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Neville and Damm > MCQs that rock Austin > Flashcards

MCQs that rock Austin Flashcards

1
Q

Why is formalin 10% buffered?

A

to prevent acidity (acid = tissue autolysis)

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2
Q

What is the ideal fixative to tissue ratio?

A

10 fix : 1 tissue

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3
Q

What is the CAP guideline for duration of tissue fixation for optimal IHC results?

A

Min 6hrs, Max 48hrs

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4
Q

What color is the epithelium (keratin) in a Masson trichome stain?

A

RED

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5
Q

What color is collagen in a Masson trichrome stain?

A

BLUE

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6
Q

What color is smooth muscle in a Masson trichrome stain?

A

RED

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7
Q

What does a reticulin stain use to demonstrate reticulin fibers?

A

silver

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8
Q

What disease is associated with Lewy bodies?

A

Parkinson Dz

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9
Q

Which laboratory test is most specific for rheumatoid arthritis?

A

Anti-citrullinated protein antibodies (ACPAs)

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10
Q

What are the 4 nuclear descriptors for papillary thyroid carcinoma?

A
  1. orphan annie eye nuclei 2. intranuclear pseudoinclusions 3. nucelar grooves 4. nuclear enlargement
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11
Q

What is the name of bilateral metastatic GI neoplasia to the ovaries?

A

Krukenberg tumor

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12
Q

What syndrome results from deletion of paternal 15q12?

A

Prader-Willi Syndrome

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13
Q

Which two viral glycoproteins are crtitical for an HIV infection?

A

gp120 and gp41 (both on the HIV-1 viral spike protein used to infect CD4 cells)

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14
Q

Which amyloid light chain occurs more freqently in amyloidosis- kappa or lambda?

A

Lambda light chain amyloid occurs more often than kappa (so OPPOSITE of normal, which is in alphabetical order lol)…remember a normal K:L = 2or3:1 in serum

In amyloidosis the ratio of kappa:lambda light chains is 1:3, suggesting that lambda immunoglobulin light chains are predisposed to form the beta-pleated sheet ultrastructure associated with amyloid

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15
Q

Which amyloid forms the core of cerebral plaques in Alzheimer dz?

A

Beta-amyloid

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16
Q

Which oncoprotein is being described? It acts primarily through p21, it can promote apoptosis, it functions as a tumor suppressor, and its levels are NEGATIVELY regulated by MDM2

A

p53

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17
Q

Which stage in the adenoma-carcinoma sequence in colorectal cancer is associated with the loss of p53 on chromosome 17p?

A

Late adenoma —> carcinoma stage

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18
Q

What type of virus is Mollescum Contagiosum?

A

poxvirus

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19
Q

What is the most common immunoglobulin subtype in multiple myeloma?

A

IgG

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20
Q

What are Dutcher bodies associated with?

A

multiple myeloma (intranuclear immunoglobulin inclusion)

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21
Q

What is eczema herpeticum associated with?

A

Darier disease ( a form of Kaposi varicelliform eruption caused by viral infection, usually with the herpes simplex virus (HSV), is an extensive cutaneous vesicular eruption that arises from pre-existing skin disease, usually atopic dermatitis (AD) OR DARIER DZ in this case. Children with AD have a higher risk of developing eczema herpeticum, in which HSV type 1 (HSV-1) is the most common pathogen)

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22
Q

4 diagnostic criteria for HHT?

A

1.Recurrent epistaxis 2.Telangiectasias of mucosa/skin 3.AV malformations in lungs 4.Family history

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23
Q

4 clinical signs of acrodynia

Bonus: what is acrodynia?

A

1.sialorrhea 2.severe sweating 3.HTN 4. ulcerative gingivitis

Chronic mercury exposure in infants and children is
termed acrodynia (pink disease or Swift-Feer disease). An
erythematous and pruritic rash is present, often with desquamation
of the palms and soles.

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24
Q

5 EC-Clearinghouse Group 1 entities

A

Group 1 = strongly assoc with HIV infection:

  1. Candidiasis (erythem, pseudo mem, ang cheil) 2. Hairy leukoplakia 3.KS 4. NHL 5. Peiro Dz (linear ging erythema, NUG, NUP)
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25
Q

What are 4 drugs that can have significant interactions with fluconazole?

A
  1. Phenytoin 2. Warfarin 3.Sulfonylureas 4. Cyclosporine
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26
Q

Rank least to most potent…and tell me IV or oral route

Ibandronate (Boniva)

Risedronare (Actonel)

Alendronate (Fosamax)

Pamidronate (Aredia)

Zoledronic acid (Zometa)

A

Alendronate (Fosamax) Oral

Ibandronate (Boniva) Oral

Risedronare (Actonel) Oral (not in order)

Zoledronic acid (Zometa) IV

Pamidronate (Aredia) also IV (not in order)

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27
Q

What is the best marker for thyroid follicular epithelial origin?

A

Thyroglobulin

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28
Q

What is the histology of Tangier disease?

A

Deposition of xanthomatous cells (Tangier dz = inherited disorder characterized by significantly reduced levels of high-density lipoprotein (HDL) in the blood)

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29
Q

What are 4 diseases assoc with gingival fibromatosis?

A

1.Zimmerman-Laband syn 2.Ramon syn 3.Cross syn 4.Murray-Puretic-Drescher syn

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30
Q

What syndrome is associated with a parathyroid adenoma?

A

MEN2A (also hyperparathyroidism-jaw tumor syndrome)

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31
Q

What syndrome is associated with an optic glioma?

A

NF1

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32
Q

What syndrome is associated with mucosal neuromas?

A

MEN2B

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33
Q

What syndrome is associated with spinal meningiomas?

A

NF2

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34
Q

What syndrome is associated with bilateral schwannomas of the vestibular nerve?

A

NF2

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35
Q

What is least helpful in distinguishing acinic cell carcinoma from secretory carcinoma?

