Neuropathology 1,2,3 Flashcards
A 43-year-old South Asian man is brought
into the emergency department with general-
ized seizures and fever >38 (101F). CT head
does not show any abnormality. LP is per-
formed with an opening pressure of 22 cm
H2O and CSF analysis shows: WCC 748
(Polymorphs 113, Lymphocytes 635), RBC
28, normal protein and normal glucose.
Which one of the following is the most likely
cause?
a. Enterovirus
b. Listeria monocytogenes
c. Mycobacterium tuberculosis
d. Streptococcus pneumoniae
e. Wegener’s granulomatosis
a. Enterovirus
A 45-year-old woman presents with sudden
onset headache and photophobia. CT head
is unremarkable and she undergoes a lumbar
puncture. CSF analysis shows WCC 3, RBC
15000 and subarachnoid hemorrhage cannot
be excluded due to the presence of oxyhemo-
globin. CSF xanthochromia is detected by
which one of the following assays
a. Fluorescence in situ hybridization
b. Immunoprecipitation
c. Light microscopy
d. Spectroscopy
e. Western blotting
b. Immunoprecipitation
Which one of the following is the most appropriate marker for tumor proliferation?
a. GFAP
b. Ki-67
c. LDH
d. P53
e. S100
b. Ki-67
Which one of the following pathologies is most likely to exhibit the finding shown?
a. Ataxia telangiectasia
b. Neurofibromatosis-1
c. Neurofibromatosis-2
d. Sturge-Weber syndrome
e. Tuberous sclerosis
b. Neurofibromatosis-1
Which one of the following is most accurate
regarding tumors with 0-6-methylguanine-
DNA methyltransferase methylation?
a. More susceptible to alkylating agents
b. More susceptible to antimetabolites
c. More susceptible to antitumor antibiotics
d. More susceptible to topoisomerase
inhibitors
e. More susceptible to ribunucleotide reduc-
tase inhibitors
a. More susceptible to alkylating agents
Which one of the following genetic muta-
tions are associated with improved brain
tumor prognosis?
a. Loss of 1p/19q
b. Loss of 1p/22q
c. Loss of 1p/10q
d. Loss of 1p/10q
e. Loss of 1p/10q
a. Loss of 1p/19q
Which one of the following types of cerebral
edema is seen in malignant hypertension?
a. Cytotoxic
b. Hydrostatic
c. Interstitial
d. Osmotic
e. Vasogenic
b. Hydrostatic
Cerebral ischemia is usually seen when global
cerebral blood flow is below:
a. 60 ml per 100 g tissue per min
b. 50 ml per 100 g tissue per min
c. 40 ml per 100 g tissue per min
d. 30 ml per 100 g tissue per min
e. 20 ml per 100 g tissue per min
e. 20 ml per 100 g tissue per min
Which one of the following descriptions sug-
gest WHO grade II astrocytoma?
a. Microcystic change
b. Nuclear atypia and hyperchromasia
c. >10 mitoses per high power field
d. Numerous mitoses and anaplasia
e. Microvascular proliferation or necrosis
b. Nuclear atypia and hyperchromasia
Which one of the following best describes the finding below?
a. Ash-leaf (macule)
b. Café-au-lait spot
c. Plexiform neurofibroma
d. Port wine stain
e. Shagreen patch
a—Ash-leaf spot
Which one of the following best describes
the finding below?
a. Cowden syndrome
b. Gorlin syndrome
c. MEN1
d. Tuberous sclerosis
e. Von Hippel Lindau
d. Tuberous sclerosis
Which one of the following genetic mutations
is most likely seen with the finding below?
a. 9q34/16p13
b. 3p25
c. 17p13
d. 9q22
e. 5q21
a. 9q34/16p13
Which one of the following best describes
the finding shown?
a. Angiofibroma
b. Collagenoma
c. Neurofibroma
d. Neuroma
e. Periungual fibroma
e. Periungual fibroma
Which one of the following findings are most
likely associated with the clinical feature below?
a. Brainstem arteriovenous malformation
b. GI polyps
c. Optic glioma
d. Retinal hamartoma
e. Sensorineural deafness
e. Sensorineural deafness
Which one of the following best describes
the finding shown?
