NEURO MSK DERM ENDO Flashcards
When the brain undergoes infarction, which cells are the first to be called in?
Neutrophils? So first there is red neuron formation then there are neutrophils and then lastly, the microglia come in
Stain for GBM
GFAP
What kind of amyloid is present in Alzheimers? Explain how APP gets transformed to this
A-beta amyloid; Normally, APP is degraded by an alpha secretase but in Alzheimers it is degraded by a Beta-secretase leading to the abnormal protein structure called A beta amyloid
Psammoma bodies are typical of which CNS tumor
meningioma
How do you test for Acromegaly?
failur to suppress GH after an oral load of glucose
What is overexpressed in achondroplasia?
FGF3
Describe the histology of the skin cancer that predominately affects the upper lip
nodules of basal cells with peripheral pallisading
Which type of basal cell carcinoma can metastasize?
morphea subtype
What is increased in an ephelis?
(Freckle; increased number of MELANOSOMES, not melanocytes)
If a hydrosyrinx lead to a Horner syndrome, which tract is most likely affected?
Hypothalamothalamic
Classic cause of an intracerebral hemorrhage
rupture of charcot Bouchard aneurysm
What is the most accurate name for Mad Cow Disease?
Variant Creutzfeld Jakob disease
What is the cause of multinodular goiters (and ultimately, toxic multinodular goiters)?
Iodine deficiency
When do you see osteitis fibrosa cystica? Renal osteodystrophy?
primary hyperparathyroidism (parathyroid adenoma); Secondary hyperparathyroidism in CKD
How does a person get osteomyelitis of the epiphysis? Metaphysis?
Epiphysis = open wound; Metaphysis = transient bacteremia
Endomysial inflammation
Polymyositis (NOT to be confused with anti-endomysial antibodies seen in celiac dz)
What may you see in the nails of a psoriasis patient?
pitting of the nails
Which infection is associated with lichen planus?
chronic hepatitis C
Which 2 skin cancers arise from the basal layer?
basal cell carcinoma; melanoma
What is the precursor molecule to melanin? Where in the melanocyte is melanin synthesized?
Tyrosine; melanosome
What is a Duret hemorrhage?
Brainstem hemorrhage
What is the Orphan annie nucleus seen in? Hurthle cell change? Amyloid stroma? (ALL WITH RESPECT TO THYROID)
Orphan Annie nucleus seen in papillary carcinoma; Hurthle cell in Hashimoto; Amyloid stroma in medullary CA of thyroid
How do papillary carcinoma of the thyroid and follicular carcinoma spread?
Papillary = LN (jugulodigastric, juguloomohyoid); Follicular = hematogenous
Who gets Hyperosmolar non-ketotic coma?
Type II DM only due to hyperglycemia
Inward bending of ribs with anterior protrusion of the sternum
Pigeon Breast Deformity
What would you see with erythrasma on wood lamp? Bug?
coral red (confused with tinea cruis), Corynebacterium minitussimum
Medial Tx of A) prolactinoma B) GH adenoma
A) bromocriptine B) octreotide
Mnemonic for hypercalcemia
Stones, painful boans, abdominal groans, psychic moans
What is rheumatoid factor?
IgM autoantibody against Fc of IgG? Anti-citrullinated peptide is better
Velvet-like skin
Acanthosis nigricans
What is the key histological feature to tell you that you are dealing with follicular carcinoma of the thyroid?
The cancer has broken through the capusle of the follicle
Explain the pathology of Friedrichs Ataxia
Mutated Frataxin leads to an inability of mitochondria to regulate iron and leads to damage of Cerebellum and SPC
What fluid is secreted by the joint capsule (synovium)?
hyaluronic acid
Neuroendocrine tumor of bone
Ewings sarcoma t(11;22)
A Crohn’s fistula draining onto the skin may predispose to what CA?
SCC
A coinlike stuck on skin lesion likely has what histology?
keratin pseudocysts
What is the most common cause hypothyroidism in areas where iodine levels are adequate?
Hashimoto thryoiditis
What is anti-smooth muscle Ab assoc with?
