MCQs that rock Austin Flashcards
Why is formalin 10% buffered?
to prevent acidity (acid = tissue autolysis)
What is the ideal fixative to tissue ratio?
10 fix : 1 tissue
What is the CAP guideline for duration of tissue fixation for optimal IHC results?
Min 6hrs, Max 48hrs
What color is the epithelium (keratin) in a Masson trichome stain?
RED
What color is collagen in a Masson trichrome stain?
BLUE
What color is smooth muscle in a Masson trichrome stain?
RED
What does a reticulin stain use to demonstrate reticulin fibers?
silver
What disease is associated with Lewy bodies?
Parkinson Dz
Which laboratory test is most specific for rheumatoid arthritis?
Anti-citrullinated protein antibodies (ACPAs)
What are the 4 nuclear descriptors for papillary thyroid carcinoma?
- orphan annie eye nuclei 2. intranuclear pseudoinclusions 3. nucelar grooves 4. nuclear enlargement
What is the name of bilateral metastatic GI neoplasia to the ovaries?
Krukenberg tumor
What syndrome results from deletion of paternal 15q12?
Prader-Willi Syndrome
Which two viral glycoproteins are crtitical for an HIV infection?
gp120 and gp41 (both on the HIV-1 viral spike protein used to infect CD4 cells)
Which amyloid light chain occurs more freqently in amyloidosis- kappa or lambda?
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
Which amyloid forms the core of cerebral plaques in Alzheimer dz?
Beta-amyloid
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
p53
Which stage in the adenoma-carcinoma sequence in colorectal cancer is associated with the loss of p53 on chromosome 17p?
Late adenoma —> carcinoma stage
What type of virus is Mollescum Contagiosum?
poxvirus
What is the most common immunoglobulin subtype in multiple myeloma?
IgG
What are Dutcher bodies associated with?
multiple myeloma (intranuclear immunoglobulin inclusion)
What is eczema herpeticum associated with?
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)
4 diagnostic criteria for HHT?
1.Recurrent epistaxis 2.Telangiectasias of mucosa/skin 3.AV malformations in lungs 4.Family history
4 clinical signs of acrodynia
Bonus: what is acrodynia?
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.
5 EC-Clearinghouse Group 1 entities
Group 1 = strongly assoc with HIV infection:
- Candidiasis (erythem, pseudo mem, ang cheil) 2. Hairy leukoplakia 3.KS 4. NHL 5. Peiro Dz (linear ging erythema, NUG, NUP)
What are 4 drugs that can have significant interactions with fluconazole?
- Phenytoin 2. Warfarin 3.Sulfonylureas 4. Cyclosporine
Rank least to most potent…and tell me IV or oral route
Ibandronate (Boniva)
Risedronare (Actonel)
Alendronate (Fosamax)
Pamidronate (Aredia)
Zoledronic acid (Zometa)
Alendronate (Fosamax) Oral
Ibandronate (Boniva) Oral
Risedronare (Actonel) Oral (not in order)
Zoledronic acid (Zometa) IV
Pamidronate (Aredia) also IV (not in order)
What is the best marker for thyroid follicular epithelial origin?
Thyroglobulin
What is the histology of Tangier disease?
Deposition of xanthomatous cells (Tangier dz = inherited disorder characterized by significantly reduced levels of high-density lipoprotein (HDL) in the blood)
What are 4 diseases assoc with gingival fibromatosis?
1.Zimmerman-Laband syn 2.Ramon syn 3.Cross syn 4.Murray-Puretic-Drescher syn
What syndrome is associated with a parathyroid adenoma?
MEN2A (also hyperparathyroidism-jaw tumor syndrome)
What syndrome is associated with an optic glioma?
NF1
What syndrome is associated with mucosal neuromas?
MEN2B
What syndrome is associated with spinal meningiomas?
NF2
What syndrome is associated with bilateral schwannomas of the vestibular nerve?
NF2
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
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)
What 2 lesions raise concern for Kasabach-Merritt Phenominion?
- tufted hemangioma
- 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%.
What is a dandy-walker malformation?
posterior brain fossa anomalies (PHACES)
Whats is a cervical segmental hemangioma associated with?
BONUS: What are the rest of the lesions in this syndrome?