FISH for ETV6-NTRK3 gene fusion
IHC DOG1
IHC p63
IHC mammaglobin
IHC S100
A

p63 (secretory = neg and acc = neg) by the way…

Acinic Cell:
DOG1 +
SOX10 +
S100 -
p63 - (not a tumor of myoepithelial origin)

Secretory: (many were called acinic cell before)
S100 +
BRST2 +
Mammaglobin +
ETV6-NTRK3 mutation
p63 - (not a tumor of myoepithelial origin)

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36
Q

What 2 lesions raise concern for Kasabach-Merritt Phenominion?

A
  1. tufted hemangioma
  2. Kaposiform hemangioendothelioma

This disorder is characterized by severe thrombocytopenia and hemorrhage because of platelet trapping within the tumor. The mortality rate is as high as 20% to 30%.

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37
Q

What is a dandy-walker malformation?

A

posterior brain fossa anomalies (PHACES)

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38
Q

Whats is a cervical segmental hemangioma associated with?

BONUS: What are the rest of the lesions in this syndrome?

A

PHACES (its the H = Hemangioma (usually cervical segmental hemangioma)

Posterior fossa brain anomalies (usually Dandy-Walker malformation)
Hemangioma (usually cervical segmental hemangioma)
Arterial anomalies
Cardiac defects and Coarctation of the aorta
Eye anomalies
Sternal cleft or Supraumbilical raphe

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39
Q

What is the Hyam grade for olfactory neurobalstoma with Flexner-Wintersteiner rosettes, abundant necrosis, lacking neurofibrillary matrix?

A

IV

I = Homer Wright rosettes, no mitoses

II = Homer Wright rosettes, mitoses

III = Flexner-Wintersteiner rosettes little necrosis

IV = Flexner-wintersteiner rosettes, lots of necrosis

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40
Q

This is boards-y, not really Neville-y but:

What are 4 facts about lymphoepithelial carcinoma?

A
  1. parotid gland = most common site
  2. lymphocytoplasmic infiltrate is non-neoplastic
  3. Arctic native and southern China predilections
  4. EBV usually identified only in endemic populations
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41
Q

Which point mutation is most specific for chondroblastoma?

A

H3F3A

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42
Q

Which nuclear feature of papillary thryroid carcinoma is not seen in cytologic preparations?

A

Nuclear clearing

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43
Q

What does a mutation in type I collagen lead to?

A

osteogenesis imperfecta

(this came from a question stem about RUNX2/cleidocranial dysplasia and how it is NOT involved in Type I collagen folding)

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44
Q

Which gene mutation results in the MOST SEVERE enamel alterations in amelogenesis imperfecta?

A

FAM83H

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45
Q

Deficient enzyme in Gaucher

A

glucocerebrosidase

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46
Q

Deficient enzyme in Niemann-Pick

A

sphingomyelinase

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47
Q

Deficient enzyme in Tay-Sachs

A

β-hexosaminidase A

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48
Q

Deficient enzyme in Fabry

A

α-galactosidase A (α-Gal A). Fabry disease is a LIPID RETICULOENDOTHELIOSES genetic disorder that prevents the body from making an enzyme called alpha-galactosidase A. This enzyme is responsible for breaking down a type of fat called globotriaosylceramide (Gb3 or GL-3) into building blocks that the body’s cells can use.

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49
Q

Deficient enzyme in Krabbe

A

galactocerebrosidase (GALC) (very close to Gaucher) another lipid reticuloendothelosis syndrome

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50
Q

Dyskeratosis congenita: What is the pattern of hyperpigmentation that develops early in the disease?

A

reticular

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51
Q

Dyskeratosis congenita: What type of change is seen in the nails?

A

dystrophic OR dysplastic

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52
Q

Dyskeratosis congenita: What form of anemia develops in a large majority of patients?

Bonus: what is the other systemic condition associated with this form of anemia?

A

aplastic anemia…fanconi anemia is also associated with aplastic anemia

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53
Q

Dyskeratosis congenita: are oral lesions benign or malignant?

Bonus: What about HMD? Benign or malignant?

A

DC: malignant oral lesions

HMD (hereditary mucoepithelial dysplasia): benign (so not dysplastic like the name implies lol) (fiery-red erythema of the hard palate)

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54
Q

Dyskeratosis congenita: Which inheritance patterns show\ the most severe disease?

A

Autosomal recessive and X-linked recessive

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55
Q

Which glycoprotein is most affected in pemphigus vulgaris?

A

Desmoglein 3

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56
Q

Which condition uses indirect IF with rat bladder mucosa?

A

Paraneoplastic pemphigus

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57
Q

4 facts about familial gigantiform cementoma (gender, race, age, site)

A
  1. no gender predilection
  2. white or Asian predilection
  3. seen by adolescence
  4. multiple quadrants affected, both mand and max
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58
Q

What are 4 criteria for diagnosis of Wegner (granulomatosis w polyangiitis)

A
  1. Oral ulcerations or nasal discharge
  2. Abnormal chest xray
  3. Abdnormal urinary sediment
  4. Gran inflam on bx
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59
Q

Hamman’s crunch

A

Cervicofacial emphysema

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60
Q

Early widspread secondary dentin

A

progeria

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61
Q

What are the thyroxine and TSH levels for a patient with hypothyroid?

A

low thyroxine, high TSH

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62
Q

What is the second most common location for an ameloblastic fibroma?

A

posterior maxilla (post mand #1) (rare in anterior)…(so similar to an OKC)

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63
Q

Auclair grading system (mucoep): How many points for anaplasia

A

4

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64
Q

Auclair grading system (mucoep): How many points for 4+ mitoses / 10hpf

A

3

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65
Q

Auclair grading system (mucoep): How many points for Necrosis

A

3

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66
Q

Auclair grading system (mucoep): How many points for neural invasion

A

2

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67
Q

Auclair grading system (mucoep): How many points for intracystic less than 20%

A

2

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68
Q

TLE1 positive

A

SynoviaL Sarcoma = tLe1 (SSX-SS18)

You got this confused with ASPL-TFE3 (where TFE3 is positive)

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69
Q

Most common site for metastasizing ameloblastoma

A

lungs (cervial LN are second most common)

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70
Q

HRPT2 gene mutation leads to what 3 clinical manifestations?