Autoimmune Hepatitis
Another word for subacute granulomatous thyroiditis
De Quervain Thyroiditis
What is the major life-threatening event that occurs in DM II?
Hyperosmolar non-ketotic coma (high glucose causes a life-threatening diuresis with hyperosmolarity)
What distinguishes a large hydrosyrinx from ALS?
ALS often involves the hands and syringomyelia does as well since it usually affects C8-T1 however, ALS does not have sensory signs
Which MSK pathology is likely to involve a myelophthisic anemia with hepatosplenomegaly?
Osteopetrosis due to filling of the marrow with bone
What is the difference in neurofibrillary tangles of Pick’s Dz and Alzheimer’s?
None really, they are both composed of tau protein but they occur in different locations
Most common cause of targetoid rash
HSV but also mycoplasma pneumoniae
Fibroblast proliferation after an MI is most similar to what action in the repair of a stroke?
Reactive gliosis (first it is red neuron (like contraction band necrosis) then neutrophil then microglia (like MO) then reactive gliosis (like fibroblast))
Why are calcium and phosphate usually opposites?
Because phosphate binds calcium. So if calcium goes up, phosphate goes down.
What is orthokeratosis?
hyperkeratosis with loss of nuclei
Which HLA is associated with Hashimoto thyroiditis?
HLA DR5
What is parakeratosis?
hyperkeratosis with retention of nuclei
Why are adult women more susceptible to meningiomas than men?
meningiomas express the estrogen receptor (tumors of arachnoid tissue)
What metabolic abnormality does diabetic ketoacidosis cause?
wide anion gap metabolic acidosis
Death in Duchenne Muscular Dystrophy
Cardiac or Respiratory failure (recall that X-linked dilated cardiomyopathy is a deficiency in dystrophin)
What is the most common cause of primary hyperparathyroidism?
Parathyroid adenoma
Differentiate VIPoma sx from Somatostatinoma sx
VIPoma = Watery Diarrhea, Hypokalemia, Achlorhydria; Somatostatinoma = achlorhydria (no gastrin) and steatorrhea
What are the spines in the stratum spinosum?
desmosomes
What is the geographical predisposition to multiple sclerosis?
more commonly seen in areas away from the equator
What is the “acral” surface?
palmar
Why is the implication of Propionibacterium acnes important?
It breaks down sebum into PRO INFLAMMATORY fatty acids which results in a pustule
Which thyroid issue commonly follows a viral infection?
De Quervain Thyroiditis (subacute granulomatous thyroiditis)
Anti-Jo-1 Ab
Dermatomyositis
Which degenerative disease results in a loss of cholinergic neurons? GABAergic?
Alzheimer; Huntington
Tx of LEMS
remove the cancer causing paraneoplastic syndrome
Through which foramen does the MMA travel through?
Foramen spinosum
Treatment of this dermatitis involves removal of the offending agent and corticosteroid creams
contact dermatitis
Translocation in Ewings Sarcoma? Type of cell
t(11;22)? Neuroendocrine cell
Which skin cancer is S-100 positive?
melanoma
4 subcategories of melanoma
Superficial spreading, lengtigo maligna, nodular (worst prognosis), acral lentiginous
Exfoliative toxins of staph aureus cause acantholysis of what layer?
stratum granulosum
Name 3 common autoantibodies in Hashimoto thyroiditis
Anti-thyroglobulin, Anti-thyroid peroxidase, Anti-microsomal
What cell is most responsible for pannus formation and joint deformity in RA?
myofibroblast causes joint contracture
Epidermal hyperplasia associated with insulin resistance
Acanthosis nigricans
Reduction of trabecular bone mass
osteoporosis
Normally, Tau is associated with what structure?
Microtubules
What is acanthosis?
Epidermal hyperplasia
What is hyperpigmentation of the cheeks in pregnancy?
melasma
Which areas of the brain are the most susceptible to global cerebral ischemia?
Watershed areas
Which thryoid cancer can present with hypocalcemia?
