory compromise in spinal injury?

A

C4 or above

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9
Q

2 types of cerebral oedema and pathogenesis

A

vasogenic oedema: malignancy / infection –> BBB diruption & ↑ vascular permeability

cytotoxic oedema: generalised hypoxia / ischaemic insult –> neuronal / glial cell injury –> cellular swelling

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10
Q

Cushing triad

A

sinus bradycardia, hypertension, irregular breathing

==> ↑ ICP

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11
Q

Signs of ↑ ICP

A

papilledema
headache, projectile vomiting without nausea
Cushing triad

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12
Q

4 types of herniation (herniated structure)

A
  1. Subfalcine (cingulate gyrus)
  2. Uncal (uncus)
  3. Central (bilateral uncus)
  4. Tonsilar (cerebellar tonsils)
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13
Q

Results of uncal herniation

A

[CN3] ipsilateral pupil dilation
[cerebral peduncle] hemiplegia
[midbrain] coma

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14
Q

Results of tonsillar herniation

A

[medulla] respiratory arrest, BP instability
[cerebellum] cerebellar signs

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15
Q

Brain tumours predominantly found in children (3)

A

pilocytic astrocytoma
ependymoma
medulloblastoma

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16
Q

Benign brain tumours (3)

A

pilocytic astrocytoma
meningioma
Schwannoma

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17
Q

What are the brain tumours?

A

Glioma
1. Glioblastoma multiforme
2. Diffuse astrocytoma
3. Pilocytic astrocytoma
4. Oligodendroglioma
5. Ependymoma

Extra-axial tumours
1. Meningioma
2. Schwannoma
3. Pituitary adenoma

Other primary tumours
1. Medulloblastoma
2. Primary CNS lymphoma
3. CNS germinoma

Metastasis
1. Cerebral
2. Leptomeningeal

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18
Q

MC brain tumour in adult (what is the origin)

A

Glioblastoma multiforme
(astrocytes)

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19
Q

Common site and the respective gross pathology of glioblastoma

A

Corpus callosum (butterfly lesion)

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20
Q

Pathology of glioblastoma multiforme (4)

A

necrosis, endothelial proliferation, markedly pleomorphic cells, contrast ring-enhancement in CT/MRI

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21
Q

Median survival of glioblastoma multiforme with treatment

A

15 months

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22
Q

MC spinal cord tumour

A

Ependymoma

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23
Q

Site of medulloblastoma

A

vermis of cerebellum

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24
Q

Common site of CNS germinoma

A

pineal gland

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25
Q

MC sources of brain metastasis (3)

A

lungs, breasts (long latent period), colorectal

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26
Q

Brain tumour with diffuse infiltration, fibrillary matrix, and thus incurable by surgery

A

Diffuse astrocytoma

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27
Q

Brain tumour with cystic lesion, with mural nodule and spindle cells

A

Pilocytic astrocytoma

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28
Q

Brain tumour with calcifications, clear vacuolated cells (fry egg cell), branching vessels

A

Oligodendroglioma

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29
Q

Brain tumour with whorls, psammoma, calcifications

A

Meningioma

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30
Q

Brain tumour with rosettes

A

Medulloblastoma

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31
Q

What is lacunar infarct?

A

small infarcts (<15mm) at deep grey / white matter of the brain

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32
Q

Causes of global ischaemia of the brain (Which area is the most vulnerable?)

A

circulatory collapse, severe hypoglycaemia, epilepsy

(Hippocampus)

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33
Q

Pathology of brain ischaemia

A

Gross: acute swelling +/- herniation –> liquefactive necrosis

Microscopy:
[early] red neurons, acute inflammation (neutrophils, oedema), shrinking & karyolysis of neurons
[late] microglial cells with haemosiderin, liquefaction, glial fibres

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34
Q

MC site and MC cause of cerebral haemorrhage

A

basal ganglia
hypertension

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35
Q

MC cause of lobar haemorrhage (which disease is it associated with?)

A

cerebral amyloid angiopathy
Alzheimer’s disease

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36
Q

Causes of Berry aneurysm

A

hypertension, connective tissue disease, structural defects

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37
Q

Sites of Berry aneurysm (4)

A

Anterior communicating artery (MC)
MCA bifurcation
Terminal ICA
Basilar artery bifurcation

38
Q

Risk factors for sporadic type of Alzheimer’s disease

A

age
multiple trauma
DM
apoE4

39
Q

Genes for familial early-onset type of Alzheimer’s disease

A

APP on chromosome 21 (related to Down’s syndrome)

PS1, PS2

40
Q

MC site of pathology in Alzheimer’s disease

A

hippocampus

41
Q

Pathogenesis of Alzheimer’s disease

A
  1. abnormal cleavage of amyloid precusor protein (APP) –> polymerisation of Aβ42 peptides –> large aggregates (neuritic plaque)
  2. hyperphosphorylation of tau protein –> tangle formation (neurofibrillary tangles)
42
Q

Which protein is involved in the neuronal inclusions in
a. Parkinson’s disease?
b. Fronto-temporal dementia (FTD)?

A

a. lewy bodies, tau
b. TDP-43, tau

43
Q

Which dementia presents with behaviour and language preceding memory loss?

A

fronto-temporal dementia (FTD)

44
Q

Creutzfeldt-Jakob disease

A

Prion disease

45
Q

Which disease is related to Gower’s sign, calf pseudohypertrophy, cardiomyopathy? (heritance)

A

Duchenne / Becker muscular dystrophy (X-linked)

46
Q

Floppy baby syndrome is the infantile presentation of which disease?

A

Spinal muscular atrophy

47
Q

Histology is only useful in which two endocrine cancers to determine malignancy?