A
  1. parathyroid adenoma
  2. ossifying fibromas of the jaws
  3. Wilms tumor

(hyperparathyroidism-jaw tumor syndrome)

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71
Q

What are 4 predisposing factors for NOMA?

A
  1. Malnutrition
  2. Poor sanitation
  3. Proximity to unkempt livestock
  4. malignancy
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72
Q

What is granulomatous angiits associated with?

A

Its ischemic stroke from a VZV infection moving from the trigeminal nerve and invading into the internal carotid artery. holy shit.

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73
Q

Compound odontoma most common location

A

anterior maxilla

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74
Q

Complex odontoma most common location

A

molar regions of either jaw

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75
Q

What causes botryomycosis?

A

Staph Aureus (ha, NOT a fungus like the name leads you believe)

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76
Q

What are 3 conditions associated with sialadenosis?

A

Sialadenosis (aka sialosis - enlargment of the salivary glands w/o significant inflammation)

  1. Diabetes mellitus
  2. Pregnancy
  3. Anorexia nervosa and or bulemia

There are many more including

  1. Alcholism
  2. general malnutrition
  3. Hypothyroidism
  4. Acromegaly
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77
Q

Congenital hypertrophy of the retinal pigment

A

FAP (aka pigmented lesions of the ocular fundus). Remember Gardner Syn is a variant of FAP. Gardner Syn is used when the extraintestional manifestations are especially prominent

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78
Q

4 syndromes associated with Hemihyperplasia

A
  1. NF 2.Beckwith-Wiedemann 3.Proteus 4.Maffuci

many more…

  1. ollier
  2. SOD
  3. McCune-Albright

even more than that

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79
Q

Facial trichilemmomas assoc w?

A

Cowden (multiple hamartoma syndrome, PTEN)

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80
Q

5 features of Tuberous Sclerosis (haha there are 14 total)

A
  1. Facial angiofibromas
  2. Hypomelanotic macules (ash leaf)
  3. Shagreen patches
  4. Subependymal giant cell astrocytomas
  5. Oral fibromas
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81
Q

Mittenlike deformity

A

Recessive, Dystrophic Epidermolysis Bullosa (RDEB) (generalized gravis type). Wow. That’s a mouthful.

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82
Q

Ocular gelatinous plaques

A

HBID

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83
Q

Treatment for chronic sclerosing osteomyelitis

A

debridement + abx

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84
Q

All meds are associated with gingval hyperplasia EXCEPT:

erythromycin
verapamil
cyclosporine
azathioprine
nifedipine
A

azathioprine IS NOT (immunosuppressive drug for transplant patients)

erythromycin (abx, yes)
verapamil (calcium channel blocker, yes)
cyclosporine (calcineruon inhibitor immunosuppression, yes)
nifedipine (anti-seizure, yes)

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85
Q

Failure of tooth eruption may occur in patients which disease?

Hypothyroidism
Graves Dz
Amyloidosis
Langerhans cell disease

A

Hypothyroidism (cretinism) (tooth formation might not be impaired, but fail to erupt)

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86
Q

All the following syndromes are associated with hypodontia EXCEPT:

Hurler (muccopolysaccharidosis)
Sturge-Weber
Ehlers-Danlos
Peutz-Jeghers

A

Peutz-Jeghers

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87
Q

Neutrophile Nitroblue tetrazolium reduction test

A

chronic granulomatous disease

Nitro blue tetrazolium is used in a diagnostic test,[3] particularly for chronic granulomatous disease and other diseases of phagocyte function. When there is an NADPH oxidase defect, the phagocyte is unable to make reactive oxygen species or radicals required for bacterial killing. As a result, bacteria may thrive within the phagocyte. The higher the blue score, the better the cell is at producing reactive oxygen species

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88
Q

Most common malignant salivary gland tumor of the submandibular gland

A

adenoid cystic carcinoma

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89
Q

Hodgkin Lymphoma stage III

A

LN involvment both sides of diaphragm

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90
Q

Serum levels of beta2-microglobulin and albumin

A

multiple myeloma

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91
Q

All have been assoc w premature loss of teeth EXCEPT:

LCH
Down
Oxalosis
Ehlers-Danlos
Taurodontism
A

Answer: Taurodontism

LCH
Down
Oxalosis (is a rare metabolic disorder in which the kidneys are unable to eliminate calcium oxalate crystals through the urine. On Nevilles list of 21 entities that cause premature tooth loss)
Ehlers-Danlos

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92
Q

What kind of glands are sebaceous glands?

A

Holocrine

93
Q

Blandin-Nuhn gland found where?

A

tongue (anterior ventral, mentioned in neville as a place for mucocele formation)

94
Q

Most common location of a palisaded capsulated neuroma

A

face (nose and cheek)

95
Q

Perivascular deposits of basement membrane material

A

lipoid proteinosis

96
Q

Psammommatous melanocytic schwannomas assoc with

A

carney syndrome

Carney complex is a rare genetic disorder characterized by multiple benign tumors (multiple neoplasia) most often affecting the heart, skin and endocrine system and abnormalities in skin coloring (pigment) resulting in a spotty appearance to the skin of affected areas

97
Q

Lymphaniomyomatosis seen exclusively in what age/gender?

A

women of child bearing age

aka LAM, cant find in Neville, but cystic lung destruction can be assoc with Tuberous Sclerosis.

98
Q

All have been assoc with increased risk for leukemia EXCEPT:

Bloom
Fanconi
Down
Prader-Willi
Wiscott-Aldrich
A

Prader-Willi is NOT assoc with increase leukemia risk

99
Q

Second most frequent site for OKC

A

posterior maxilla

100
Q

Libman-Sacks endocarditis in SLE:

Manifests primarily in the tricuspid valve
is cased by streptococcus
only rarely causes emboli
features small non-caseating granulomas
is the most freqent cardiac manifestation

A

ONLY RARELY CASUES EMBOLI (Libman–Sacks endocarditis (LSE) is a form of non-bacterial endocarditis that is seen in association with systemic lupus erythematosus (SLE), antiphospholipid syndrome, and malignancies.)