Medullary carcinoma since it is a cancer of C-cells which secrete calcitonin
Discuss the pathogenesis of diabetic retinopathy
Glucose converted to sorbitol by aldose reductase in retinal pericytes leads to microaneurysms
Which subcategory of melanoma is not related to sun exposure?
Acral lentiginous
How are most cases of ALS inherited?
Sporadic; however, familial forms are associated with SOD1 mutations (zinc copper superoxide dismutase)
What are the 2 serious forms of erythema multiforme?
Stevens Johnson syndrome and Toxic Epidermal Necrolysis (TEN is a medical emergency)
Why would a hypothyroid patient have a large tongue?
Because of myxedema (not pretibial) but GAGs can accumulate
Who gets acral lentiginous melanoma?
Asians and Africans
What are rheumatoid nodules?
central zones of necrosis surrounded by histiocytes (looks like caseating granuloma)
What is a compound nevus?
A junctional nevus that grows into the dermis
Kimmelsteil-Wilson nodules involves sclerosis of what renal constituent?
mesangium
What is the leading cause of hydrocephalus in newborns?
Cerebral aqueduct stenosis
What is the histology of beta cell exhaustion in DM II?
Amyloid deposition in the parenchyma
Which type of herniation is most likely to affect the oculomotor nerve?
Uncal herniation (medial temporal lobe)
2 patients who are susceptible to central pontine myelinolysis
Alcoholics and Chronic liver disease
How is a nevus different from a freckle?
A nevus is a benign proliferation of melanocytes; a freckle is just increased number of melanosomes
What is the Auspitz sign?
Occurs in psoriasis when you peel the skin, it is tearing off of the epidermis above the dermal papilla vessel
What is the most common neoplastic cause of chronic adrenal insufficiency?
lung cancer mets
What is the significance of aldose reductase in peripheral neuropathy in DM?
Converts glucose to sorbitol which leads to Schwann cell death
Brain disorder that is due to inability to attach CoA to long chain fatty acids
Adrenoleukodystrophy
What is a well-differentiated SCC that comes on quickly and then regresses (on skin)
keratoacanthoma
Paternal age is significant for which MSK path
Achondroplasia
IgG against desmoglein
pemphigus vulgaris (IgG antibody to desmoglein)
What is a junctional nevus?
A benign growth of melanocytes at the dermal epidermal jxn
What are 2 associations of Arnold Chiari malformations?
most cases involve meningomyelocele (this is what pulls the medulla down) and syringomyelia
What are two things you’ll see on histology of papillary carcinoma of the thyroid?
Psammoma bodies and Orphan annie nuclei
What are 4 causes of hypopituitarism?
Obstructive adenomas, Sheehans, Apopexy, Empty sella syndrome
What pituitary issue is a neurosurgical emergency?
pituitary apopexy (bleeding into an adenoma)
What is Hurthle cell change?
Eosinophilic metaplasia of cells lining thyroid follicles in Hashimoto thyroiditis
Which arthritis gets better throughout the day?
RA
How is albinism different from vitiligo?
Albinism is the congenital lack of pigment; vitiligo is an autoimmune destruction of melanocytes
Where do you see Pautrier microabscesses? Munro microabscesses?
Sezary syndrome and Mycosis fungoides; Psoriasis
What are the lipid abnormalities of graves disease?
HYPOcholesterolemia
Explain why pemphigus vulgaris has a Nikolsky sign
This is an easy ability to rupture the bulla; this is because there is only acantholysis of the stratum spinosum which is relatively superficial? This occurs because the antibodies are against the stratum spinosum desmosomes
Cystic lesion in cerebellum with mural nodule
Pilocytic astrocytoma, Rosenthal fibers GFAP (+)
What is erythema multiforme with oral mucosa and lip involvement referred to as?
Stevens Johnson syndrome
Name 3 leukodystrophies and what is deficient
Krabbe disease (galactocerebrosidase); Metachromatic leukodystrophy (most common, arylsulfatase A); Adrenoleukodystrophy (inability to add coA to long chain FA’s)
What kind of isotype are oligoclonal bands in MS?