a. Cowden syndrome
b. McCune-Albright syndrome
c. Neurofibromatosis type 1
d. Neurofibromatosis type 2
e. Rhabdoid tumor syndrome
c. Neurofibromatosis type 1
Which one of the following best describes
the finding shown?
a. Acanthosis nigricans
b. Legius syndrome
c. Muenke syndrome
d. Neurofibromatosis type 2
e. Pfeiffer syndrome
b. Legius syndrome
Which one of the following best describes
the finding shown?
a. Cowden syndrome
b. Legius syndrome
c. Neurofibromatosis type 1
d. Rhabdoid tumor syndrome
e. Tuberous sclerosis complex
c. Neurofibromatosis type 1
Which one of the following is most likely in
the image shown?
a. Basal cell naevus syndrome (Gorlin)
b. Hereditary Hemorrhagic Telangiectasia
c. Neurofibromatosis type 2
d. Sturge-Weber syndrome
e. Tuberous sclerosis
c. Neurofibromatosis type 2
Which one of the following is most likely in the image shown?
a. Crouzon syndrome
b. Familial adenomatous polyposis syndrome
c. Gardener’s syndrome
d. Gorlin syndrome
e. Osler-Weber-Rendu syndrome
d. Gorlin syndrome
Molecular assays of NS tumors:
a. B-cell and T-cell receptor gene rearran-
gement
b. BRAF-KIAA1549 gene fusion/
duplication
c. Chromosome 1p/19q loss
d. EGFR gene amplification/10q loss
e. EWSR1 gene rearrangement
f. MGMT promotor methylation status
g. Monosomy chromosome 6
h. MYC gene amplification
i. SMARCB1 gene loss/INI1 protein absent
j. Wnt signaling pathway upregulation
For each of the following descriptions, select the
most appropriate answers from the list above.
Each answer may be used once, more than once
or not at all.
1. Diagnosis of atypical teratoid/rhabdoid
tumor
2. Response to alkylating agents in high grade
glioma
3. Found in most pilocytic astrocytomas
1—i, 2—f, 3—b
Tumor syndromes:
a. APC
b. MEN1
c. NF-1
d. NF-2
e. PTCH
f. PTEN
g. SMARCB1
h. TP53
i. TSC1/TSC2
j. VHL
For each of the following descriptions, select the
most appropriate answers from the list above.
Each answer may be used once, more than once
or not at all.
1. Gliomas and medulloblastoma
2. AT/RT
3. Hemangioblastoma
1—a: APC (Turcot syndrome), 2—g: SMARCB1 (Rhabdoid tumor predisposition syndrome),
3—j: VHL (Von Hippel Lindau)
Tumor markers:
a. Alpha-fetoprotein (AFP)
b. Beta-2-microglobulin
c. Beta-human chorionic gonadotropin
d. CA-125
e. CA15-3/CA27.29
f. CA19-9
g. Calcitonin
h. CEA
i. Chromogranin-A
j. Cytokeratin fragment 21-1
k. HE-4
l. LDH
m. PSA
For each of the following descriptions, select the
most appropriate answers from the list above.
Each answer may be used once, more than once
or not at all.
1. Neuroendocrine tumors
2. Multiple myeloma
3. Liver and germ cell cancers
1—i: Chromogranin A, 2—b: Beta-2-microglobulin, 3—a: Alpha-fetoprotein
Cytopathology of neurones and glia:
a. Central chromatolysis
b. Cowdry type A intranuclear inclusions
c. Flexner Wintersteiner rosette
d. Hirano Bodies
e. Homer-Wright rosette
f. Inclusion bodies
g. Lewy bodies
h. Negri bodies
i. Neurofibrillary tangles
j. Perivascular pseudorosette
k. Pick Bodies
l. Pick Cells
m. Schiller-Duval bodies
n. Verocay bodies
For each of the following descriptions, select the
most appropriate answers from the list above.
Each answer may be used once, more than once
or not at all.
1. Schwannoma
2. Ependymoma
3. Retinoblastoma
4. Rabies virus
5. Alzheimer’s disease
1—n: Verocay, 2—j: Pseudorosette, 3—c: Flexner Wintersteiner rosette, 4—h: Negri bodies, 5—i:
Neurofibrillary tangles
Which one of the following is most likely
based on the image shown below?
a. Congestive edema
b. Diffuse cytotoxic edema
c. Focal cytotoxic edema
d. Interstitial edema
e. Vasogenic edema
e—Vasogenic edema secondary to GBM.