Manifests primarily in the tricuspid valve (both valves)
is cased by streptococcus (nah)
features small non-caseating granulomas (nah)
is the most freqent cardiac manifestation (pericarditis is most freq)

101
Q

Uremic stomatitis can mimic what other oral lesion?

A

hairy leukoplakia (whatevs)

102
Q

Enlarged LN w necrosis, nuclear debris, histiocytes, agg of lymphocytes, plasmacytoid monocytes, young male pt w fever leukopenia

A

Kikuchi-Fujimoto Dz (Kikuchi-Fujimoto disease (KFD) is a benign and self-limited disorder, characterized by regional cervical lymphadenopathy with tenderness, usually accompanied with mild fever and night sweats)

Treatment is symptomatic (analgesics-antipyretics, non-steroidal anti-inflammatory drugs and, rarely, corticosteroids). Spontaneous recovery occurs in 1 to 4 months. Patients with Kikuchi-Fujimoto disease should be followed-up for several years to survey the possibility of the development of systemic lupus erythematosus

103
Q

Mycosis fungoides cell origin

A

CD4+ T cell

104
Q

Mass of the chest of a teenage male w lymphoid cells lobulated nuclei stippled chromatin scant cytoplasm, mitoses, CD1, CD3, CD5

A

Lymphoblastic lymphoma

105
Q

Jones-Hartsfield syndrome = gingival fibromatosis + ?

A

sensorineural hearing loss

106
Q

Which has the lowest 5-year survival rate:

Oral Cavity SCC
Melanoma
Laryngeal Carcinoma
Cervical Carcinoma
Hodgkin Lymphoma
A

Laryngeal Carcinoma (61%)

SCC (66%)
Melanoma (Skin 93%, Stage 3 63%)
Cervical (66%)
HL (80%

107
Q

Which test is performed for a malignancy in a LN w architecture effaced by small lymphocytes?

A

Western blot

108
Q

Which is TRUE re: CMV

Etiology HHV6
Transmission is Human-Human contract only
Approx 50% of population has antibodies
Co-infection with other herpes viri rare
Neonatal infec causes cemental defects and exfoliation of teeth

A

Answer: Approx 50% of population has antibodies

Etiology HHV6 (nope, HHV5)

Transmission is Human-Human contract only (humans and monkeys are hosts)

Co-infection with other herpes viri rare (often with HSV or EBV)

Neonatal infec causes cemental defects and exfoliation of teeth (CMV causes enamel defects (The teeth exhibited diffuse enamel hypoplasia,
significant attrition, enamel hypomaturation, and yellow
coloration from the underlying dentin.)

109
Q

What is the function of p63?

A

epidermal-mesenchymal interactions during embryologic dev

110
Q

Which is FALSE re Calretinin?

Vit-D dependet calcium binding protein for calcium signaling

Has both cytoplasmic and nuclear staining

Positive in ameloblastoma

Lost in malignancy

A

Lost in malignancy is FALSE

Positive in ameloblastoma (stains the stellate reticulum)

111
Q

Which is LEAST likely to be seen in a PEDs pt?

Ewing Sarc
Rhabdomyosarc
Liposarc
Ameloblastic Fibrosarc
Acinic Cell Carcinoma
A

Liposarcoma

112
Q

Haha YES!

How many new cases of oral cancer were diagnosed in 2008?

A

34,000

113
Q

1 y/o bilateral facial swelling, fever, leukocytosis, hyperostosis of facial bones. Neg blood cultures

A

Caffey Dz

114
Q

Fever and rash, swollen extrematies, erythematous bulbar conjunctiva, cervical LAD, red swollen tongue

A

Kawasaki disease

115
Q

Cherubism + gingival fibromatosis =

A

Ramon syndrome

116
Q

What growth factor is responsible for promoting angiogenesis in granulation tissue?

A

VEGF (vascular endothelial growth factor)

117
Q

Collapse of the bridge of the nose is classic for

A

leprosy (you thought syphilis, didn’t you)

118
Q

What has been linked to multiple superficial mucoceles?

A

tartar control toothpaste

119
Q

What type of candidiasis is Angular cheilitis?

A

Erythematous candidiasis (and you taught that)

120
Q

What general type of IHC markers stain Perivascular epithelioid cell tumors (PEComas)?

A

Melanocytic markers

121
Q

Come on Austin. What is the most common type of sinonasal papilloma?

A

Inverted

122
Q

Atrophy of upper lip, unilateral posterior open bite, coup de sabre, unilarteral hypoplasia of facial bones =

A

Parry-Romberg syndrome (Progressive Hemifacial Atrophy)…the other coup de sabre condition is limited scleroderma (morphea)…Neville says they have a “close relationship”

123
Q

CD10+, Bcl2+, CD5-, CD43-

A

Follicular lymphoma

CD10+ (germinal cell marker)
Bcl2+ (this is aberrant expression caused by t(14;18))
CD5- (T cell marker that is aberrant positive in CLL, so this rules out CLL/SLL and mantle cell)
CD43- (pan T cell marker, this result rules out MALT lymphoma)

124
Q

What are 3 causes for regional odontodysplasia?

A
  1. Vascular abnormalities 2.neural disorders 3.Growth abnormalities
125
Q

The lyon affect is typically seen in

A

women

126
Q

2 causes for Papillon-Lefevre

A
  1. Chemotactic effect
  2. Impaired T and B lymphocyte activity

Neville: cathepsin C gene. This gene is important in the structural
growth and development of the skin and is critical for
appropriate immune response of myeloid and lymphoid
cells. Researchers believe that the loss of appropriate function
of the cathepsin C gene results in an altered immune
response to infection. In addition, the altered gene may
affect the integrity

127
Q

Organism w large (20-60um) round spherules containing numerous endospores

A

blastomycosis

128
Q

Varocay bodies are made of

A

BOTH reduplicated basement membrane AND cytoplasmic processes

129
Q

Which Behcet association is fatal?

