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MS 2 - Unit 3 > Mixed path cards > Flashcards

Mixed path cards Flashcards

1
Q

What feature is similar about Warthin’s tumor, pleomorphic adenoma, and mucoepidermoid carcinoma?

A

all commonly localize to the parotid gland

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2
Q

papillary cystadenoma lymphomatosum and adenolymphoma other names for what? Why is it helpful to remember this?

A

Warthin’s tumor - useful because cystic glandular benign tumor (cystadenoma) with lymph node-like stroma consisting of abundant lymphocytes and germinal centers (lymphomatosum ). Cystic spaces are surrounded by two uniform rows of cells with centrally placed pyknotic nuclei papillary - b/c epithelium surrounding cystic spaces exhibits “papillary infolding” adenolymphoma - useful to remember because neoplasm of glandular tissue (adenoma) with lymph-node like structures (lymphoma) *only type of salivary gland tumor more common in men than women, 15% of cases are bilateral

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3
Q

Rough whitish patch on the lateral tongue, usually arising in immunocompromised Pts, cannot be scraped off. What is it? What causes it? Is it cancerous?

A

Hairy leukoplakia Caused by EBV which induces squamous cell hyperplasia (not dysplasia!) not pre-malignant

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4
Q

Painful superficial ulceration of the oral mucosa that is characterized a greyish base surrounded by erythema What condition is this? What causes it?

A

Aphthous ulceration arises in relation to stress, spontaneously resolves

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5
Q

vesicles in the oral mucosa that rupture and result in shallow painful red ulcers. Usually seen in children. What is this? What causes it?

A

Primary HSV-1 infection Lesions heal but virus remains dormant in trigeminal nerve ganglion

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6
Q

Vesicles that rupture and result in shallow painful red ulcers - often occurring on the lips. What is it what causes it?

A

Reactivation of HSV-1 inefection that caused by stress or exposure to sunlight

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7
Q

How can you differentiate aphthous ulcers from primary HSV-1 infections?

A

primary HSV-1 doesn’t have grey base of lesion and usually occurs in childhoord. HSV-1 reactivations don’t have grey base and also occur on the lips

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8
Q

syndrome marked by recurrent aphthous ulcers, genital ulcers and uveitis What is it? What causes symptoms?

A

Bechet syndrome small vessel immune-complex vasculitis

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9
Q

easily scraped away white deposit on tongue seen in immunocompromised states

A

Oral candidiasis aka thrush

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10
Q

reddish plaque on tongue that cannot be scraped away . What is this? What is it a strong indicator of? Is it cancerous, pre-cancerous or benign?

A

Erythroplakia squamous cell dysplasia of the oral mucosa per-cancerous ==> can lead to squamous cell carcinoma Alcohol and tobacco are biggest risk factors

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11
Q

Protrusion of edematous, inflammed mucosa that usually arises secondary to repeated bouts of rhinitis but also occurs in cystic fibrosis and aspirin-intolerant asthma.

A

Nasal polyp

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12
Q

Protrusion of edematous, inflammed mucosa in a child should be checked for what? In adults?

A

cystic fibrosis Aspirin intolerant asthma

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13
Q

What is the most common cause of a malignant turmor of the nasopharyngeal epithelium? Who is most susceptible?

A

Nasopharyngeal carcinom - caused by EBV infection African CHILDREN or Chinese ADULTS

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14
Q

Pt. 16 YO male presents with recurrent epistaxis - what could be the cause?

A

Nasopharyngeal angioblastoma benign but locally aggressive vascular tumor that grows in the back of the nasal cavity (consists of large blood vessels and fibrous CT). Most commonly affects adolescent males. Usually presents with one-sided nasal obstruction and recurrent bleeding.

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15
Q

45 YO chinese pt. presents with swollen cervical lymph node, blood in saliva, bloody discharge from the nose, nasal congestion, hearing loss, frequent ear infections, headaches. What is a likely diagnosis? What might have caused this?