Widened gyri, narrowing of sulci, compression of ventricles may be focal or diffuse.
Vasogenic edema often associated with focal
lesions, tumors, abscess.
Which one of the following is most likely
based on the image shown below?
a. Arachnoid granulations
b. Calcification
c. Dural metastasis
d. Meningitis
e. Venous thrombosis
a—Arachnoid granulations. These whitish
granular structures are located at the superior
medial aspect of the cerebral hemispheres
near the sagital sinus. They function in resorption of CS.
Which one of the following is most likely
based on the image shown below?
a. Hydrocephalus
b. Subfalcine herniation
c. Tonsillar herniation
d. Transtentorial herniation
e. Upwards herniation
b—Subfalcine herniation
Which one of the following is most likely
based on the image shown below?
a. Brain stem compression
b. Demyelination
c. Infarction
d. Primary brainstem hemorrhagic stroke
e. Subarachnoid hemorrhage
a—Brain stem compression.
Which one of the following is most likely
based on the image shown below?
a. Alobar holoprosencephaly
b. Arhinencephaly
c. Lobar holoprosencephaly
d. Semilobar holoprosencephaly
e. Syntelencephaly
c—Lobar holoprosencephaly
Which one of the following is most likely
based on the image shown below?
a. Chiari I malformation
b. Chiari II malformation
c. Dandy-Walker Malformation
d. Joubert syndrome
e. Rhombencephalosynapsis
b—Chiari II malformation—small cerebellum
with marked tonsillar and vermian herniation
Which one of the following is most likely
based on the image shown below?
a. Chiari malformation III
b. Craniospinal rachischisis
c. Dandy-Walker malformation
d. Semilobar holoprosencephaly
e. Syntelencephaly
c—Dandy-Walker malformation
Which one of the following is most likely
based on the image shown below?
a. Focal cortical dysplasia
b. Lissencephaly type 1
c. Lissencephaly type 2
d. Pachygyria
e. Pick’s disease
d—Pachygyria—enlarged gyri adjacent to
sylvian fissure.
Which one of the following is most likely
based on the image shown below?
a. Acute diffuse hypoxia
b. Canavan disease
c. Carbon monoxide poisoning
d. Cerebral amyloid angiopathy
e. Pachygyria
a. Acute diffuse hypoxia
Which one of the following is most likely
based on the image shown below?
a. Huntington’s disease
b. Intraventricular hemorrhage
c. Multiple sclerosis
d. Multiple system atrophy
e. Periventricular leukomalacia
e—Periventricular leukomalacia (hemorrhagic). Areas of periventricular necrosis
may undergo extensive hemorrhage
Which one of the following is most likely
based on the image shown below?
a. Left ACA infarct
b. Left pericallosal infarct
c. Left SCA infarct
d. Right PCA infarct
e. Right pericallosal infarct
d—Right PCA infarct. Remote infarct in
region of right posterior cerebral artery
appears as a depressed, cavitated area.
Which one of the following is most likely
based on the image shown below?
a. Brain contusion
b. CNS lymphoma
c. Malignant infarction
d. Non-accidental injury
e. PRES
c—Malignant infarction. A massive
right cerebral infarct (recent) resulted in
hyperemia, swelling, and right cingulate gyrus
herniation.
Which one of the following is most likely
based on the image shown below?
a. Cerebral Toxoplasmosis
b. HSV encephalitis
c. Mycotic aneurysm
d. Rosenthal fibers
e. Tuberculous meningitis
c—Mycotic aneurysm. Vasoinvasive fungi
are revealed by Gomori methenamine silver
(GMS) stain
Which one of the following is most likely
based on the image shown below?
a. Arteriovenous malformation
b. Capillary telangiectasia
c. Caverous hemagioma
d. Developmental venous anomaly
e. Dural arteriovenous fistula
d—DVA—congenital venous malformation
Which one of the following is most likely
based on the image shown below?
a. Aneurysmal subarachnoid hemorrhage
b. Contrecoup contusion
c. Hemorrhagic stroke
d. Ischemic stroke
e. Vasculitis
b—Contrecoup contusions.