A

Neurologic and HLA-B4…interesting…Neville says CNS involvment, but no mention of HLA-B4 with Bechets. Ok, couldn’t find it any where on the internet, but ok

130
Q

Large cell lymphoma arising in CLL is known as

A

Richter syndrome

131
Q

Erythema infectosum is also known as? and is caused by?

A

Fifth dz, parvovirus (B19)

132
Q

Mikulicz cells

A

Rhinoscleroma

133
Q

translocation for Anaplastic large cell lymphoma

A

t(2,5)

134
Q

Intracellular glycogen found in all EXCEPT

Leiomyosarcoma
Acinic Cell Carcinoma
Clear Cell Carcinoma (salivary)
Ewing Sarcoma

A

Acinic Cell (its Zymogen) (1% can have clear cell variant w glycogen)

135
Q

Occlusive subintimal depositis of PAS+ material at arteriolo-capillary junctions seen on gingival biopsy

A

Thrombotic thrombocytopenia

136
Q

3 syndromes associated with hypertrichosis

A
  1. hemihyperplasia
  2. Segmental Odontomaxillary Dysplasia
  3. Gingival fibromatosis
137
Q

t(11;22)

A

Ewing sarcoma

138
Q

Which does NOT present with interface mucositis?

Lichen Planus
EM
SLE
Scleroderma
Lichenoid mucositis
A

Scleroderma

139
Q

Auer bodies

A

aka Auer rods… myeloid leukemia (AML)

140
Q

Diagnose that entitiy:

Tongue neoplasm
"glomeruloid" pattern
"orphan annie nuclei"
p63 +
thyroglobulin -
TTF1 -
A

Polymorphous Adenocarcinoma, cribriform

formerly “cribriform adenocarcinoma of the tongue and minor salivary glands (CATMSG)”

141
Q

TFE3 positive

A

Alveolar soft part sarcoma (remember synovial sarc is TLE1 pos)

142
Q

WTF?!
Wet keratin is not seen in which?

Craniopharyngioma
COC
AOT
Trichoep
Complex Odontoma
A

Complex odontoma does not.

What the hell is wet keratin?
Keratin pearls or wet keratin (nodules of plump eosinophilic, keratinized cells with ghost nuclei) are characteristic histologic features; often associated with calcification

Also, a craniopharyngioma is….
-Adamantinomatous craniopharyngioma: suprasellar or sellar epithelial neoplasm resembling ameloblastoma
-Tumor with palisading epithelium, “wet” keratin and stellate reticulum associated with surrounding gliosis and Rosenthal fibers
-Epithelial neoplasm resembling ameloblastoma or keratinizing and calcifying odontogenic cyst
-Age: bimodal with peaks at 5 - 10 years and 50 - 60 years
More common than papillary craniopharyngioma (even in adults)
Higher frequency in Africans and Far East Asians
-Possible origin in remnants of Rathke pouch epithelium
Misplaced odontogenic rests along pituitary stalk

143
Q

What’s the best stain for Leishmaniasis?

A

Giemsa

144
Q

What is the best stain for necrotic fungal organisms?

A

GMS

145
Q

Which entity should NOT be considered in the ddx for orofacial granulomatosis?

Paracoccidiomycosis
Sarcoidosis
Foreign body rxn
Ulcerative colitis
Tuberculosis
A

Answer: Ulcerative colitis

From tables 9-2 and 9-3 in Neville R/O:

Chronic granulomatous disease (Neutrophil nitroblue tetrazolium reduction test)

Crohn disease (heme eval: low albumin, calcium, folate, iron, RBC, high ESR OR leukocyte scintigraphy using Tc-HMPAO, then scope)

Sarcoid (serum ACE and chest X-ray for hilar LAD)

TB (skin test, chest xray…NEGATIVE AFB on histo DOES NOT R/O TB)

Infections: so paracoccidio, candida, etc

allergy

146
Q

Eosinophilic, ring-shaped calcifications with surrounding multinucleated giant cells and lymphoctes

A

Hyaline bodies

AKA pulse granuloma, giant-cell hyaline angiopathy…as seen in inflammatory cysts

147
Q

Xerostomia and keratoconjunctivitis sicca are both seen in:

A

Sarcoidosis

sialosis threw me off here…

148
Q

What is the typicall pattern for amyloid deposit in salivary glands?

A

perivascular and periductal

149
Q

Which entity is NOT of perivascular derivation?

Glomangiopericytoma
Myofibroma
Myopericytoma
Solitary fibrous tumor
Glomus tumor
A

Myofibroma

150
Q

Which is considered a proto-oncogene?

P16
P53
PRb
BCL-2
Ras
A

Ras is considered a proto-oncogene

A proto-oncogene is a normal gene that could become an oncogene due to mutations or increased expression. Upon acquiring an activating mutation, a proto-oncogene becomes a tumor-inducing agent, an oncogene. Examples of proto-oncogenes include RAS, WNT, MYC, ERK, and TRK.

p16 = tumor suppressor
p53 = tumor suppressor
PRb = tumor suppressor
BCL-2 = anti-apoptosis
Ras = proto-oncogene
myc = proto-oncogene
151
Q

Which is NOT a viral protein?

P16
E6
E7
LMP
P24
A

P16 is not a viral protein

Brief mechanisms:

P16 = human tumor suppressor gene

E6/E7 = E6 and E7 are essential HPV E-gene products, they target P53 and retinoblastoma (Rb) tumuor-suppressor proteins, respectively.

LMP = EBV gene assoc w lymphoproliferative disorders

P24 = an HIV core protein

152
Q

What must be ruled out when considering a diagnosis of PFAFA syndrome in children?