IgG
2 tumors that familial retinoblastoma increases risk for
retinoblastoma and osteosarcoma
Which skeletal disorder is treated with bone marrow transplant, why?
Osteopetrosis because the osteoclasts are defective and they are from monocytes
Which type of CNS infarction is caused by hyaline arteriolosclerosis?
lacunar infarct
Name the 4 Thyroid Cancers
Papillary, Follicular, Medullary, Anaplastic
Degenerative Joint Dz is also called
Osteoarthritis
Which meningeal layers are affected by meningitis?
arachnoid and pia (leptomeninges)
3 structures affected by uncal herniation
CN III, PCA, paramedian artery
What does a person with mad cow disease have?
Variant Creutzfeld Jakob disease
Most common location for ependymoma
4th ventricle
What is the precursor lesion to SCC?
actinic keratosis
What is missing in a berry aneurysm in comparison to most vessels?
there is no medial layer? So the tunica media does not develop at the branch point (i.e. circle of willis) this causes formation of the aneurysm
Which skin cancer comes from neural crest?
melanoma
Name 4 blistering dermatoses
Pemphigus vulgaris, Bullous pemphigoid, Dermatitis herpetiformis, Erythema multiforme (SJS and TEN)
Only tumor to arise in the epiphysis
Giant Cell tumor of bone (osteoclastoma)
Why is acne vulgaris associated with puberty?
sebaceous (holocrine) glands have androgen receptors
What is the cause of the amyloid background in medullary carcinoma of the thyroid?
Calcitonin deposits as amyloid
Linear pattern of IgG immunofluorescence at the dermal epidermal junction of skin
Bullous pemphigoid - IgG at the hemidesmosomes
What is the major risk of Riedel Fibrosing Thryoiditis?
It may invade other structures such as the airway
Explain the exophthalmos and pretibial myxedema of Graves disease
The excessive TSH stimulation actually causes an increase in GAG synthesis; thus, THESE TISSUES EXPRESS THE TSH RECEPTOR
There is an increased risk of what cancer in Hashimoto?
Marginal Zone Lymphoma (a B cell cancer)
Sunburst appearance on Xray of metaphysis
osteosarcoma
Which dopamine receptors are stimulatory and inhibitory in the nigrostriatal pathway?
D1 is stimulatory; D2 is inhibitory but technically leads to disinhibtion
What is vitiligo?
autoimmune destruction of melanocytes
What inherited disorder has the same Sx as poliomyelitis? What is the route for polio?
Werdnig Hoffman; fecal oral
A malignant proliferation of parafollicular cells is seen in which cancer?
Medullary Carcinoma (from ultimobranchial body)
Which disease is associated with Wickham striae?
Lichen planus
Discuss the high dose dexamethasone suppression test
will decrease ACTH secretion from pituitary but not an ectopic site
What is the actual cause of erythema multiforme?
Hypersensitivity reaction to something (M. pneumoniae, HSV, drug)
What does an intradermal nevus arise from?
A compound nevus (junctional nevus with dermal extension) that has lost its junctional part
IgA at the tips of dermal papillae
Dermatitis herpetiformis (Tx dapsone, not in G6PD def)
Explain why CKD causes secondary hyperparathyroidism
There is decreased phosphate excretion which binds to calcium, this decreases the freely ionized calcium and causes PTH to be secreted
What is the risk associated with Osteochondromas?
The cartilaginous cap of the osteochondroma may transform to chondrosarcoma
Why does cortisol waste muscles?
The idea is to provide amino acids for gluconeogenesis
Explain the metabolic acidosis seen in osteopetrosis
There is metabolic acidosis because there is a deficiency of carbonic anhydrase that is not only in osteoclasts but also the renal tubules, thus less HCO3 is reabsorbed
Malignant cell in osteosarcoma
osteoblast
HLA type in RA?
HLA DR4
3 phases of Pagets Dz of bone
Osteoclastic; Mixed osteoclastic osteoblastic; Osteoblastic
Which HLA is psoriasis associated with?
HLA-C
Sensory loss of pain and temp with preserved fine touch in a cape like distribution
Syringomyelia
Breslow thickness is a staging technique for what cancer?