Which one of the following is most likely
based on the image shown below?
a. Kernicterus
b. Multicystic encephalopathy
c. Pontosubicular necrosis
d. Status marmoratus
e. Ulegyria
a—Kernicterus
Which one of the following is most likely
based on the image shown below?
a. Germinal matrix hemorrhage
b. Hydrancephaly
c. Lissencephaly
d. Multicystic encephalopathy
e. Porencephalic cyst
e—Porencephaly cyst
Which one of the following is most likely
based on the image shown below?
a. Agyria
b. Cobblestone cortex
c. Pachygyria
d. Porencephaly
e. Schizencephaly
e—Schizencephaly
Which one of the following is most likely in a
patient where the findings shown affect mul-
tiple (3 or more) lobes of the brain?
a. Cerebral infarct
b. Gliomatosis cerebri
c. Kernicterus
d. Periventricular leukomalacia
e. Primary CNS lymphoma
b—Gliomatosis cerebri
Which one of the following is most likely
based on the image shown below?
a. Idiopathic intracranial hypertension
b. NF-1
c. Retinal detachment
d. Retinoblastoma
e. Terson’s syndrome
b—NF-1
Which one of the following is most likely
based on the image shown below?
a. Diffuse astrocytoma
b. Germinal matrix hemorrhage
c. Perventricular heterotopia
d. Tuberous sclerosis
e. Von Hippel-Lindau
d—Tuberous sclerosis
Which one of the following is most likely
based on the image shown below?
a. Fourth ventricular subependymoma
b. Duret hemorrhage
c. Infarct of cerebellar vermis
d. Myxopapillary ependymoma
e. Tanycytic ependymoma
a—Fourth ventricular subependymoma
Which one of the following is most likely
based on the image shown below?
a. Atypical teratoid/rhabdoid tumor
b. Cerebral abscess
c. Choroid plexus papilloma
d. Intraventricular meningioma
e. Mesial temporal sclerosis
a—Atypical teratoid/rhabdoid tumor
Which one of the following is most likely
based on the image shown below?
a. Ependymoma
b. Glioblastoma multiforme
c. Meningioma
d. Oligodendroglioma
e. Supratentorial PNET
c—Meningioma
Which one of the following is most likely
based on the image shown below?
a. Arteriovenous malformation
b. Choroid plexus papilloma
c. Glioma
d. Intracranial aneurysm
e. Meningioma
e—This intraventricular meningioma arose from the choroid plexus on the left side. It had histologic features of a fibrous meningioma
Which one of the following is most likely
based on the image shown below?
a. Abscess
b. Aneurysm
c. Arachnoid cyst
d. Glioma
e. Schwannoma
e—Schwannoma.
Which one of the following is most likely
based on the image shown below?
a. Dermoid cyst
b. Diffuse astrocytoma
c. Hemorrhagic stroke
d. Intraventricular meningioma
e. Primary CNS lymphoma
e—Primary CNS lymphoma
Which one of the following is most likely
based on the image shown below?
a. Cerebral abscess
b. Cystic Meningioma
c. Ex-vacuo dilatation
d. Germinoma
e. Hemangioblastoma
e—Hemangioblastoma
Which one of the following is most likely
based on the image shown below?
a. Colloid cyst
b. Optic glioma
c. Pineal cyst
d. Pituitary adenoma
e. Sheehan’s syndrome
d—Large soft tan-brown pituitary adenoma
Which one of the following is most likely
based on the image shown below?
a. Arachnoid cyst
b. Dermoid cyst
c. Epidermoid cyst
d. Pineal cyst
e. Rathke’s cleft cyst
e—Rathke’s cleft cyst
Which one of the following is most likely
based on the image shown below?
a. Colloid cyst
b. Craniopharyngioma
c. Epidermoid cyst
d. Pituitary adenoma
e. Teratoma
a—Colloid cyst of third ventricle
Which one of the following is most likely
based on the image shown below?
a. Cerebral vasculitis
b. Multifocal glioma
c. Multiple abscesses
d. Multiple metastasis
e. Neurofibromatosis
d—Multiple metastasis.