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
What is the Hyam grade for olfactory neurobalstoma with Flexner-Wintersteiner rosettes, abundant necrosis, lacking neurofibrillary matrix?
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
This is boards-y, not really Neville-y but:
What are 4 facts about lymphoepithelial carcinoma?
- parotid gland = most common site
- lymphocytoplasmic infiltrate is non-neoplastic
- Arctic native and southern China predilections
- EBV usually identified only in endemic populations
Which point mutation is most specific for chondroblastoma?
H3F3A
Which nuclear feature of papillary thryroid carcinoma is not seen in cytologic preparations?
Nuclear clearing
What does a mutation in type I collagen lead to?
osteogenesis imperfecta
(this came from a question stem about RUNX2/cleidocranial dysplasia and how it is NOT involved in Type I collagen folding)
Which gene mutation results in the MOST SEVERE enamel alterations in amelogenesis imperfecta?
FAM83H
Deficient enzyme in Gaucher
glucocerebrosidase
Deficient enzyme in Niemann-Pick
sphingomyelinase
Deficient enzyme in Tay-Sachs
β-hexosaminidase A
Deficient enzyme in Fabry
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.
Deficient enzyme in Krabbe
galactocerebrosidase (GALC) (very close to Gaucher) another lipid reticuloendothelosis syndrome
Dyskeratosis congenita: What is the pattern of hyperpigmentation that develops early in the disease?
reticular
Dyskeratosis congenita: What type of change is seen in the nails?
dystrophic OR dysplastic
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?
aplastic anemia…fanconi anemia is also associated with aplastic anemia
Dyskeratosis congenita: are oral lesions benign or malignant?
Bonus: What about HMD? Benign or malignant?
DC: malignant oral lesions
HMD (hereditary mucoepithelial dysplasia): benign (so not dysplastic like the name implies lol) (fiery-red erythema of the hard palate)
Dyskeratosis congenita: Which inheritance patterns show\ the most severe disease?
Autosomal recessive and X-linked recessive
Which glycoprotein is most affected in pemphigus vulgaris?
Desmoglein 3
Which condition uses indirect IF with rat bladder mucosa?
Paraneoplastic pemphigus
4 facts about familial gigantiform cementoma (gender, race, age, site)
- no gender predilection
- white or Asian predilection
- seen by adolescence
- multiple quadrants affected, both mand and max
What are 4 criteria for diagnosis of Wegner (granulomatosis w polyangiitis)
- Oral ulcerations or nasal discharge
- Abnormal chest xray
- Abdnormal urinary sediment
- Gran inflam on bx
Hamman’s crunch
Cervicofacial emphysema
Early widspread secondary dentin
progeria
What are the thyroxine and TSH levels for a patient with hypothyroid?
low thyroxine, high TSH
What is the second most common location for an ameloblastic fibroma?
posterior maxilla (post mand #1) (rare in anterior)…(so similar to an OKC)
Auclair grading system (mucoep): How many points for anaplasia
4
Auclair grading system (mucoep): How many points for 4+ mitoses / 10hpf
3
Auclair grading system (mucoep): How many points for Necrosis
3
Auclair grading system (mucoep): How many points for neural invasion
2
Auclair grading system (mucoep): How many points for intracystic less than 20%
2
TLE1 positive
SynoviaL Sarcoma = tLe1 (SSX-SS18)
You got this confused with ASPL-TFE3 (where TFE3 is positive)
Most common site for metastasizing ameloblastoma
lungs (cervial LN are second most common)
HRPT2 gene mutation leads to what 3 clinical manifestations?
- parathyroid adenoma
- ossifying fibromas of the jaws
- Wilms tumor
(hyperparathyroidism-jaw tumor syndrome)
What are 4 predisposing factors for NOMA?
- Malnutrition
- Poor sanitation
- Proximity to unkempt livestock
- malignancy
What is granulomatous angiits associated with?
Its ischemic stroke from a VZV infection moving from the trigeminal nerve and invading into the internal carotid artery. holy shit.
Compound odontoma most common location
anterior maxilla
Complex odontoma most common location
molar regions of either jaw
What causes botryomycosis?
Staph Aureus (ha, NOT a fungus like the name leads you believe)
What are 3 conditions associated with sialadenosis?