Depth of invasion of melanoma
What is the treatment for osteopetrosis
Bone marrow transplant to replace the defective osteoclasts
What is the etiology of Paget Dz of bone?
Probably viral
What kind of amyloidosis may be seen in rheumatoid arthritis?
Secondary amyloidosis = SAA –> AA (due to chronic inflammation)
What would be seen in the vessel of a lacunar infarct?
Hyaline arteriolosclerosis
Which thryoid cancer cannot be identified using an FNA?
Follicular carcinoma because you need to be able to see the invasion through the basement membrane
Differentiate pain mgmt in osteoid osteoma and osteoblastoma
Osteoid osteomas respond to asprin but osteoblastomas do not
Which seronegative spondyloarthropathy is associated with aortitis?
Ankylosing spondylitis is assoc with aortitis and uveitis
What is the most common cause of death in Alzheimers?
Infection because they become mute and bedridden
What is the most common cause of a dyshormonogenetic goiter?
Lack of thyroid peroxidase (can present as cretinism)
What is Ritter’s disease?
Staphylococcal scalded skin syndrome
Umbilicated papules
Molluscum contagiosum
Where do the following tumors arise 1) Osteoid osteoma and Osteoblastoma 2) Osteochondroma 3) Osteosarcoma 4) Giant Cell tumor 5) Ewing sarcoma 6) Chondroma 7) Chondrosarcoma
1) In the cortex of long bones 2) laterally from metaphysis 3) metaphysis 4 )epiphysis 5) diaphysis 6) medulla of small bones 7) medulla of large bones
Explain why a thrombotic stroke causes a pale infarct and an embolic stroke causes a hemorrhagic infarct
A thrombotic stroke chokes off blood supply; an embolic stroke will get lysed and cause a hemorrhagic stroke
2 complications of Paget Dz of Bone
High output cardiac failure (due to AVMs) and Osteosarcoma
Which type of “matter” is affected in degenerative disorders?
GREY, you are losing motor nuclei, deep basal nuclei or BOTH
3 Dz with leonine facies
Congenital syphilis, Paget Dz of bone, Hansen’s disease (lepromatous form)
Which skin cancer has peripheral pallisading?
basal cell carcinoma
Where does most of the arterial hyalinzation in DM occur in the kidney?
Efferent arteriole (increases risk of hyperfiltration injury)
Which myopathy is associated with gastric cancer?
Dermatomyositis
How do you Tx contact dermatitis?
Remove offending agent and give glucocorticoids
How would you treat a patient that has hypothyroidism following a viral illness?
De Quervain Thyroiditis is usually self limited
2 situations you see cold nodules on thyroid
Adenoma and carcinoma so warrants Bx (Hot nodules are in Graves and Nodular Goiter)
Name a childhood CNS malignancy caused by a tumor of neurons (not glia)
medulloblastoma (neuroectoderm–granular cells of cerebellum)
Which HLA types are associated with DM (2)?
HLA-DR3 and HLA-DR4 (type IV hypersensitivity)
Keratin pseudocysts are the hallmark of this
Seborrheic keratosis
Name 3 seronegative spondyloarthropathies
Ankylosing spondylitis, Psoriatic arthritis, and Reiters
2 syndromes associated with Berry aneurysm predisposition
Marfans Syndrome Autosomal Dominant PKD
What kind of necrosis occurs in an ischemic stroke?
Liquefactive necrosis; it is ALWAYS THIS WAY IN THE CNS
What is a keratoacanthoma?
A sporadic SCC that is well differentiated, comes on rapidly and regresses rapidly
Type of hypersensitivity in eczematous dermatitis. Type in contact dermatitis
Type I; Type IV
Where do osteochondromas arise?
Lateral projections from the metaphysis
How to you Tx normal pressure hydrocephalus
ventriculoperitoneal shunt
What autosomal dominant disorder predisposes to melanoma (not xeroderma pigmentosum)
dysplastic nevus syndrome; note that xeroderma pigmentosum also predisposes
What is the fatal complication of Graves disease?
