Neuropathology Flashcards
1. Neoplasma SSP primer manakah yang berasosiasi dengan badan-badan granular eosinopilik (eosinophilic granular bodies)? A. Anstrositoma Anaplastik B. Oligodendroglioma C. Astrositoma Genistositik D.Astrositoa Pilositik E.Gerninoma
D. Pilocytic astrocytomas typically have a biphasic
appearance. They usually consist of regions of elongated cells arranged in compact fascicles intermixed with regions of stellate cells that encompass microcysts. Pilocytic astrocytomas can exhibit some nuclear pleomorphism and hyperchromasia, but mitoses and necrosis are absent. These tumors are classically associated with Rosenthal fibers and intracellular eosinophilic globules (granular bodies) . Intracellular eosinophilic conglomerations can also be observed in pleomorphic xanthoastrocytoma but not anaplastic astrocytoma or oligodendroglioma. Gemistocytic astrocytoma is characterized by large , plump astrocytes with diffuse, glassy cytoplasm
2. Manakah di antara yang berikut ini yang berasosiasi dengan deposisi dari phosphorylated Tau-protein ? A. HIRANO bodies B. Kait neurofibrilaris C. Plak amiloid difusi D. LEWY bodies E. Degenerasi granulovakuolar
B . Neurofibrillary tangles (NFTs) are cytoplasmic, basophilic structures that are prevalent in neurons in patients with Alzheimer’s disease (AD) . NFTs contain large amounts of paired helical filament protein, which largely consists of hyperphosphorylated tau. Tau protein is also phosphorylated in normal brain; however, these phosphate groups are easily removed by phosphatases. The hyperphosphorylated tau of NFTs is largely resistant to phosphatases, which may be a key feature in its deposition in AD. Other key features of AD include Hirano bodies (which are composed of actin) , amyloid plaques, and granulovacuolar degeneration (which primarily affects hippocampal neurons) .
- Neoplasma manakah yang dijelaskan pada fotomikrograf di bawah ini?
PIC
A. Lymphoma B. Fibrillary astrocytoma C. Glioblastoma D.Medulloblastoma E. Meningioma
C. Glioblastoma multiforme ( GB11 ) is characterized by cellular pleomorphism and a dh•ersity of histologic appearances. Regardless of the predominant histologic pattern of a particular GEM, cytologic pleomorphism, nuclear hyperchromasia, and frequent mitoses are often obsen•ed. By definition, tumor necrosis and/or microvascular proliferation is present. Pseudopalisading of neoplastic cells around a central necrotic region (pseudopalisading necrosis ) . as depicted here, is characteristic of GB
4. Kelainan kromosom manakah yang berasosiasi dgn neurofibromatosis Tipe 1? A. 5 B. 7 C. 10 D. 17 E. 20
D. Neurofibromatosis type 1 is associated with abnormalities of the neurofibromin gene, which is located on chromosome 1 7q l l . NFI exhibits autosomal inheritance with almost complete penetrance; however, approximately 50% of all cases are secondary to spontaneous mutations. Neurofibromin is a guanosine triphosphatase-activating protein that is important for cell proliferation and differentiation
5. Infeksi CMV kongenital ditandai oleh semua hal di bawah ini, KECUALI A. Kalsifikasi periventrikular B. Nodula mikrogial C. Klorioretinitis D. Megalensepali E. Hidrosepalus
D. Congenital CMV infection represents the most common intrauterine viral infection, affecting 0.5 to 2 . 0% of all births. Macroscopically, CMV infection is characterized by microcephaly, periventricular and basal ganglial calcifications, and hydrocephalus. Microscopically, CMV infections exhibit microglial nodules, cytomegalic inclusion cells, ventriculoencephalitis, and gliosis. Infants with congenital GtvfV infections can also exhibit mental retardation, seizures, chorioretinitis, optic atrophy, sensorineural hearing loss, and death in 30% of acute infections
6. Diantara gangguan-gangguan di bawah ini, gangguan manakah yg berasosiasi dengan sel-sel OPALSKI pada pemeriksaan mikroskopik? A. Penyakit HALLERVORDEN-SPATZ B. Penyakit WERDNIG-HOFFMAN C. Penyakit WILSON D. Penyakit TAY-SACHS E. Penyakit GAUCHER
C. Opalski cells are round, with a small central nucleus and prominent granular eosinophilic cytoplasm . These cells are most commonly observed in the globus pallidus in patients with Wilson’s disease (hepatolenticular degeneration) and acquired hepatic encephalopathy
7. Di antara protein-protein di bawah ini, protein manakah yang membentuk dari LEWY body ? A. Ubikuitin B. Neurofilamen C. α-Sinuklein D. A & B E. Semua benar
E . Lewy bodies are associated with Parkinson’s disease and are composed of neurofilament proteins (form the cytoskeleton of the inclusion), ubiquitin ( ilwoh’ed in Cytosolic proteolisis), a.B crystallin (neurofilament chaperone protein) , and a.-synuclein (catalyze phosphorylation of neurofilaments). Immunohistochemical stains for ubiquitin are among the most sensitive methods of identiiying Y bodies
8. Penyakit CANAVAN disebabkan defisiensi enzim yang mana? A. Aspartoasilase B. Aril Sulfatase A C. Glukoserebrosidase D. Heksosaminidase A E. Iduronidase
A. Canavan’s disease (spongiform leukodistrophy) is an autosomal recessive disorder characterized by extensive vacuolation of the white matter due to the widespread loss of myelin at the gray-white junction. Although cortical neurons are normal, there are numerous Alzheimer type II astrocytes within the gray matter. Cortical changes include enlarged pale astrocytes in the deeper cortical layers that contain abnormally long mitochondria with ladder-like cristae, an abnormality unique to Canavan’s disease. Canavan’s disease does not spare the subcortical U fibers and is a result of deficiencies of the enzyme aspartoacylase
- Apa yang dijelaskan pada foto-mikrgraf di bawah ini ?