Sialadenosis (aka sialosis - enlargment of the salivary glands w/o significant inflammation)
- Diabetes mellitus
- Pregnancy
- Anorexia nervosa and or bulemia
There are many more including
- Alcholism
- general malnutrition
- Hypothyroidism
- Acromegaly
Congenital hypertrophy of the retinal pigment
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
4 syndromes associated with Hemihyperplasia
- NF 2.Beckwith-Wiedemann 3.Proteus 4.Maffuci
many more…
- ollier
- SOD
- McCune-Albright
even more than that
Facial trichilemmomas assoc w?
Cowden (multiple hamartoma syndrome, PTEN)
5 features of Tuberous Sclerosis (haha there are 14 total)
- Facial angiofibromas
- Hypomelanotic macules (ash leaf)
- Shagreen patches
- Subependymal giant cell astrocytomas
- Oral fibromas
Mittenlike deformity
Recessive, Dystrophic Epidermolysis Bullosa (RDEB) (generalized gravis type). Wow. That’s a mouthful.
Ocular gelatinous plaques
HBID
Treatment for chronic sclerosing osteomyelitis
debridement + abx
All meds are associated with gingval hyperplasia EXCEPT:
erythromycin verapamil cyclosporine azathioprine nifedipine
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)
Failure of tooth eruption may occur in patients which disease?
Hypothyroidism
Graves Dz
Amyloidosis
Langerhans cell disease
Hypothyroidism (cretinism) (tooth formation might not be impaired, but fail to erupt)
All the following syndromes are associated with hypodontia EXCEPT:
Hurler (muccopolysaccharidosis)
Sturge-Weber
Ehlers-Danlos
Peutz-Jeghers
Peutz-Jeghers
Neutrophile Nitroblue tetrazolium reduction test
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
Most common malignant salivary gland tumor of the submandibular gland
adenoid cystic carcinoma
Hodgkin Lymphoma stage III
LN involvment both sides of diaphragm
Serum levels of beta2-microglobulin and albumin
multiple myeloma
All have been assoc w premature loss of teeth EXCEPT:
LCH Down Oxalosis Ehlers-Danlos Taurodontism
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
What kind of glands are sebaceous glands?
Holocrine
Blandin-Nuhn gland found where?
tongue (anterior ventral, mentioned in neville as a place for mucocele formation)
Most common location of a palisaded capsulated neuroma
face (nose and cheek)
Perivascular deposits of basement membrane material
lipoid proteinosis
Psammommatous melanocytic schwannomas assoc with
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
Lymphaniomyomatosis seen exclusively in what age/gender?
women of child bearing age
aka LAM, cant find in Neville, but cystic lung destruction can be assoc with Tuberous Sclerosis.
All have been assoc with increased risk for leukemia EXCEPT:
Bloom Fanconi Down Prader-Willi Wiscott-Aldrich
Prader-Willi is NOT assoc with increase leukemia risk
Second most frequent site for OKC
posterior maxilla
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
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)
Uremic stomatitis can mimic what other oral lesion?
hairy leukoplakia (whatevs)
Enlarged LN w necrosis, nuclear debris, histiocytes, agg of lymphocytes, plasmacytoid monocytes, young male pt w fever leukopenia
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
Mycosis fungoides cell origin
CD4+ T cell
Mass of the chest of a teenage male w lymphoid cells lobulated nuclei stippled chromatin scant cytoplasm, mitoses, CD1, CD3, CD5
Lymphoblastic lymphoma
Jones-Hartsfield syndrome = gingival fibromatosis + ?
sensorineural hearing loss
Which has the lowest 5-year survival rate:
Oral Cavity SCC Melanoma Laryngeal Carcinoma Cervical Carcinoma Hodgkin Lymphoma
Laryngeal Carcinoma (61%)
SCC (66%)
Melanoma (Skin 93%, Stage 3 63%)
Cervical (66%)
HL (80%
Which test is performed for a malignancy in a LN w architecture effaced by small lymphocytes?
Western blot
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
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.)
What is the function of p63?
epidermal-mesenchymal interactions during embryologic dev
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
Lost in malignancy is FALSE
Positive in ameloblastoma (stains the stellate reticulum)
Which is LEAST likely to be seen in a PEDs pt?
Ewing Sarc Rhabdomyosarc Liposarc Ameloblastic Fibrosarc Acinic Cell Carcinoma
Liposarcoma
Haha YES!