A

cyclic neutropenia (sporatic or AD, ELAINE gene)

(PFAFA syndrome (Periodic Fever, Aphthous Stomatitis, Pharyngitis, Adenitis) is a childhood syndrome that affects both boys and girls. It causes repeated episodes of fever, mouth sores, sore throat, and swollen lymph nodes. PFAPA usually starts in early childhood between ages 2 and 5.

153
Q

What effects can herpes zoster have on bone and teeth?

A

bone loss and tooth necrosis

154
Q

Reduced counts of which T cell type may indicate poorer outcomes in SCC patients?

A

CD8 cytotoxic T cells

155
Q

Wow, you guessed and got this right!

How many IgG4+ plasma cells must be seen at high power for a diagnosis of IgG4 disease?

A

100

156
Q

The hyoid bone separates which of the following lymph node levels?

A

Tricky question:

The hyoid separates Ia from VI anteriorly, but posteriorly it separates Ia from IIa….

Good to review this - practice this when doing head and neck exams (this should be taught to dental students better)

157
Q

Which of the following is an encapsulated tumor?

Neurofibroma
Schwannoma
Oral focal mucinosis
Pyogenic granuloma
fibroma
A

Schwannoma

I got this right, just wanted to cement it

158
Q

Which virus is associated with….

Merkel cell carcinoma
Pityriasis rosea
Shingles
Kaposi’s Varicelliform eruption

A

Merkel cell carcinoma - Merkel cell polyomavirus (MCPyV) in 80% of cases

Pityriasis rosea - herpes family (HHV6,7 suspected, but lack of evidence)

Shingles (aka herpes zoster) - HHV 3 (Vericella-Zoster Virus)

Kaposi’s Varicelliform eruption - HSV 2

159
Q

Nice, guessed and got this right:

Multiple enamel pits seen in….

A

Tuberous sclerosis

160
Q

Pigmented lesions of the gingva may be seen in:

Hypoparathyroidism
Hyperparathyroidism
Hypoadrenocorticism
Hyperadrenocorticism
Hyperthryroidism
A

Hypoadrenocorticism (Addison Dz)

You really shouldnt have missed this one.

Lets review:
Hypoparathyroidism = no alternate name
Hyperparathyroidism = no alternate name
Hyperadrenocorticism = Cushing Dz
Hypoadrenocotricism = Addison Dz
Hyperthyroidism = Graves Dz
Hypothyroidism = Myxedema (adults), Cretinism (children)
161
Q

Wrinkled silk histiocyte

A

Gaucher

162
Q

“Sea blue” histiocyte

A

Neimann-Pick

163
Q

Lingual thyroid:

Overall sex predilection?
Which sex has tendency for malignancy?

A

overall: Female
carcinoma: Male

164
Q

Which is true of incontinentia pigmenti?

Strong male predilection
Hyperdontia
Ocular involvment considered exclusionary in diagnosis
CNS involvment in more than 90% patients
Early stages resemble vesiculobullous lesions

A

True: Early stages are characterized by vesiculobullous lesions

Predilection: 37:1 FEMALE predilection (X-linked dominant, so lethal for most males unless they are Kleinfelter XXY)

Hyperdontia: Welp, thats true too….Neville says BOTH hypo and hyperdontia, but in paragraph form mostly hypodontia

35% of patients have ocular involvment (strabismus, nystagmus, cataracts, etc)

CNS involment: 30%

165
Q

Which is true of Xeroderma Pigmentosum?

Mutations in DNA repair proteins seen
AD inheritance
Frequent dev of Melanomas
Sun exposure no effect on prognosis
No change to life expectancy
A

Mutations in DNA repair proteins seen - TRUE

AD inheritance- False, AR inheritance

Melanomas - False, only 5%, most have SCCs or BCCs

Sun exposure no effect on prognosis - False, biggest effect

No change to life expectancy - False, 30 years less than average

166
Q

Antigen for pemphigus vulgaris

A

Desmoglein 3

167
Q

Herald patch

A

Pityriasis rosea (not in Neville): Pityriasis rosea is a rash that usually begins as a large circular or oval spot on your chest, abdomen or back. Called a herald patch, this spot can be up to 4 inches (10 centimeters) across.

The herald patch is typically followed by smaller spots that sweep out from the middle of your body in a shape that resembles drooping pine-tree branches.

Pityriasis (pit-ih-RIE-uh-sis) rosea can affect any age group. It most commonly occurs between the ages of 10 and 35. It usually goes away on its own within 10 weeks. Pityriasis rosea can cause itching. Treatment may help relieve the symptoms.

Again, Herpes family suspected

168
Q

Herpes zoster on the tip of the nose involves which nerve branch?

A

Nasociliary (guessed and got it right)

169
Q

So dumb:

The term used to describe an extremely even illumination of a sample without the image of the illumination source being visible in the resulting image is termed:

A

Kohler illumination

170
Q

Name that method of illumination lol:

Yields dark objects on a bright background, is the simplest technique for optical microscopy. The light source is positioned below the sample. Light then propagates through the sample, and is observed by the objective lens and sensor, which are positioned above the sample.

A

brightfield illumination

171
Q

Name that method of illumination lol:

A contrast-enhancing technique that improves the quality of the image obtained with birefringent materials

A

Polarizing illumination

172
Q

Name that method of illumination lol:

A technique in optical microscopy that eliminates scattered light from the sample image. This yields an image with a dark background around the specimen, and is essentially the complete opposite of the brightfield illumination technique. The primary imaging goal is to enhance the contrast of an unstained sample, which is incredibly powerful, yet simple, for live cellular analysis or samples that have not gone through the staining process

A

Darkfield illumination

173
Q

Name that method of illumination lol:

Static illumination

A

Not a typical term used in microscopy

174
Q

NICE! You guessed and got this right…

Dermatitis, dementia, and diarrhea = which vitamin deficincy?

A

Niacin deficiency (Vit B3) AKA Pellagra

It’d be beneficial to review your chapter 17 cards for the rest of these deficiencies

175
Q

Blackfoot disease

A

Arsenic poisoning

176
Q

Virus assoc with plasmablastic (multicentric) Castleman Disease?