PIC
A. Astrositoma fibrilaris B. Astrositosis Reaktif C. Astrositoma anaplastik D.Meningioma sel bening E. Tumot sac merah telur
A. Fibrillary astrocytoma is characterized by atypical astrocytes in a loose fibrillary matrix. The neoplastic cells lack visible cytoplasm and show features of mild nuclear atypia, such as hyperchromasia, elongation, or angulation . As in this case, microcysts are often prominent. li’Iitoses, necrosis, and endothelial proliferation are not observed. Reactive astrocytosis can occasionally be confused with a fibrillary astrocytoma; however, astrocytosis is characterized by an even distribution of slightly enlarged astrocytic nuclei with abundant cytoplasm and long, tapering processes. There is usually no significant hypercellularity in reactive astrocytosis. Microcysts are also not observed with reactive astrocytosis
10. Neoplasma berikut yang mana TIDAK berasosiasi dgn neurofibromatosis tipe 2 ? A. Ependimoma B. Schwannoma C. Meningioma D. Glioma E. Neurofibroma Fleksiform
E. NF-2 is an autosomal dominant condition that is most commonly associated with bilateral schwannomas of the eighth cranial nerve and multiple intracranial meningiomas. NF-2 is also associated with schwannomas of other cranial nerves, spinal meningiomas, astrocytomas (spinal, brainstem, and cerebellar), and spinal ependymomas. Spinal schwannomas are occasionally observed with NF-2, although spinal neurofibromas and plexiform neurofibromas are not
- Riwayat klinis manakah yang paling mungkin berhubungan dengan fotomikrograf di bawah ini?
PIC
A. Kejang-kejang dan hipotonia progresif semasa bayi
B. Penyakit demensia yang cepat berkembang semasa dewasa
C. Defisit neurologis fokal yang semakin lama semakin progresif
D. Luka asimptomatis yang seringkali dapat dirawat dengan antibiotik saja
E. Luka asimptomatis yang biasanya merespons dengan baik hanya kepada pembedahan saja
B. The photomicrograph illustrates the classic spongiform change that is associated with Creutzfeldt-Jalwb disease (CJD) . CJD usually affects adults in the sixth to eighth decades of life: Approximately 85% of all cases of CJD are sporadic and 10% are familial. Microscopically, CJD is characterized by neuronal loss, astrocytosis, spongiform change (fine vacuolation of the neuropil). and a lack of inflammation. Clinically, CJD is characterized initially by subtle motor signs and ataxia, followed by a rapidly progressive dementing illness that culminates in Severe myoclonus, akinetic mutism. and death within 1 year from initial symptom onset. The prion diseases, including C.ID, GerstmannStraussler- Scheinker disease, fatal familial insomnia, and kuru, are helieved to have a common molecular pathology that im•oh-cs the conversion of a normal cellular protein (encoded on human chromosome 2 0 ) , called prion protein ( PrP), into an abnormal isoform that is resistant to protease degradation. This abnormal isoform is believed to accumulate within cells, and also outside of cells in the form of amyloid though immunostaining for PrP’c’ is diagnostic for CJ D . the CSF immunoassay for protein has 96% sensitivity and specificity for detecting CJD among patients with dementia. The characteristic EEG findings include bilateral, symmetric, and periodic bi- or triphasic synchronous sharp-wave complexes (periodic spikes, 0.5 to 2/s), which have 70% sensitivity and 86% specificity for CJD. Fully effective and recommended operating room procedures for instrument sterilization includes steam autoclaving for 1 hour at 132°C or immersion in IN sodium hydroxide (NaOI-I) for 1 hour at room temperature. Partially effective procedures include steam autoclaving at either 121 or 132°C for 15 to 30 minutes, immersion in IN NaOI-I for 15 m inutes, or immersion in sodium hypochlorite (household bleach) undiluted or up to 1 : 10 dilution (0.5%) for 1 hour. Ineffective sterilization procedures include boiling, mr light, ionizing radiation, ethylene oxide, ethanol, formalin, betapropiolactone, ammonium compounds, iodine , or acetone
12. MARINESCO bodies A. Aktin B. Ubikuitin C. Poliglukosan D. Sklerosis lateral amiotropik E. α-Sinuklein