A

nasopharyngeal carcinoma secondary to EBV infection

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16
Q

biopsy of a nasopharyngeal carcinoma would likely show what two histological features?

A

pleomorphic keratin-positive (poorly differentiated) epithelial cells Background of lymphocytes

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17
Q

Most common cause of acute epiglottitis?

A

H influenza type B (especially among non-immunized)

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18
Q

inflamation of the epiglottis that results in high fever, sore throat, drooping with dysphagia, muffled voice, inspiratory stridow, and risk of airway obstruction

A

acute epiglottitis

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19
Q

What is croup? What is the most common cause?

A

inflammation of the upper airway (aka laryngotracheaobronchitis) parainfluenza virus

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20
Q

Pt. is a singer who presents with hoarseness that resolves with resting of voice - what might they have?

A

vocal cord nodule - nodules on true vocal cords that develop from overuse, usually bilaterally, composed of degenerative(mixoid) CT. not a laryngeal papilloma (also has hoarseness) because resolves with non-use

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21
Q

what causes benign tumors on the vocal cords that present with hoarseness and does not get better with resting voice?

A

HPV 6 or 11 laryngeal papilloma

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22
Q

T/F layngeal papillomas are usually multiple in children and single in adults

A

true

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23
Q

T/F laryngeal papillomas are typically associated with epithelial dysplasia

A

False - not typically, only rarely pre-cancerous! But does occur - HPV 6 , 11 “Low risk” for cancer – though can lead to laryngeal carcinoma in rare cases

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24
Q

Most common causes of epithelial dysplasia on true vocal cords that transisions to squamous cell carcinoma of the larynx (laryngeal carcinoma)?

A

Alcohol and tobacco

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25
Q

benign mobile painless and circumscribed mass in the parotid gland with high recurrence rate after surgical excision

A

pleomorphic adenoma

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26
Q

in rare cases pleomorphic adenomas can become malignant resulting in parotid adenocarcinoma. What clinical symptom would be indicative of possible malignancy and why?

A

diffuse unilateral upper and lower facial pain – facial nerve runs through parotid gland

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27
Q

Pt presents with bilaterally inflammed parotid glands, testicular pain, feeling of bloating after eating with diffuse left upper abdominal pain that radiates to the back, painful headache, fever, sensitivity to light, nausea and vomiting. Labs show high serum amylase. What do they have? What is the greatest risk of complications in teenagers?

A

Mumps virus infection with orchitis, pancreatitis and aseptic meningitis sterility

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28
Q

How are neural tube defects usually detected during pregnancy?

A

elevated AFP levels in amniotic fluid or maternal blood

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29
Q

Congenital failure of cerebellar vermis to develop resulting in massively dilated 4th ventricle very diminished or absent cerebellum; often accompanied by hydrocephalus.

A

Dandy-Walker malformation

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30
Q

Congenital downward displacement of cerebellar vermis and tonsils through the foramen magnum that can obstruct CSF flow and cause hydrocephalus - very commonly associated with meningomyelocele

A

Arnold-Chiari malformation Type II meningomyelocele is protrusion of meninges and spinal cord in spinal bifida

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31
Q

cystic degeneration of the spinal cord caused by the presence of a fluid filled cavity that usually occurs between C8-T1 and results in sensory loss of pain and temperature with sparing of fine touch and position sense in the upper exremities that follows a “cape-like” distribution. As fluid cavity expands, progresses to involve muscle atrophy and weakness with decreased muscle tone and impaired reflexes, ptosis, miosis, and anhidrosis

A

Syringomyelia

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32
Q

T/F polio virus damages the anterior horn of the spinal cord producing lower motor neuron lesion symptoms

A

true - syndrome called poliomyelitis flaccid paralysis, muscle atrophy, fasciculations, weakness, decreased muscle tone, impaired reflexes, negative babinski sign

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33
Q

What are symptoms of a lower motor neuron lesion?