How many new cases of oral cancer were diagnosed in 2008?
34,000
1 y/o bilateral facial swelling, fever, leukocytosis, hyperostosis of facial bones. Neg blood cultures
Caffey Dz
Fever and rash, swollen extrematies, erythematous bulbar conjunctiva, cervical LAD, red swollen tongue
Kawasaki disease
Cherubism + gingival fibromatosis =
Ramon syndrome
What growth factor is responsible for promoting angiogenesis in granulation tissue?
VEGF (vascular endothelial growth factor)
Collapse of the bridge of the nose is classic for
leprosy (you thought syphilis, didn’t you)
What has been linked to multiple superficial mucoceles?
tartar control toothpaste
What type of candidiasis is Angular cheilitis?
Erythematous candidiasis (and you taught that)
What general type of IHC markers stain Perivascular epithelioid cell tumors (PEComas)?
Melanocytic markers
Come on Austin. What is the most common type of sinonasal papilloma?
Inverted
Atrophy of upper lip, unilateral posterior open bite, coup de sabre, unilarteral hypoplasia of facial bones =
Parry-Romberg syndrome (Progressive Hemifacial Atrophy)…the other coup de sabre condition is limited scleroderma (morphea)…Neville says they have a “close relationship”
CD10+, Bcl2+, CD5-, CD43-
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)
What are 3 causes for regional odontodysplasia?
- Vascular abnormalities 2.neural disorders 3.Growth abnormalities
The lyon affect is typically seen in
women
2 causes for Papillon-Lefevre
- Chemotactic effect
- 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
Organism w large (20-60um) round spherules containing numerous endospores
blastomycosis
Varocay bodies are made of
BOTH reduplicated basement membrane AND cytoplasmic processes
Which Behcet association is fatal?
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
Large cell lymphoma arising in CLL is known as
Richter syndrome
Erythema infectosum is also known as? and is caused by?
Fifth dz, parvovirus (B19)
Mikulicz cells
Rhinoscleroma
translocation for Anaplastic large cell lymphoma
t(2,5)
Intracellular glycogen found in all EXCEPT
Leiomyosarcoma
Acinic Cell Carcinoma
Clear Cell Carcinoma (salivary)
Ewing Sarcoma
Acinic Cell (its Zymogen) (1% can have clear cell variant w glycogen)
Occlusive subintimal depositis of PAS+ material at arteriolo-capillary junctions seen on gingival biopsy
Thrombotic thrombocytopenia
3 syndromes associated with hypertrichosis
- hemihyperplasia
- Segmental Odontomaxillary Dysplasia
- Gingival fibromatosis
t(11;22)
Ewing sarcoma
Which does NOT present with interface mucositis?
Lichen Planus EM SLE Scleroderma Lichenoid mucositis
Scleroderma
Auer bodies
aka Auer rods… myeloid leukemia (AML)
Diagnose that entitiy:
Tongue neoplasm "glomeruloid" pattern "orphan annie nuclei" p63 + thyroglobulin - TTF1 -
Polymorphous Adenocarcinoma, cribriform
formerly “cribriform adenocarcinoma of the tongue and minor salivary glands (CATMSG)”
TFE3 positive
Alveolar soft part sarcoma (remember synovial sarc is TLE1 pos)
WTF?!
Wet keratin is not seen in which?
Craniopharyngioma COC AOT Trichoep Complex Odontoma
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
What’s the best stain for Leishmaniasis?
Giemsa
What is the best stain for necrotic fungal organisms?
GMS
Which entity should NOT be considered in the ddx for orofacial granulomatosis?
Paracoccidiomycosis Sarcoidosis Foreign body rxn Ulcerative colitis Tuberculosis
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
Eosinophilic, ring-shaped calcifications with surrounding multinucleated giant cells and lymphoctes
Hyaline bodies
AKA pulse granuloma, giant-cell hyaline angiopathy…as seen in inflammatory cysts
Xerostomia and keratoconjunctivitis sicca are both seen in:
Sarcoidosis
sialosis threw me off here…
What is the typicall pattern for amyloid deposit in salivary glands?
perivascular and periductal
Which entity is NOT of perivascular derivation?
Glomangiopericytoma Myofibroma Myopericytoma Solitary fibrous tumor Glomus tumor
Myofibroma
Which is considered a proto-oncogene?