B. Marinesco bodies are small eosinophilic infranuclear inclusions that are prominent in neurons of the substantia nigra and are composed largely of ubiquitin and intermediate filaments. Lafora bodies are composed of polysaccharide polvmers (polyglucosans) and have a round core that is strongly PAS-positive. Bunina bodies are small eosinophilic inclusions that are obsenved in motor neuron diseases such as amyotrophic lateral sclerosis. Hirano bodies are brightly eosinophilic cytoplasmic inclusions that are prominent in hippocampal neurons in Alzheimer’s disease. Hirano bodies are composed of actin and actinassociated proteins. Pick bodies are slightly basophilic neuronal cytoplasmic inclusions that are observed in all layers of the cerebral cortex and some subcortical nuclei in patients with Pick’s disease. Pick bodies consist of ubiquitin, tubulin, tau, and chromogranin-A
13. LAFORA bodies A. Aktin B. Ubikuitin C. Poliglukosan D. Sklerosis lateral amiotropik E. α-Sinuklein
C. Marinesco bodies are small eosinophilic infranuclear inclusions that are prominent in neurons of the substantia nigra and are composed largely of ubiquitin and intermediate filaments. Lafora bodies are composed of polysaccharide polvmers (polyglucosans) and have a round core that is strongly PAS-positive. Bunina bodies are small eosinophilic inclusions that are obsenved in motor neuron diseases such as amyotrophic lateral sclerosis. Hirano bodies are brightly eosinophilic cytoplasmic inclusions that are prominent in hippocampal neurons in Alzheimer’s disease. Hirano bodies are composed of actin and actinassociated proteins. Pick bodies are slightly basophilic neuronal cytoplasmic inclusions that are observed in all layers of the cerebral cortex and some subcortical nuclei in patients with Pick’s disease. Pick bodies consist of ubiquitin, tubulin, tau, and chromogranin-A
14. BUNINA bodies A. Aktin B. Ubikuitin C. Poliglukosan D. Sklerosis lateral amiotropik E. α-Sinuklein
D. Marinesco bodies are small eosinophilic infranuclear inclusions that are prominent in neurons of the substantia nigra and are composed largely of ubiquitin and intermediate filaments. Lafora bodies are composed of polysaccharide polvmers (polyglucosans) and have a round core that is strongly PAS-positive. Bunina bodies are small eosinophilic inclusions that are obsenved in motor neuron diseases such as amyotrophic lateral sclerosis. Hirano bodies are brightly eosinophilic cytoplasmic inclusions that are prominent in hippocampal neurons in Alzheimer’s disease. Hirano bodies are composed of actin and actinassociated proteins. Pick bodies are slightly basophilic neuronal cytoplasmic inclusions that are observed in all layers of the cerebral cortex and some subcortical nuclei in patients with Pick’s disease. Pick bodies consist of ubiquitin, tubulin, tau, and chromogranin-A
15. HIRANO bodies A. Aktin B. Ubikuitin C. Poliglukosan D. Sklerosis lateral amiotropik E. α-Sinuklein
A. Marinesco bodies are small eosinophilic infranuclear inclusions that are prominent in neurons of the substantia nigra and are composed largely of ubiquitin and intermediate filaments. Lafora bodies are composed of polysaccharide polvmers (polyglucosans) and have a round core that is strongly PAS-positive. Bunina bodies are small eosinophilic inclusions that are obsenved in motor neuron diseases such as amyotrophic lateral sclerosis. Hirano bodies are brightly eosinophilic cytoplasmic inclusions that are prominent in hippocampal neurons in Alzheimer’s disease. Hirano bodies are composed of actin and actinassociated proteins. Pick bodies are slightly basophilic neuronal cytoplasmic inclusions that are observed in all layers of the cerebral cortex and some subcortical nuclei in patients with Pick’s disease. Pick bodies consist of ubiquitin, tubulin, tau, and chromogranin-A
16. PICK bodies A. Aktin B. Ubikuitin C. Poliglukosan D. Sklerosis lateral amiotropik E. α-Sinuklein
B. Marinesco bodies are small eosinophilic infranuclear inclusions that are prominent in neurons of the substantia nigra and are composed largely of ubiquitin and intermediate filaments. Lafora bodies are composed of polysaccharide polvmers (polyglucosans) and have a round core that is strongly PAS-positive. Bunina bodies are small eosinophilic inclusions that are obsenved in motor neuron diseases such as amyotrophic lateral sclerosis. Hirano bodies are brightly eosinophilic cytoplasmic inclusions that are prominent in hippocampal neurons in Alzheimer’s disease. Hirano bodies are composed of actin and actinassociated proteins. Pick bodies are slightly basophilic neuronal cytoplasmic inclusions that are observed in all layers of the cerebral cortex and some subcortical nuclei in patients with Pick’s disease. Pick bodies consist of ubiquitin, tubulin, tau, and chromogranin-A
- Kondisi patologis manakah yang dijelaskan
pada fotomikrograf di bawah ini ?