A

flaccid paralysis, muscle atrophy, fasciculations, weakness, decreased muscle tone, impaired reflexes, negative babinski sign

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34
Q

What are symptoms of an upper motor neuron lesion?

A

result from damage to descending motor systems; include paralysis, spasticity, and a positive Babinski sign.

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35
Q

Inherited degeneration of the anterior motor horn; autosomal recessive, presents as “floppy baby”, usually fatal within several years of life

A

Werdnig-Hoffman disease

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36
Q

Degenerative disorder of upper and lower motor neurons of the corticospinal tract that typically appears in middle age adults, marked by early atrophy and weakness of the hands and overall lack of sensory impairment.

A

ALS familial cases have SOD1 mutation

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37
Q

What differentiates ALS from Syringomyelia?

A

lack of sensory impairment in ALS

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38
Q

Autosomal recessive degenerative disorder of the spinal cord and cerebellum that presents in early childhood and leads to loss of vibratory sense and proprioception, muscle weakness in the lower extremities, loss of deep tendon reflexes and ataxia

A

Friedreich’s ataxia

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39
Q

What is the genetic defect responsible for Freidrich Ataxia

A

autosomal recessive mutation of the frataxin gene due to the expansion of an unstable trinucleotide repeat (GAA)

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40
Q

What is frataxin?

A

protein essential for mitochondrial regulation of iron; loss results in iron buildup and free radical damage

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41
Q

What serious associated medical condition accompanies friedrich ataxia?

A

hypertrophic cardiomyopathy

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42
Q

T/F ALS usually appears in mid-adulthood and is typically not caused a genetically inherited mutation

A

True – SOD1 mutation is present in a fraction of familial cases but these are a vast minority of total ALS cases

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43
Q

What is most common cause of bacterial meningitis in adults and elderly?

A

Strep pneumoniae

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44
Q

What is most common cause of bacterial meningitis in children and teenagers?

A

Niseria meningitidis - enters through nasopharynx and then gets to blood then from blood gets to the meninges

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45
Q

What is the most common cause of bacterial meningitis in neonates?

A

Group B strep, E coli, Listeria monocytogenes

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46
Q

What is the most common cause of bacterial meningitis in infants?

A

H influenza (particularly in non-vaccinated instants)

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47
Q

What is a viral cause of meningitis?

A

Enteroviruses (e.g. coxsackievirus) are most common causes (fecal oral transmission, particularly affects children)

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48
Q

What is the most common source of group B strep and E coli infection that leads to meningitis in neonates

A

exposure in vaginal canal during delivery group B strep is tested in 3rd trimester for prophylaxis

49
Q

How do children and teenagers get meningitis from n minigititis?

A

enters through nasopharynx and then gets to blood then from blood gets to the meninges

50
Q

Common cause of meningitis in immunocompromised patients?

A

fungal infections of criptoccocus and aspergillus

51
Q

What is the classic triad of symptoms in meningitis?

A

Headache, nuchal rigidity and fever – other common symptoms are photo-phobia, vomiting, and altered mental status

52
Q

rapidly progressive gangrenous cellulitis of the soft tissues of the neck and floor of the mouth that results in swelling of the tongue, neck pain, and breathing problems - commonly associated with dental procedures - culture produces mixoid aeorobic and non-aerobic bacterial flora

A

Ludwig’s angina (cellulitis = spreading bacterial infection under skin; angina = strangling)

53
Q

What is Gottron’s sign? What disease is it used to detect?

A

Descrete erythematous, scaly eruptions occurring in symmetric fashion overlying the metacarpal and interphalangeal joints Dermatomyositis

54
Q

What is xerostomia? keratoconjunctivitis sicca? What disease are both of these found in?

A

dry mouth, dry eyes Sjogren syndrome

55
Q

Chronic inflammatory disease of the salivary and lacrimal glands that may be restricted there or be part of a systemic collagen vascular disease

A

Sjogren syndrome

56
Q

What happens to salivary and lacrimal glands as dissease course progresses?