P16 P53 PRb BCL-2 Ras
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
Which is NOT a viral protein?
P16 E6 E7 LMP P24
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
What must be ruled out when considering a diagnosis of PFAFA syndrome in children?
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.
What effects can herpes zoster have on bone and teeth?
bone loss and tooth necrosis
Reduced counts of which T cell type may indicate poorer outcomes in SCC patients?
CD8 cytotoxic T cells
Wow, you guessed and got this right!
How many IgG4+ plasma cells must be seen at high power for a diagnosis of IgG4 disease?
100
The hyoid bone separates which of the following lymph node levels?
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)
Which of the following is an encapsulated tumor?
Neurofibroma Schwannoma Oral focal mucinosis Pyogenic granuloma fibroma
Schwannoma
I got this right, just wanted to cement it
Which virus is associated with….
Merkel cell carcinoma
Pityriasis rosea
Shingles
Kaposi’s Varicelliform eruption
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
Nice, guessed and got this right:
Multiple enamel pits seen in….
Tuberous sclerosis
Pigmented lesions of the gingva may be seen in:
Hypoparathyroidism Hyperparathyroidism Hypoadrenocorticism Hyperadrenocorticism Hyperthryroidism
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)
Wrinkled silk histiocyte
Gaucher
“Sea blue” histiocyte
Neimann-Pick
Lingual thyroid:
Overall sex predilection?
Which sex has tendency for malignancy?
overall: Female
carcinoma: Male
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
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%
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
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
Antigen for pemphigus vulgaris
Desmoglein 3
Herald patch
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
Herpes zoster on the tip of the nose involves which nerve branch?
Nasociliary (guessed and got it right)
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:
Kohler illumination
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.
brightfield illumination
Name that method of illumination lol:
A contrast-enhancing technique that improves the quality of the image obtained with birefringent materials
Polarizing illumination
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
Darkfield illumination
Name that method of illumination lol:
Static illumination
Not a typical term used in microscopy
NICE! You guessed and got this right…
Dermatitis, dementia, and diarrhea = which vitamin deficincy?
Niacin deficiency (Vit B3) AKA Pellagra
It’d be beneficial to review your chapter 17 cards for the rest of these deficiencies
Blackfoot disease
Arsenic poisoning
Virus assoc with plasmablastic (multicentric) Castleman Disease?
HHV8
Angiomyolipoma of the kidney assoc with what genetic condition?
Tuberous sclerosis
Most common location for plasmablastic lymphoma in HIV patients
oral cavity
Hormone-induced atypical endometrial histopathologic changes
Arias-Stella reaction
Histologic change most supportive of Barrett esophagus?
columnar cells
All are markers for perineurioma EXCEPT
EMA Claudin-1 Glut-1 Type IV Collagen GFAP
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)
Which is a common feature of warty dyskeratoma and keratosis follicularis:
Histologic appearance Mode of inheritance Predilection for males Hyperpigmentation of skin Multifocal presentation
Histologic appearance
keratosis follicularis: another name for Darier Disease
Kernicterus refers to toxic bilirubin accumulation in which organ
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.
Histoplasmosis typically disseminated via
Aspiration of aerosol contaminated with bird (or bat) droppings
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
False: Risk 20x higher in EBV pos patients
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?
EXCEPT: Predominance in Asian populations
BONUS: Fraser-Lendrum histochemical staining method shows fibrin
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
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.
Billing 3rd party for pathology services all must be submitted EXCEPT:
ICD10 CPT CLIA Lab ID number Name of referring clinician Patient's SSN
Patients SSN
Embryonic odontogenic tissue origin of Squamous Odontogenic Tumor
Rests of Malassez
Organism most commonly associated with allergic fungal sinusitis?
Aspergillus fumigatus
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
False: Infections with overabundance of neutrophils
GCDFP expressed in
BCC (and Secretory carcinoma)
GCDFP (Gross Cystic Disease Fluid Protein)
Which receptor mediates adhesion of tumor cells to the BM prior to invasion?
Laminin
Cherubism + gingval fibromatosis + seizures =
Ramon syndrome
Which is NOT encountered in Sprue?