PIC
A. Telangiestasia kapilaris B. Malformasi Kavernus C. Angioma Venus D. Malformasi Arteriovenus E. Meningioma Angiomatus
D . Arteriovenous malformations (AVMs) are characterized by clusters of dilated vessels of varying diameters with abnormally thick or thin walls and occasional intervening brain parenchyma. AVMs often contain calcification, and the surrounding brain parenchyma may exhibit prominen astrocytosis. Capillary telangiectasias consist of much smaller, uniformly thin-walled vascular channels without evidence of hemorrhage or surrounding astrocvtosis. Cavernous malformations are characterized hightly packed hyalinized vascular channels without elastic tissue. There is usually no intervening brain parcnchyma. Venous angiomas are composed of th in-walled. dilated vascular channels interspersed among normal brain parenchyma
- Ciri-ciri hematoma subdural kronis yang manakah yang paling mungkin menyebabkan ekspansi progresif dalam ukuran seiring berjalannya waktu?
A. Kambuhnya cedera tabir penyambung
B. Migrasi osmotis menyeberangi dura ke ruang sub-dura
C. Pendarahan di jaringan granulasi dari psudomembran
D. Pecahnya penneykat darah-otak pada parensima otak di dekatnya
E. Jawaban A, B, C dan D semuanya salah.
C. Chronic subdural hematomas (SDH) are usually initiated from the tearing of bridging veins, which can often be precipitated by minimal trauma in patients with significant cerebral atrophy. After the initial hemorrhagic event . a pseudomembrane organizes immediately beneath the fibrous dura along the surface of the hematoma. This pseudomembrane develops dense granulation tissue with prominent neovascularization. Large-caliber vessels in this granulation tissue are initially unstable and tend to bleed spontaneously, which leads to progressive, stepwise enlargement of the SOH
- Etiologi manakah yang dijelaskan pada fotomikrograf di bawah ini yang paling mungkin pada spesimen kasar tersebut?
PIC
A. Kontusi langsung B. Cedera sobek C. Herniasi D. Diseksi arterial E. Bisul arterial
C. This specimen exhibits a prominent pontine hemorrhage, known as a Duret hemorrhage. Duret hemorrhages occur when internal herniation (usually transten torial herniation) results in compression or stretching of pontine perfora ting vessels. This leads tO ischemic damage in the pons, which then undergoes secondary hemorrhagic conYersion. This type of hemorrhage is not a direct result of trauma and occurs only after prolonged elevations in intracranial pressure with concomitant herniation
20. Organisme manakah yang paling lazim diisolasi dari abses intracranial? A. Staphylococcus aureus B. Pseudomonas aeruginosa C. Streptococcus pneumoniae D. Streptococcus milleri E. Mycobacterium tuberculosis
D. Streptococcus milleri is the most common isolate from intracranial abscesses. t-Inny intracranial abscesses are polymicrobial, however. Infants are particularlY susceptible to developing abscesses in association with the depelopment of meningitis from infections bv Citrobacter diversus or Proteus mirabilis. Brain abscesses often result from hematogenous seeding in a septic patient ( 25% ) , or direct spread from infections of the middle ear, paranasal sinuses. or dental roots (SO%)
- Neoplasma manakah yang ditunjukan pada fotomikrograf di bawah ini?
A. Koriokarsinoma B. Tumor sac indung telur C. Meningoma sekretoris D. Germinoma E. Ependimoma
D. Germinoma
22. Saraf kranial manakah yang paling lazim terkena neurosarkoidosis? A. Optik B. Okulomotor C. Trigeminal D. Abdusens E. Fasialis
E . The facial nerve by far the most commonly involved cranial nerve with neurosarcoidosis. In iact. the most common clinical presentation oi ncurosarcoidosis
23. Daerah otak manakah yang menunjukkan atropi prominen dengan penyakit Alzheimer? 1. Hipokampus 2. Lobe osipital 3. Lobe frontal 4. korteks notorik primer
B. The gross brain of patients with Alzheimer’s disease usually exhibits prominent atrophy of the medial temporal lobes, anterior frontal lobes, and the parietal lobes. The hippocampus is particularly affected, whereas the motor cortex and occipital lobes are usually spared
- Deposisi bilirubin pada otak neonatal dengan kernikterus lazimnya tampak pada daerah mana?