Thyroid storm (if under stress, i.e. childbirth, surgery)
Which skin disorder has a tombstone appearance of basal cells?
Pemphigus vulgaris, the basal cells remain attached to the basement membrane
Where are metastatic CNS tumors usually located?
Grey-White Jxn
What should you think if there is numbness in tingling particularly in a circumoral pattern?
low calcium
What is the sign of Leser Trelat associated with?
This is a random eruption of several seborrheic keratoses and suggests underlying GI carcinoma
Which thyroid issue mimics anaplastic carcinoma of the thyroid but lacks malignant change?
Reidel Fibrosing Thryoiditis
Malignant tumor of osteoblasts
osteosarcoma
Regarding bullous pemphigoid and pemphigus vulgaris, in which is the oral mucosa spared?
bullous pemphigoid
Perimysial inflammation
Dermatomyositis
The process of genetic anticipation occurs during what reproductive process?
spermatogenesis (so in other words, dad is more responsible than mom for earlier onset of Huntington in their offspring)
Discuss empty sella syndrome
herniation of arachnoid and CSF into the sella turcica which compresses and destroys the pituitary gland
Rosenthal fibers
Pilocytic astrocytoma
Explain the drop in insulin seen in late Diabetes mellitus II
Beta cell exhaustion with AMYLOID DEPOSITION
Familial Cases of Alzheimers are assoicated with what protein? What about Down’s?
Presenelin 1 and 2; APP
What is Toxic Epidermal Necrolysis?
severe form of Stevens Johson Syndrome (form of erythema multiforme) that is characterized by diffuse sloughing of skin
In which cancer would you find a lipoblast?
liposarcoma
RET mutations are important in which thyroid cancer?
medullary (may be prophylactically excised)
What is the cause of psoriasis?
excessive keratinocyte production
Why would Chediak Higashi predispose to basal cell carcinoma?
It causes albinism (LYST mutation)
What is the conformational change that happens to prion protein in prion diseases?
Changes from an alpha helical structure to a beta helical structure
What is defective in osteopetrosis?
Osteoclast function (no carbonic anhydrase II, lack of acidic environment for reabsorption)
This CNS tumor may metastasize to the cauda equina
medulloblastoma (neuroectoderm–granular cells of cerebellum)
What is a Munro microabscess?
collection of neutrophils in the stratum corneum in psoriasis
Common cause of death in Huntington
Suicide
Saw-tooth appearance of dermal epidermal junction
Lichen planus
Reticular white lines (Wickham striae) on top of pruritic, planar, polygonal, purple papules
Lichen planus
2 drugs that may cause nephrogenic DI
lithium, demeclocycline
What is pseudohypoparathyroidism? If this is inherited in an AD pattern what will ther person look like?
End organ RESISTANCE to PTH; short stature and short 4th and 5th digits
What kind of goiter is observed in Graves Disease?
Diffuse Goiter since there is constant TSH stimulation everywhere
Cells affected by SSPE
ALL! It is PANencephalitis
Explain why chronic hypertension may cause either a lacunar infarct or a Charcot Bouchard aneurysm
Hyaline arteriolosclerosis can cause a lacunar infarct or it may weaken the wall of the vessel and lead to the formation of a Charcot Bouchard aneurysm
What is the autoimmune destruction of melanocytes referred to as?
vitiligo
What relieves an insulinoma medically?
glucose
Homer wright rosettes
medulloblastoma (neuroectoderm–granular cells of cerebellum)
Where does Ewings Sarcoma arise?
Diaphysis
Describe the histology of the skin cancer that predominately affects the lower lip
keratin pearls
The presence of charcot leyden crystals and curschmann spirals in sputum suggest an association with what kind of dermatitis?
Eczematous or atopic dermatitis (type I hypersens)
What are the 2 general paradigms for symptoms in degenerative disorders?
If cortical degeneration = dementia; If basal ganglia or deeper structure degeneration = movement disorder
What is a precursor lesion to melanoma?