Glossodynia Ulcers Petechiae Atrophy of filiform papillae Glossitis
(Sprue = celiac)
Not encountered: Petechiae
Glossodynia = burning mouth syndrome
Hereditary immunodeficiency with thrombocytopenia and eczema
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)
Most common benign tumor of bone
osteochondroma
All have similar histo EXCEPT
Small cell carcinoma of Lung Biphasic synovial sarcoma Neuroblastoma Ewing Sarcoma Alveolar rhabdomyosarcoma
biphasic synovial sarcoma
Anti-Smith antibody directed against
Nuclear RNA
Lipid reticuloendotheliosis assoc w increased risk for multiple myeloma?
Gaucher
Ship’s Wheel fungus
South American Blasto (AKA paracoccidio. Jesus)
Merkel cells feature
Neurosecretory granules
Michaelis-Gutmann bodies
malakoplakia
Stains for diagnostic lipoblasts and fat on frozen section
Oil Red O or Sudan Black
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
except enlarged adipocytes
Rhabdomyosarcoma in adults =
Rhabdomyosarcoma in 10-25 year olds =
Rhabdomyosarcoma in children =
Rhabdomyosarcoma in adults = Pleomorphic (extremities)
Rhabdomyosarcoma in 10-25 year olds = alveolar
Rhabdomyosarcoma in children = Embryonal
Normal glomus body regulates
heat
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
EXCEPT Often seen 10 years earlier than conventional melanoma
t(2,13)
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
Which does NOT usually stain positive for CKs?
Clear cell sarcoma Elitheliod sarcoma synovial sarcoma Extrarenal rhabdoid tumor Epitheliod hemandioendothelioma
clear cell sarcoma
Downey cells
infectious mononucleosis
The distinctive cell associated with EBV or CMV is known as a “Downey cell”, a reactive lymphocyte
In a lymph node:
reactive follicles, clusters of epithelioid cells, patches of monocytoid cells suggests
toxoplasmosis
All are true for periosteal osteosarcoma EXCEPT:
occurs on surface predominantly chondroblastic freq affects flat bones mineralization not on imaging no intramedullary involvment
EXCEPT frequently affects flat bones
Extragnathic adamantinomas
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.
intraepithelial eosinophilic abscesses
inflammatory bowel disease
Lupus vulgaris =
Lupus pernio =
Lupus vulgaris = TB
Lupus pernio = Sarcoid
Epidermotropism
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.
Renal osteodystrophy assoc w
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
Wegners all EXCEPT
Stawberry gingivitis Positive IF for cytoplasmic (c-ANCA) Ulcerative lesions in oral mucosa Positive IF for perinuclear (p-ANCA) Necrotizing glomerulonephritis
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.
New term for p-ANCA
New term for c-ANCA
New term for p-ANCA = MPO-ANCA
New term for c-ANCA = PR3-ANCA (*more specific for Wegeners)
Pseudoepitheliomatous hyperplasia seen in all EXCEPT
Wegener GCT Blastomycosis Congenital epulis Tertiary syphilis
EXCEPT congenital epulis (just thought the others were interesting)
Did you know…varicella recurrence is NOT considered to be caused by exposure to
UV light, I guess thats good, or there would be lots of cases of ramsey hunt
High urinary VMA assoc w
Hereditary fibromatosis Stuge-Weber Medullary carcinoma of thyroid Peutz-Jegher MEN2B
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
Most common malignancy involving bone?
Met
Systemic sclerosis assoc with all EXCEPT
Raynaud Acro-osteolysis CREST Fibrous dysplasia Diffuse widening of PDL
Fibrous dysplasia
Clear cells in clear cell odontogenic carcioma share IHC and structural similarities with what cell type?
Glycogen-rich presecretory ameloblasts
What is a rare, potentially lethal, oropharyngeal infectious disease occurring in immunocompetent adolescents and young adults that is mainly due to Fusobacterium necrophorum?
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.)
What is the other name for Goltz-Gorlin Syndrome?
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.
What syndromes are these derm lesions associated with?:
Trichelemmomas
Trichoepitheliomas, Spiradenomas, Cylindromas
Facial angiofibromas
Epidermal cysts
Soft tissue angiomas
Trichelemmomas = Cowden
Trichoepitheliomas, Spiradenomas, Cylindromas = Brooke Speigler
Facial angiofibromas = Tuberous Sclerosis
Epidermal cysts = Gardner syndrome
Soft tissue angiomas = Maffuci