- Nukleus Subtalamik
- Globus Pallidus
- Dentate nucleus
- Nukleus merah
A. Bilirubin deposition with kernicterus is evidenced by yellow staining of several deep gray structures in the gross specimen. The most commonly involved regions include the lateral thalamus, globus pallidus, and subthalamic nucleus. The hipp,pcampus, colliculi, substantia nigra pars reticulata, dentate nucleus, inferior olives, brainstem reticular formation, and cranial nerve nuclei are also affected. It is the unconjugated form of bilirubin that is toxic, and its accumulation leads to neuronal necrosis with subsequent gliosis
25. Tn. X, 58 tahun dibawa dengan kejang focal dan ditemukan massa lobe frontal besar yang berasal dari pertemuan abu-abu-putih berdasarkan hasil MRI. Pasien menjalani biopsi diagnostik, dan spesimen-nya adalah CD45-negatif, vimentin-positif, sitokeratin-AE1/3 positif dan EMA-Negatif. Temuan ini paling konsisten dengan neoplasma yang mana? A. Limpoma B. Karsinoma Metastatik C. Glioblastoma D. Hemangiopersitoma E. Meningioma
C. Glioblastoma mul tifonne exhibits · staining for both vimentin and S-100. GBfl’ls are usually focally positive for GFAP as well . With small tissue biopsies, it can be difficult to distinguish GBM from metastatic carcinoma and lymphoma.Metastatic carcinoma exhibits staining for epithelial membrane
antigen ( EMA) and cytokeratins, while lymphoma is CD4S-positive, which distinguishes these neoplasms from GBM. However, occasionally exhibits cross reactivity with some keratin stains (e.g. , AE l/3 ). Hemangiopericytoma is vimentin-positive and EMA negative; however, it does not exh ibit AE l/3 cross-reactivity
- Varian-varian meningioma yang manakah yang ditunjukan pada fotomikrograf di bawah ini
PIC
A. Meningothelial B. Fibrus C. Transisional D. Sekretoris E. Kordoid
C. Meningothelial meningiomas exhibit sheets o r lobules of cells with oval nuclei and indistinct cell borders. Rudimentary whorls are often present. Fibrous meningiomas exhibit streaming of elongated (spindle-shaped) nuclei with prominent surrounding collagen deposition. Transitional meningiomas contain elements of both meningothelial and fibrous variants. Transitional variants exhibit whorls or lobules as well as a fascicular (streaming) pattern of neoplastic cells, as depicted here. Secretory meningiomas can exhibit a transitional or meningothelial pattern; however, many cells contain prominent eosinophilic (PAS-positive) globules. Chordoid meningiomas exhibit columns of cells surrounded by a mucoid matrix, thus resembling a chordoma
27. Varian-varian meningioma manakah yang berasosiasi dengan perilaku klinis yang lebih agresif? A. Papilari B. Angiomatus C. Kordoid D. Sel bening E. Metaplastik
A. Papillary meningiomas are unique variants that exhibit a high nuclear-cytoplasmic ratio, prominent mitoses, metastasis throughout the C S via CSF pathways, and occasional metastasis outside the CNS. Other meningioma variants are considered atypical if they exhibit prominem mitoses , increased cellularity, sheet-like growth patterns. and necrosis. Anaplastic meningiomas are frankly mali
28. cara dominan autosomal melalui mutasi pada gen dismutase superoksida (SOD1)? A. Penyakit REFSUM B. Sindroma SANFILIPPO C. Sindroma Zellweger D. Selerosis lateral amiotropis E. Jawaban A, B, C dan D semuanya salah
D. Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder that results in the loss of upper and lower motor neurons. Although the cause of ALS is unknown, 5 to 10% of all cases of ALS are inherited i n an autosomal dominant fashion. Approximately 25% of these familial cases of ALS are secondary to mutations of the copper/zinc superoxide dismutase (SOD1) gene located on chromosome 21q. Refsum’s disease results from deficiencies of the enzyme phytanoyl CoA hydroxylase, which results in the accumulation of phytanic acid. Clinical manifestations of Refsum’s disease include ataxia, peripheral neuropathy, and retinitis pigmentosa. Sanfilippo syndrome is one of the mucopolysaccharidoses and results from defective glucosaminoglycan (heparan sulfate) metabolism. Zellweger syndrome is a peroxisomal disorder that is associated with pachygyria, polymicrogyria, and various heterotopias
- Kompleks Histokompatibilitas utama manakah yang berasosiasi dengan perkembangan Sklerosis multiple?