A

Become atrophic with fibrosis and fatty prarenchymal infiltrates

57
Q

Differential for bilateral parotid gland swelling includes?

A

Sjogren syndrome; Mumps virus infection; Warthin cysts (15% of cases bilateral)

58
Q

focally ulcerated reddish lesion ~2mm - 1cm located on the gingiva of the mouth with highly vascularized granulation tissue

A

pyogenic granuloma

59
Q

CSF findings from bacterial meningitis?

A

neutrophils with decreased CSF glucose

60
Q

CSF findings from viral meningitis?

A

lymphocytes with normal CSF glucose

61
Q

CSF findings from fungal meningitis?

A

lymphocytes with decreased CSF glucose

62
Q

Most common cause of post-natal unilateral deafness from viral infection?

A

Mumps

63
Q

Labarynthitis

A

same as otitis interna - infection of inner ear and vestibular system commonly caused by viruses (e.g. mumps, rubella

64
Q

Prenatal viral infection that causes bilateral deafness and permanant damage to the choclea and vestibular system

A

rubella

65
Q

postnatal viral infection that causes unilateral deafness

A

mumps

66
Q

Inflammation of the salivary gland usually due to an obstructing stone and subsequent staph aureus infection; usually unilateral

A

sialadenitis

67
Q

Tumor in the nasal cavity that can cause “sinus pressure”. Marked by epithelial nests protruding into the submucosa with uniform proliferation and no evidence of cellular atypia.

A

sinonasal/nasolaryngeal inverted papilloma - caused by HPV 6,11 Inverted papilomas feature inversion of the epithelium into the underlying stroma encased by intact basement membane (so tumor can protrude into the nasal sinuses - think opposite of a polyp).

68
Q

Most common infectious agent in acute suppurative tonsilitis?

A

strep pyogenes

69
Q

consequence of chonric suppurative otidis media with rupture of typanic membrane

A

cholesteatoma

70
Q

mass of accumulated keratin and squamous mucosa that can cause hearing loss and results from growth of squamous epithelium from the external ear through the ruptured ear drum into the middle ear

A

cholesteatoma

71
Q

most clinically significant odontogenic tumor that benign tumor of odontogenic epithelium more commonly appearing in the lower jaw than the upper jaw. Rarely metastatic but progress slowly, resulting in lesions can cause severe abnormalities of the face and jaw

A

Ameloblastoma

72
Q

Hydrocephalus in a neonate associated with seizures and periventricular calcifications. Histology shows pink intranuclear/intracellular inclusions. What was the cause?

A

Vertical transmission of Cytomegalovirus accross the placenta in utero. TORCH = Toxoplasmosis, Rubella, Cytomegalovirus, Herpes simplex

73
Q

“opportunistic” virus that causes progressive multifocal leukoencephalopathy in immunocompromised states (e.g. AIDS or organ transplant).

A

JC virus

74
Q

Most susceptible brain regions (and cells) to damage from ischemia

A

perkinje neurons of cerebellum and pryimidal neurons of Sommner’s sector in hippocampus

75
Q

can cause death secondary to truama resulting in diffuse lesions/petechia in white matter

A

fat emboli - primarily affect capillaries - high density of capillaries at white matter/grey matter interface

76
Q

Favored sites of aneurysms and most common consequence

A

internal corotid, vertibral, basilar arteries thrombosis > hemorrhage /dissection

77
Q

Watershed zone most commonly affected by deminished cerebral blood flow (e.g. prolonged hypotension)

A

overlap zone between terminal branches of middle cerebral and anterior cerebral (watershed zone) - results in parasaggital infarcts

78
Q

most common cause of decline in mental status following TBI - produces “spheroids”, parasagital white matter damage accompanied by multiple infarcts - due to sheer forces from anchoring to arachnoid villi