Dysplastic nevus, literally dysplasia that arises in a nevus; HOWEVER, usually melanomas arise in areas of skin that did not have nevi
What is melasma?
hyperpigmentation of cheeks in pregnancy
Scanning speech is most similar to what?
Alcohol intoxication (MS ppl talk like drunk ppl)
Why do you give K in DKA which is a hyperkalemic metabolic acidosis?
Because when you give insulin they will become hypokalemic
Why does erythema multiforme have a targetoid rash?
The center is necrosis surrounded by areas of inflammation (erythema)
T/F: ALS is associated with a Babinski sign
It may be (and probably is) but that would depend on whether the LMN or UMN signs predominate
Scalloped colloid
Graves disease
Periodic sharp waves seen on EEG
Creutzfeld Jakob
Which thyroid cancer often invades local structures?
Anaplastic (note: the benign condition, Reidel Sclerosing Thyroiditis also can do this)
regions of necrosis surrounded by pseudopallisading tumor cells and endothelial proliferation
GBM
People taking human growth hormone or getting corneal transplants are at risk for what?
CJD
Benzoyl peroxide and vitamin A derivatives are used to treat _________
acne vulgaris
What predisposes the elderly to subdural hematomas
Age related cerebral atrophy
What is an eosinophilic structure in the cell of a substantia nigra of PD pt represent?
alpha synuclein lewy body
Fishnet immunofluorescent pattern on skin biopsy
Pemphigus vulgaris (IgG against desmoglein in stratum spinosum)
What is seen on histology of Hashimoto thyroiditis?
Germinal centers and Hurthle Cell change
Where is the classic location for basal cell carcinoma? SCC?
upper lip; lower lip
Which type of diabetes can present with DKA?
Type I only
Differentiate multinodular goiter from toxic multinodular goiter
A multinodular goiter is just an enlarged thyroid gland with nodules; a TOXIC multinodular goiter is when these nodules become independent of TSH and result in thyrotoxicosis
What is the most common cause of isolated alkaline phosphatase in an older pt?
Paget Dz of Bone
Sausage fingers and toes
Psoriatic arthritis
What is the most common type of thyroid carcinoma?
Papillary Carcinoma
What is the most common cause of chronic adrenal insufficiency in U.S.? Developing world?
Addison’s Autoimmune Adrenalitis; TB
Why doesnt bullous pemphigoid have a Nikolsky sign?
because the acantholysis occurs at the dermal epidermal junction due to antibodies against the hemidesmosomes that are situated there = TENSE BULLAE
What is the HLA association with MS?
HLA-DR2
Which 2 subtypes of melanoma have radial growth and good prognosis
superficial spreading and lentigo maligna
What is the mechanism by which MPTP and possibly paraquat causes PD?
damages mitochondria in the substantia nigra = cell death
Codman triangle
Dragging of the periosteum in an osteosarcoma (osteoblastic tumor) occurs in metaphysis
How would empty sella syndrome present?
hypopituitarism
Which CNS tumor occurs in brain parenchyma and is calcified?
oligodendroglioma
What is sequestrum and involucrum?
Sequestrum = lytic focus of osteomyelitis; involucrum = sclerotic surrounding portion
Autoimmune destruction of desmosomes between keratinocytes; Autoimmune destruction of hemidesmosomes between basal cells and basement membrane
Pemphigus vulgaris; Bullous pemphigoid
What is an eosinophilic metaplasia of thryoid follicle cells?
Hurthle cell change in Hashimoto thyroiditis
What are the lab findings in osteoporosis?
normal
Which CNS tumor metastasizes via CSF?
medulloblastoma (neuroectoderm–granular cells of cerebellum)
Etiology of primary gout
idiopathic
Desmin positive SKM cancer
Rhabdomyosarcoma
Where does the substrate accumulation occur in Krabbe disease? Metachromatic leukodystrophy?
Krabbe = galactocerebroside in MO; Metachromatic = sulfatides in lysosomes
Who gets the Rachitic rosary?
Rickett’s osteoid deposition in the costochondral jxn
Why do you use vitamin A derivatives to treat acne?
it reduces keratin production