- HLA-DR15
- HKA-DR2
- HLA-B7
- HLA-DR4
A. Multiple sclerosis ( MS ) is classically associated with the HLA-DR2 allele, and HLA-D R 1 S is common in Northern Europeans with MS . The HLA alleles A3, B7, and DR3 are also overrepresented in the MS population. The incidence and prevalence of MS vary with latitude, increasing wi th greater distance from the equator. If, however, an individual migrates to a higher-risk latitude after the teen years, that individual’s risk of developing MS is no greater than the risk associated with the original region
30. Limpoma A. Vimentin B. CD 45 C. CD 43 D. S-100 E. Sinaptofisin
B. Hemangiopericytoma is vimentinpositive, with focal reactivity to CD34 as well. The sustentacular cell of paragangliomas exhibits immunoreactivity for S-100, while chief cells exhibit chromogranin-A and synaptophysin positivity. Meningiomas are vimentin positive, with occasional focal reactivity for EM.A, S 100, and cytokeratins. Notably, meningiomas are GFAP-negative. Central neurocytoma exhibits immunoreactivity for synaptophysin, GFAP, and neurofilament proteins. Primary CNS T-cell lymphomas are CD 4 5- and CD 3-positive, while B cell lymphomas usually show immunoreactivity to CD 79a and CD 20
31. Hemangioperisitoma A. Vimentin B. CD 45 C. CD 43 D. S-100 E. Sinaptofisin
C. Hemangiopericytoma is vimentinpositive, with focal reactivity to CD34 as well. The sustentacular cell of paragangliomas exhibits immunoreactivity for S-100, while chief cells exhibit chromogranin-A and synaptophysin positivity. Meningiomas are vimentin positive, with occasional focal reactivity for EM.A, S 100, and cytokeratins. Notably, meningiomas are GFAP-negative. Central neurocytoma exhibits immunoreactivity for synaptophysin, GFAP, and neurofilament proteins. Primary CNS T-cell lymphomas are CD 4 5- and CD 3-positive, while B cell lymphomas usually show immunoreactivity to CD 79a and CD 20
32. Sel sustentakular dari paraganglioma A. Vimentin B. CD 45 C. CD 43 D. S-100 E. Sinaptofisin
D. Hemangiopericytoma is vimentinpositive, with focal reactivity to CD34 as well. The sustentacular cell of paragangliomas exhibits immunoreactivity for S-100, while chief cells exhibit chromogranin-A and synaptophysin positivity. Meningiomas are vimentin positive, with occasional focal reactivity for EM.A, S 100, and cytokeratins. Notably, meningiomas are GFAP-negative. Central neurocytoma exhibits immunoreactivity for synaptophysin, GFAP, and neurofilament proteins. Primary CNS T-cell lymphomas are CD 4 5- and CD 3-positive, while B cell lymphomas usually show immunoreactivity to CD 79a and CD 20
33. Meningioma A. Vimentin B. CD 45 C. CD 43 D. S-100 E. Sinaptofisin
A. Hemangiopericytoma is vimentinpositive, with focal reactivity to CD34 as well. The sustentacular cell of paragangliomas exhibits immunoreactivity for S-100, while chief cells exhibit chromogranin-A and synaptophysin positivity. Meningiomas are vimentin positive, with occasional focal reactivity for EM.A, S 100, and cytokeratins. Notably, meningiomas are GFAP-negative. Central neurocytoma exhibits immunoreactivity for synaptophysin, GFAP, and neurofilament proteins. Primary CNS T-cell lymphomas are CD 4 5- and CD 3-positive, while B cell lymphomas usually show immunoreactivity to CD 79a and CD 20
34. Neurositoma sentral A. Vimentin B. CD 45 C. CD 43 D. S-100 E. Sinaptofisin
E. Hemangiopericytoma is vimentinpositive, with focal reactivity to CD34 as well. The sustentacular cell of paragangliomas exhibits immunoreactivity for S-100, while chief cells exhibit chromogranin-A and synaptophysin positivity. Meningiomas are vimentin positive, with occasional focal reactivity for EM.A, S 100, and cytokeratins. Notably, meningiomas are GFAP-negative. Central neurocytoma exhibits immunoreactivity for synaptophysin, GFAP, and neurofilament proteins. Primary CNS T-cell lymphomas are CD 4 5- and CD 3-positive, while B cell lymphomas usually show immunoreactivity to CD 79a and CD 20
- Neoplasma apa yg dijelaskan pd fotomikrograf
PIC
A. Meningioma sel bening B. Meduloblastoma C. Astrositoma fibrilaris D. Oligodendroglioma E. Hemangioperisitoma
D. Oligodendroglioma
- Kelainan apakah yang ditunjukkan pada fotomikrograf di bawah ini ?