A

diffuse axonal injury

79
Q

Durret hemorrhage

A

result of uncle transtentorial herniation

80
Q

Most common cause of death from ALS

A

respiratory insufficiency ALS is a degenerative disease of motor neurons of the brain and spinal cord (atrophy of ventral roots, motor cortex, and motor nuclei in brainstem) that results in weakness and wasting of the muscles of the hands (can be unilateral) accompanied by fasciculations and pain from muscle wasting, rapid decline and death, usually in 6 years or less

81
Q

Defining histological change in the brain from ALS

A

loss of motor neurons, atrophy of motor cortex, gliosis

82
Q

inborn error of metabolism/lysosomal storage disorder caused by autosomal recessive mutation in lysosomal enzyme arylsulphatase. Causes accumulation of the cerebroside galactosyl sulphatide in white matter leading to astrogliosis, failure to thrive and death (~6 months) from respiratory insufficiency

A

multichromatic leukodistrophy - most common leukodystrophy accumulation of sufatides (breakdown product of myelin-sulfatides) in lysosomes and “metachromatic material” in white matter

83
Q

x-linked inborn error of metabolism high levels of long-chain fatty acids in tissues and body fluids dysfunctional adrenal glands and bilaterally symetric demyelination, gliosis, and perivascular lymphocytic infiltrates Disease is _____ caused by ____

A

Adrenoleukodystrophy caused by defective peroxisomes

84
Q

Fatal infantile disease associated with autosomal recessive diffeciency in galactocerebrocide beta-galactosidases

A

Krabbe disease

85
Q

Krabbe disease is associated with what histological findings?

A

White matter disease, associated with perivascular accumulation of mononuclear and and multinucleated “globoid cells” containing undigested galactosylcerimide

86
Q

Defective GFAP Rosenthal fibers

A

Alexanders disease

87
Q

Accumulation of mucopolysaccarides

A

Hurler disease

88
Q

Cause of subacute sclerosing panencephalitis

A

reactivation of latent measles virus

89
Q

Histologic features of subacute sclerosing panencephalopathy

A

patchy loss of myelin, prominant intranuclear inclusions in neurons and oligodendrocytes, marked gliosis affecting grey and white matter, perivascular lymphocytes and macrophages

90
Q

What causes subacute slclerosing panencephalopathy? How is disease different in children vs adults?

A

reactivated measles virus In children time course is protracted and primarily affects cerebral grey matter in adults time course is more rapid

91
Q

Fatal familial insomnia and spongiform encephalopathy are caused by ________

A

prion disease

92
Q

First signs of medulloblastoma

A

symptoms of hydrocephalus, truncal ataxia and wide based gate rapid and regionally infiltrative tumor of the cerebellum

93
Q

symptoms of hydrocephalus in children

A

vomiting, sleepiness/lethargy, irritability, downward deviation of the eyes (also called “sunsetting”), and seizures

94
Q

Midline cerebellar tumor characterized histologically by small hyperchromatic cells with neuroblastic rosettes

A

medulloblastoma

95
Q

cell-markers (suggestive of meduloblastomas, ependoma or pineal parenchymal tumors) that rule out lymphoma, metastatic epithelial tumor or neuroectodermal malignancy

A

synaptophysin or nestin

96
Q

hereditary disorder in which cerebellar hemangioblastomas are associated with retinal angiomas and other turmors like renal cell carcinoma

A

von-hippel lindau syndrome

97
Q

Cause of von-hippel lindau syndrome

A

mutated VHL tumor suppressor gene

98
Q

Clincal signs of Von-Hippel Lindau syndrome

A

headache, unsteadiness in walking (wide based gait), unilateral impaired coordinated movements in arm and leg (disdiodokinesia), intentional tremor

99
Q

non-familial congenital disorder featuring facial “port wine stain” (nevus flammeus) and leptominingeal angiomas