A

papillary thyroid carcinoma, neuroblastoma

48
Q

1st and 2nd MC pituitary adenoma

A

Prolactinoma, Null cell adenoma

49
Q

Size limit in pituitary adenoma to differentiate between macroadenoma and microadenoma

50
Q

Pathology of pituitary adenoma (4)

A
  • foci of haemorrhage
  • cellular monomorphism
  • lack of reticulin network
  • may infiltrate adjacent bone, dura
51
Q

Aetiology of goitre (4)

A
  • TSH (e.g. iodine deficiency)
  • Graves’ disease
  • Thyroiditis
  • Neoplasm
52
Q

Post-thyroidectomy monitoring (3)

A
  • Neck USG
  • TSH & thyroglobulin
53
Q

Pathogenesis of Hashimoto’s thyroiditis (2)

A

anti-TSH-R Ab
CD8+ T cells mediate killing

54
Q

Genetic association with Hashimoto’s thyroiditis

A

HLA-DR3, DR5

55
Q

Pathology of Hashimoto’s thyroiditis (3)

A
  • atrophic thyroid follicles
  • infiltration of lymphocytes & plasma cells
  • abundant Hurthle cells
56
Q

Genetic association of Graves’ disease

57
Q

Pathology of Graves’ disease (2+2)

A

[thyroid] diffuse hyperplasia of thyroid epithelium, T-cell infiltration
[orbital tissue / skin] T-cell infiltration, ↑ ECM components

58
Q

MC thyroid carcinoma

A

Papillary thyroid carcinoma

59
Q

Which thyroid carcinoma orginates from para-follicular C cells?

A

Medullary thyroid carcinoma

60
Q

Which thyroid carcinoma spread via blood only?

A

Follicular thyroid carcinoma

61
Q

Genes for papillary thyroid carcinoma (3)

A

BRAF, RET, RAS

62
Q

Gene for follicular thyroid carcinoma

A

PAX8/PPARγ1 fusion

63
Q

Gene for anaplastic thyroid carcinoma

64
Q

Gene for medullary thyroid carcinoma

A

RET [MENII]

65
Q

Which thyroid carcinoma has very poor prognosis?

A

anaplastic thyroid carcinoma

66
Q

Pathology of papillary thyroid carcinoma (6)

A
  • multi-focal, non-encapsulated
  • Nuclear size and shape: nuclear enlargement, elongation, overlapping
  • Chromatin: Ophan Annie nucleus
  • Nuclear membrane: irregular contour, nuclear groove, nuclear pseudoinclusion
  • Architecture: papillary / follicular
  • Others: Psammoma bodies
67
Q

Pathology of follicular thyroid carcinoma

A

focal, encapsulated (cannot be distinguished from follicular adenoma without signs of invasion)

68
Q

Pathology of anaplastic thyroid carcinoma

A

small blue round cells

69
Q

Pathology of medullary thyroid carcinoma

A

amyloid deposits

70
Q

Triple assessment for thyroid gland

A

TFT, USG, FNAC

71
Q

Framework for follow-up of thyroid nodule

A

Bethesda system

72
Q

Sources of metastatic thyroid cancer (2)

A

RCC, breast

73
Q

MC endocrine disorder in adult

A

Hyperparathyroidism

74
Q

Familial syndrome associating with parathyroid hyperplasia

A

MEN1, MEN2a

75
Q

Genes (2) associated with hyperparathyroidism

A

PRAD1, MEN1

76
Q

What is pseudohypoparathyroidism?

A

(AD) PTH resistance

77
Q

Pathology of adrenal cortex in exogenous cushing syndrome

A

adrenal atrophy sparing zona glomerulosa

78
Q

Pathology of adrenal cortex in Cushing disease

A

bilateral adrenal hyperplasia, yellow thick cortex

79
Q

Which is the “10% tumour”? Explain (4)

A

Phaeochromocytoma. 10% bilateral, extra-adrenal, malignant, secrete adrenaline/ dopamine

80
Q

Familial syndrome related to phaeochromocytoma

A

MENII, von Hippel-Lindau syndrome, NF1

81
Q

Pathology of phaeochromocytoma (2)

A

Zellballen pattern, rich vascularity

82
Q

What is the only criteria of malignancy for phaeochromocytoma?

A

Distant metastasis

83
Q

Pathology of neuroblastoma

84
Q

MEN1 syndrome (gene, 3 associated tumours)

A

MEN1, parathyoid, pancreas, pituitary

85
Q

MEN2A syndrome (gene, 3 associated tumours)

A

RET, MTC, adrenal medulla, parathyroid

86
Q

MEN2B syndrome (gene, 3 associated tumours)

A

RET, medullary thyroid carcinoma, adrenal medulla, extra-endocrine

87
Q

MC SOL in head injury

A

Subdural haematoma

88
Q

Autopsy findings in ↑ ICP (6)

A

flattened gyri, narrowed sulci
midline shift
obliterated ventricles
herniation, commpression of brainstem
cerebral ischaemia
cerebral oedema

89
Q

Types of intracranial haemorrhage

A

Epidural haematoma
Subdural haematoma
Subarachnoid haemorrhage
Cerebral haemorrhage

90
Q

Which intracranial haemorrhage is assoicated with lucid interval (~1 hour)?

A

Epidural haemorrhage

91
Q

What is leukoaraiosis? Which disease does it imply? How does it present on imaging?

A

demyelination of white matter, esp. in the periventricular region

Binswanger disease (subcortical ischaemic vascular dementia)

periventricular radiolucency

92
Q

What is neuritic plaque and neurofibrillary tangles? How to stain them (2)?

A

Extracellular amyloid core, surrounded by neurites (irregular twisted axons)

Intracellular tau-containing filaments

IHC or silver stain

MED4 ACP (13 decks)

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