A. Astrositoma gemistrositik B. Astrositosis Reaktif C. Infark akut D. Ensepalistis viral E. Meningitis Bakteria
C. Infark akut
37. Manakah yang TIDAK tampak pada cedera spinal cord akut jika menggunakan mikroskop? A. Steroid aksonal B. Nekrosis hemorargis C. Kavitasi D. Infiltrasi inflamatoris E. Edema
C . Acute spinal cord injury i s characterized b y axonal swellings (spheroids), hemorrhagic necrosis of gray and white matter, and variable amounts of surrounding edema. Over the following weeks there is infiltration of macrophages and a gradual removal of myelin and neuronal debris. Posttraumatic syrinx formation, or cavitation, is a relatively late feature of spinal cord injury, often occurring months to years after the original injury. The gray matter often shows prominent fibroblastic proliferation and associated collagenous fibrosis, as well as hyaline thickening of small blood vessels
38. Manakah yang merupakan kelainan kromosom yang paling lazim berasosiasi dengan Meningioma? A. Hilang allelic sejumlah 1 p B. Monosomi 22 C. Hilang allelic sejumlah 10 D. Hilang allelic sejumlah 22 q E. Monosoma 2
B. Monosomy 22 is by far the most common cytogenetic abnormality of meningiomas, and greater than 75% of all meningiomas exhibit loss of heterozygosite· for chromosome 22q markers. Allelic losses of chromosomes 1 p , 10, and 14q are associated with progression to more aggressive meningiomas (atypical and anaplastic ) . Despite the occurrence of (multiple) meningiomas with Nf-2. Which also localizes to chromosome 22, the tumor suppressor gene that is responsible for tumorigenesis with meningiomas in patients without neurofibromatosis is separate from the NF-2 gene locus
39. Manakah yang merupakan pola keturunan dari sindroma Sturge-Weber? A. Resesif-Autosomal B. Dominan-Autsomal C. Resesif terkait-X D. Mitokondrioal E. Sporadis
E. Sturge-Weber svndrome ( encephalotrigeminal angiomatosis) is a neurocutaneous disorder that occurs sporadically. The disorder is characterized by port wine stains in the distribution of the sensory fibers of the trigeminal nerve, with associated ocular angiomas and leptomeningeal venous angiomas of the ipsilateral cerebral hemisphere. Occasionally the cerebral hemispheres are involved bilaterally. Most patients with Sturge-Weber syndrome develop epilepsy over time, and many exhibit progressive neurologic deficits such as hemiparesis, hemisensory loss, and homonymous hemianopsia. O n microscopic analysis, there is widespread gliosis and dystrophic calcification of the involved brain parenchyma, with iron and calcium deposition in large, tortuous meningeal vessels. The treatment of this disorder is largely symptomatic
- Gangguan manakah yang berasosiasi dengan luka yg ditunjukkan pd fotomikrograf di bwh ini?
PIC - HIV ensepalistis
- Toksoplasmosis
- CMV ensepalistis
- Neurosifilis
E. This photomicrograph depicts a microglial nodule. Microglia typically have rod-shaped nuclei and are CD68-positive. Microglia proliferate in many chronic CNS infections and viral encephalitides. IV!icroglial nodules sometimes contain neurons with viral inclusion bodies, and they are commonly observed with neurosyphilis, toxoplasmosis, and many different viral infections of the CNS (e.g. , C.tl-fV, I-IIV, arboviruses, polioviruses) . The aggregation of microgl ia and macrophages around dying neurons is called “neuronophagia”
- Manakah di antara ciri-ciri di bawah ini yang TIDAK berasosiasi dengan Sindroma Hunter (mukopolisakaridsis Tipe II)?
A. Gangguan lisosomal B. Keturunan resesif-rantai-X C. Hepatosplenomegali D. Kornea buram E. Keterbelakangan mental
D. Hunter syndrome is a lysosomal disorder that results from deficiencies of the enzyme iduronate sulfatase . It is inherited in an X-linked recessive fashion and usually presents in the first 2 to 4 years of life. Clinical findings of Hunter syndrome include delayed growth (short stature) , coarse facial features, joint stiffness, macrocephaly, progressi,·e hearing loss, hepatosplenomegaly, and various degrees of mental retardation. H u rler syndrome (MPS I ) , not Hunter syndrome, is associated with corneal clouding
- Manakah yang ditunjukkan pada fotomikrograf di bawah ini ?