A

Sturge-Weber syndrome

100
Q

Associated disease: highly vascularized cerebellar tumor that features endothelium lined cannals interspersed with “plump cells” that may secrete eyrethropoin and induce polycythemia

A

Von-Hippel Lindau syndrome

101
Q

Relative likelihood of intracranial metastasis Colon cancer Breast cancer Lung cancer Melanoma Renal cancer

A

Melanoma>breast/lun>renal/colon

102
Q

HMB-45

A

marker for melanoma used to diagnose brain metastasis

103
Q

invasive brain tumor that exhibits vascular changes (“arteric obliterateration”), pallasading pleiomorphic, multinuclear tumor cells around patches of yellow necrosis, and redzones of hemorrhage

A

glioblastoma multiforme tumor cells comprised of astroyctes can present with “butterfly lesion”, large tumor extending bridge of malignant cells across corpus collosum** **can result in ipsilateral symptoms to large tumor.

104
Q

tumor with characteristic “epithelial appearance” may feature “perivascular pseudorosettes” of tumor cells surrounding blood vessels typically associated with central canal of spinal cord, walls of 4th ventricle, and often results in hydrocephalus

A

ependoma

105
Q

slow growing benign tumor that may displace brain tissue and erode contiguous bone of the skull. Does not infiltrate the brain.

A

meningeoma

106
Q

Histologic presentation of a miningeoma

A

well circumscribed, firm, “bossylated” masses of variable size with whirled pattern of meningothelial cells

107
Q

Solid cystic lesion displacing the region of the hypotalamus (located above stella turcica) that arises from the Rathke pouch and compresses the medial aspect of the optic chiasm resulting in bitemporal hemianopsia, headaches, and sometimes pituitary failure that can result in diabetes insipidus

A

Cranialpharyngioma Rathke pouch = part of embyronic nasopharynx that migrates cephalad to give rise to the anterior lobe of the hypothalamus

108
Q

Most likely type of brain tumor in AIDS patient

A

primary deep cerebral (B-cell) lymphoma with bilateral perivascular distribution

109
Q

Kayser-Feischer rings

A

ocular lesions from deposition of copper in the Descemet membrane of the iris

110
Q

Disease marked by degeneration of corpus striatum resulting in extrapyramidal symptoms (lack of coordination, tremor), chronic hepatitis/cirrhosis, deposition of copper in the iris causing Keyser-Feischer ocular lesions

A

Wilson disease

111
Q

slow growing tumor arising in the white matter marked by a dense patterning of neoplastic cells with small rounded nuclei, pleomorphic features, and randomly distributed (radiographically observable) “Calcospherites”

A

Oligodendroglioma

112
Q

Cause of syndrome defined by bilateral benign tumors of the 8th cranial nerve (acustic neuromas), which are commonly associated with meningeioms and gliomas

A

Neurofibromatosis type II deletion of NF2 gene

113
Q

What differentiates neurofibromatosis type I vs type II?

A

Both have neurofibromas but only type 2 has acustic neuromas - intracranial shwannoma of the 8th cranial nerve

114
Q

What is pseudotumor cerebri?

A

ideopathic intracranial hypertension (increased pressure without evidence of tumor/obstruction) [+] papilloedema [-] mental status changes [-] focal neurologic findings

115
Q

Cause of compression of midbrain, CNIII, PCA, parasympathetic fibers that results in Duret hemorrhages, down and out dilation (mydriatic) with hemmoragic infarction of occipital lobe

A

Uncal herniation (medial temporal lobe pushes through tentorium cerebelli)

116
Q

Coning of cerebellar tonsils that produces cardiorespiratory arrest

A

tonsilar herniation

117
Q

Duret hemorrhage and causes

A

small midbrain bleeds cause by downward movement of brainstem or compression of midbrain

118
Q

most common cause of laryngotracheobronchitis in children

A

parainfluenza virus ==> causes a type of laryngotracheobronchitis called “Croup”

MS 2 - Unit 3 (45 decks)

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