A

HHV8

177
Q

Angiomyolipoma of the kidney assoc with what genetic condition?

A

Tuberous sclerosis

178
Q

Most common location for plasmablastic lymphoma in HIV patients

A

oral cavity

179
Q

Hormone-induced atypical endometrial histopathologic changes

A

Arias-Stella reaction

180
Q

Histologic change most supportive of Barrett esophagus?

A

columnar cells

181
Q

All are markers for perineurioma EXCEPT

EMA
Claudin-1
Glut-1
Type IV Collagen
GFAP
A

GFAP

(A perineurioma is a rare benign tumor within the sheath of a single nerve that grows but typically does not recur or metastasize. These lesions are only composed of perineurial cells, cloned from a single cell. They are distinct from schwannoma and neurofibroma)

182
Q

Which is a common feature of warty dyskeratoma and keratosis follicularis:

Histologic appearance
Mode of inheritance
Predilection for males
Hyperpigmentation of skin
Multifocal presentation
A

Histologic appearance

keratosis follicularis: another name for Darier Disease

183
Q

Kernicterus refers to toxic bilirubin accumulation in which organ

A

Brain

Kernicterus is a type of brain damage that can result from high levels of bilirubin in a baby’s blood. It can cause athetoid cerebral palsy and hearing loss.

184
Q

Histoplasmosis typically disseminated via

A

Aspiration of aerosol contaminated with bird (or bat) droppings

185
Q

FALSE about PTLD:

4x higher incidence in peds
20x higher risk in EBV pts
Most commonly GI tract
Polymorphic-type extranodal disease better prognosis than monomorphic with LN involvment
Assoc with DLBCL
A

False: Risk 20x higher in EBV pos patients

186
Q

Ligneous gingivitis assoc with EXCEPT

Predominance in Asian populations
Type 1 plasminogen def
Nodular enlargment with Ulceration
Concomitant cervical, tracheobronchial / skin leisons
Subepithelial eosinophilic fibrin depositis

BONUS: What is the IHC method for determing fibrin in plasminogen def vs amyloid?

A

EXCEPT: Predominance in Asian populations

BONUS: Fraser-Lendrum histochemical staining method shows fibrin

187
Q

FALSE regarding alkaptonuria:

Result of incomplete metabolism of homogentisic acid, arginine, and tyrosine

AR inheritance

Blue discoloraiton of dentition due to Tyndall effect

Recurrent nephrolithiasis

Dark brown urine

A

FALSE: Result of incomplete metabolism of homogentisic acid, arginine, and tyrosine

(yes homogentistic acid, couldn’t find arginine/tyrosine

Ochronosis: blue-black color in connective tissue, tendons, and cartilage.

188
Q

Billing 3rd party for pathology services all must be submitted EXCEPT:

ICD10
CPT
CLIA Lab ID number
Name of referring clinician
Patient's SSN
A

Patients SSN

189
Q

Embryonic odontogenic tissue origin of Squamous Odontogenic Tumor

A

Rests of Malassez

190
Q

Organism most commonly associated with allergic fungal sinusitis?

A

Aspergillus fumigatus

191
Q

False about Leukocyte Adhesion Deficiency Type 1:

Results from mutation long arm chromosome 21

Lack of CD11/CD18 expression assoc wors prog

Infections with overabundance of neutrophils

Primary sites are oral cavity and GI

Etiologic factor in juvenile periodontitis

A

False: Infections with overabundance of neutrophils

192
Q

GCDFP expressed in

A

BCC (and Secretory carcinoma)

GCDFP (Gross Cystic Disease Fluid Protein)

193
Q

Which receptor mediates adhesion of tumor cells to the BM prior to invasion?

A

Laminin

194
Q

Cherubism + gingval fibromatosis + seizures =

A

Ramon syndrome

195
Q

Which is NOT encountered in Sprue?

Glossodynia
Ulcers
Petechiae
Atrophy of filiform papillae
Glossitis
A

(Sprue = celiac)

Not encountered: Petechiae

Glossodynia = burning mouth syndrome

196
Q

Hereditary immunodeficiency with thrombocytopenia and eczema

A

Wiskott-Aldrich syndrome

Wiskott–Aldrich syndrome (WAS) is a rare X-linked recessive disease characterized by eczema, thrombocytopenia (low platelet count), immune deficiency, and bloody diarrhea (secondary to the thrombocytopenia)

197
Q

Most common benign tumor of bone

A

osteochondroma

198
Q

All have similar histo EXCEPT

Small cell carcinoma of Lung
Biphasic synovial sarcoma
Neuroblastoma
Ewing Sarcoma
Alveolar rhabdomyosarcoma
A

biphasic synovial sarcoma

199
Q

Anti-Smith antibody directed against

A

Nuclear RNA

200
Q

Lipid reticuloendotheliosis assoc w increased risk for multiple myeloma?

A

Gaucher

201
Q

Ship’s Wheel fungus

A

South American Blasto (AKA paracoccidio. Jesus)

202
Q

Merkel cells feature

A

Neurosecretory granules

203
Q

Michaelis-Gutmann bodies

A

malakoplakia

204
Q

Stains for diagnostic lipoblasts and fat on frozen section

A

Oil Red O or Sudan Black

205
Q

ID liopblasts with all EXCEPT

enlarged adipocytes
Hyperchormatic indented or sharply scalloped nucleus
Lipid-rich droplets in cytoplasm
Appropriate histologic background
Staining with oil red o
A

except enlarged adipocytes

206
Q

Rhabdomyosarcoma in adults =

Rhabdomyosarcoma in 10-25 year olds =

Rhabdomyosarcoma in children =

A

Rhabdomyosarcoma in adults = Pleomorphic (extremities)

Rhabdomyosarcoma in 10-25 year olds = alveolar

Rhabdomyosarcoma in children = Embryonal

207
Q

Normal glomus body regulates

A

heat

208
Q

True regarding Desmoplastic Melanoma EXCEPT:

often located on head and neck
assoc with overlying lentigo maligna
seen 10 years earlier than conventional melanoma
HMB45 neg
S100 pos
A

EXCEPT Often seen 10 years earlier than conventional melanoma

209
Q

t(2,13)

A

alveolar rhabdomyosarcoma

Two distinct chromosomal translocations have been identified in alveolar rhabdomyosarcoma: PAX3-FKHR (FOXO1) and PAX7-FKHR (FOXO1)

which i guess are on 2,13. Jesus

210
Q

Which does NOT usually stain positive for CKs?