PIC
A. Abses intrakranial B. Metastase Intrakranial C. Plak selerosis majemuk D. Infarksi akut E. Infeksi jamur
B. Metastase Intrakranial
43. Di antara gangguan di bawah ini, manakah yang berasosiasi dengan paralisis akomodasi (siliaris), paralisis fasial, preservasi gerakan ekstraokular, dan asending polineuropati sensomotoris ? A. Neurosarkoidosis B. Neurosipilis C. Dipteri D. Penyakit pengapuran E. Sindroma GUILLAIN- BARRE
C. Diphtheria infections can result in paralysis of accommodation (ciliary ganglion ) , followed by facial and oropharyngeal paralysis with preservation of extraocular movements. The fifth to eighth week of the illness is associated with an ascending sensorimotor polyneuropathy in approximately 20% of all cases; this results in a mild to severe paralysis. The disease course is shortened by early treatment
with antitoxin and antibiotics, and the majority of patients eventually make a full recovery. Symptoms of neurosarcoidosis include cranial nerve palsies (facial weakness, hearing loss, vertigo, optic atrophy), hypopituitarism, hydrocephalus, and ataxia. Neurosyphilis is associated with cranial nerve palsies, hydrocephalus, arteritis, seizures, and eventually psychosis and cognitive decline. Lyme disease results in an enlarging maculopapular rash with · central clearing (erythema chronicum migrans) , followed by the development of axonal neuropathies, lymphocytic meningitis, encephalopathy, polyradiculitis, and cranial nerve palsies. Lyme disease can also affect the j oints and cardiovascular system. Guillain-Barre syndrome (GBS) is an acute ascending monophasic motor polyneuropathy that can involve the face, limbs, and even respiratory musculature. GBS is not typically associated with any sensory loss or ciliarv paralysis, however
- Penyebab paling lazim dari pendarahan intraventrikular pada bayi yang lahir normal
A. Pendarahan matriks germinal subependimal
B. Pendarahan pleksus koroid
C. A dan B
D. Bukan A dan Bukan B
B. Subependymal germinal matrix hemorrhage i s usually observed in low-birth-weight premature infants and can result in intraventricular hemorrhage. The microcirculation of the periventricular matrix zone is extremely fragile and persists in the neonate until 34 weeks of gestation. This microcirculation is prone to hemorrhage, with hypoxia and secondary failures of autoregulation. Choroid plexus hemorrhage is the most common cause of i ntraventricular hemorrhage in the term infant and can result in anything from minimal (asymptomatic) hemorrhage to massive intraventricular hemorrhage
- Penyebab paling lazim pendarahan intraventrikular pada bayi yang lahir premature
A. Pendarahan matriks germinal subependimal
B. Pendarahan pleksus koroid
C. A dan B
D. Bukan A dan Bukan B
A. Subependymal germinal matrix hemorrhage i s usually observed in low-birth-weight premature infants and can result in intraventricular hemorrhage. The microcirculation of the periventricular matrix zone is extremely fragile and persists in the neonate until 34 weeks of gestation. This microcirculation is prone to hemorrhage, with hypoxia and secondary failures of autoregulation. Choroid plexus hemorrhage is the most common cause of i ntraventricular hemorrhage in the term infant and can result in anything from minimal (asymptomatic) hemorrhage to massive intraventricular hemorrhage
- Gangguan-gangguan manakah di bawah ini yang merupakan gangguan sekunder dari Migrasi neuronal cacad?
- Polimikrogira
- Skizensepali
- Heterotopia nodular focal
- Holoprosensepali
B. Disorders of abnormal neuronal migration include agyria, pachygyria, polymicrogyria, cortical dysplasia, and focal and diffuse heterotopias. Schizencephaly and porencephaly are fetal hypoxic-ischemic lesions, and holoprosencephaly results from a failure of the normal growth and cleavage of the prosencephalic vesicles
47. Anak usia 1 – 5 tahun A. Streptococcus pneumoniae B. Haemophilus influenzae C. Listeria monocytogenes D. Proteus mirabilis E. S. epidermidis
B. Pediatric patients with bacterial meningitis are usually due to infection by Streptococcus pnewno n iae, Neisseria meningitidis, or Haemophilus illfluenzae. The incidence of H. irifluenzae meningitis in rhe pediatric population has decreased significantly in the past decade because of the widespread use of the H. influensae B vaccination. Bacterial meningitis in the adult population 110 Intensive Neurosurgery Board Review is usually secondary to infection by S. pneumoniae or N. meningitidis . Meningitis in the elderly commonly results from S. pneumoniae and gram-negative rods. Listeria monocytogenes can also afflict this older population. Neonatal bacterial meningitis is usually a result of infection by group B streptococci and Escherichia coli; however, Citrobacter clivasus and Proteus mirabilis-related meningitis are associated with the development of concomitant cerebral abscesses in this population
48. Dewasa A. Streptococcus pneumoniae B. Haemophilus influenzae C. Listeria monocytogenes D. Proteus mirabilis E. S. epidermidis
A. Pediatric patients with bacterial meningitis are usually due to infection by Streptococcus pnewno n iae, Neisseria meningitidis, or Haemophilus illfluenzae. The incidence of H. irifluenzae meningitis in rhe pediatric population has decreased significantly in the past decade because of the widespread use of the H. influensae B vaccination. Bacterial meningitis in the adult population 110 Intensive Neurosurgery Board Review is usually secondary to infection by S. pneumoniae or N. meningitidis . Meningitis in the elderly commonly results from S. pneumoniae and gram-negative rods. Listeria monocytogenes can also afflict this older population. Neonatal bacterial meningitis is usually a result of infection by group B streptococci and Escherichia coli; however, Citrobacter clivasus and Proteus mirabilis-related meningitis are associated with the development of concomitant cerebral abscesses in this population