Clear cell sarcoma
Elitheliod sarcoma
synovial sarcoma
Extrarenal rhabdoid tumor
Epitheliod hemandioendothelioma
A

clear cell sarcoma

211
Q

Downey cells

A

infectious mononucleosis

The distinctive cell associated with EBV or CMV is known as a “Downey cell”, a reactive lymphocyte

212
Q

In a lymph node:

reactive follicles, clusters of epithelioid cells, patches of monocytoid cells suggests

A

toxoplasmosis

213
Q

All are true for periosteal osteosarcoma EXCEPT:

occurs on surface
predominantly chondroblastic
freq affects flat bones
mineralization not on imaging
no intramedullary involvment
A

EXCEPT frequently affects flat bones

214
Q

Extragnathic adamantinomas

A

osteofibrous dysplasia

Osteofibrous dysplasia (OFD) is a rare disease. It is considered a benign non-neoplastic condition of unknown cause, characterized by a fibrovascular defect. Common sites of involvement are the two leg bones, the tibia, and the fibula

OFD can be classified as monostotic, polyostotic, and McCune Albright syndrome. Most cases of monostotic lesions present with no significant symptoms and are often found incidentally on x-ray. The condition mainly affects patients in their third decade

Extragnathic adamantinomas:

Adamantinoma is a bone tumor which is commonly showed in mandible. Its occurrence in long bones constitutes a rare affection and a difficult histological diagnosis This rare malignant tumor of mesenchymal and epithelial origin

Adamantinoma is characterized by a slow clinical development marked by the prevalence of lung metastases and local recurrences.

215
Q

intraepithelial eosinophilic abscesses

A

inflammatory bowel disease

216
Q

Lupus vulgaris =

Lupus pernio =

A

Lupus vulgaris = TB

Lupus pernio = Sarcoid

217
Q

Epidermotropism

A

mycosis fungoides

Epidermotropism refers to the phenomenon of lymphocytes residing in the epidermis. This is in contrast to exocytosis in which lymphocytes move out through the epidermis.

218
Q

Renal osteodystrophy assoc w

A

enlargment of the jaws

Renal osteodystrophy is a bone disease that occurs when your kidneys fail to maintain the proper levels of calcium and phosphorus in your blood. It’s a common problem in people with kidney disease and affects most dialysis patients

219
Q

Wegners all EXCEPT

Stawberry gingivitis
Positive IF for cytoplasmic (c-ANCA)
Ulcerative lesions in oral mucosa
Positive IF for perinuclear (p-ANCA)
Necrotizing glomerulonephritis
A

EXCEPT Positive IF for perinuclear (p-ANCA)

MPO-ANCAs (FKA p-ANCA)are detected in several vasculitides that typically do not present in the oral cavity.

220
Q

New term for p-ANCA

New term for c-ANCA

A

New term for p-ANCA = MPO-ANCA

New term for c-ANCA = PR3-ANCA (*more specific for Wegeners)

221
Q

Pseudoepitheliomatous hyperplasia seen in all EXCEPT

Wegener
GCT
Blastomycosis
Congenital epulis
Tertiary syphilis
A

EXCEPT congenital epulis (just thought the others were interesting)

222
Q

Did you know…varicella recurrence is NOT considered to be caused by exposure to

A

UV light, I guess thats good, or there would be lots of cases of ramsey hunt

223
Q

High urinary VMA assoc w

Hereditary fibromatosis
Stuge-Weber
Medullary carcinoma of thyroid
Peutz-Jegher
MEN2B
A

MEN2B

I got thrown off by MTC. MTC does not cause increased VMA (even though its apart of MEN2B). It causes increase in urine calcitonin

224
Q

Most common malignancy involving bone?

A

Met

225
Q

Systemic sclerosis assoc with all EXCEPT

Raynaud
Acro-osteolysis
CREST
Fibrous dysplasia
Diffuse widening of PDL
A

Fibrous dysplasia

226
Q

Clear cells in clear cell odontogenic carcioma share IHC and structural similarities with what cell type?

A

Glycogen-rich presecretory ameloblasts

227
Q

What is a rare, potentially lethal, oropharyngeal infectious disease occurring in immunocompetent adolescents and young adults that is mainly due to Fusobacterium necrophorum?

A

Lemierre syndrome

( and that is characterized by septic thrombophlebitis of the internal jugular vein that leads to septic, usually pulmonary, embolism, associated with ENT (ear, nose, and throat) infection that manifests with fever, neck pain, and tonsillopharyngitis.)

228
Q

What is the other name for Goltz-Gorlin Syndrome?

A

Focal dermal hypoplasia (FDH), also known as Goltz syndrome, is a rare multisystem disorder that principally involves the development of the skin, hands and feet and eyes. It is a type of ECTODERMAL DYSPLASIA, a group of heritable disorders causing the hair, teeth, nails, and glands to develop and function abnormally.

229
Q

What syndromes are these derm lesions associated with?:

Trichelemmomas

Trichoepitheliomas, Spiradenomas, Cylindromas

Facial angiofibromas

Epidermal cysts

Soft tissue angiomas

A

Trichelemmomas = Cowden

Trichoepitheliomas, Spiradenomas, Cylindromas = Brooke Speigler

Facial angiofibromas = Tuberous Sclerosis

Epidermal cysts = Gardner syndrome

Soft tissue angiomas = Maffuci

Neville and Damm (72 decks)

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