Path 3

Question 1

is ameloblastoma benign or malig? XR? odontomas sxs; most likely locations?

Answer 1

benign but mets. radiolucent w/o calc. delayed erupt, impaction; max ant, post mandib

Question 2

sinuses and resp epith of nasal inflam polyps. factors, location, characteristic in nasopharyngeal angiofibroma

Answer 2

eth/max; pseudostrat, goblet cells, ciliated cells. CTNNB1; VEGF, IGF-II, TGFB1; upper sphenopalatine foramen; fibrous stroma (fibroblast + connective tissue), slit-like staghorn

Question 3

3 forms of sinonasal papilloma. color and 4 markers of olf neuroblastoma. 3 forms and location of NUT midline ca

Answer 3

fungiform -> septum, stalk; inverted -> lat wall & paranasal sinus; oncocytic -> lat wall & paranasal sinus, tall columnar polypoid, granular. red/gray polypoid; small blue round nuclei w/ scant cyto; s100, chromogranin, synaptophysin, enolase. small cell, undifferentiated, squamous; up aerodigest, trunk, mediastinal LN, pleural dz, distant mets

Question 4

appearance & 3 layers of cholesteatoma. 3 forms of branchial cleft cyst. thyroglossal duct cyst location

Answer 4

anucleated, white friable mass; cystic content, matrix, fibrous stroma. cyst, fistula, sinus. mid neck, thyrohyoid > suprahyoid > intralingual

Question 5

intrinsic vs extrinsic vs neuromusc d/o of restrictive lung dz. characteristics of restrictive lung dz?

Answer 5

inflam/scar of lung tissue; interstitial lung dz vs affect chest wall, pleura; manually compress lungs or limit expansion vs dec ability of resp mm to in/deflate lungs. dec lung vol, TLC, FEV1, FVC, DLCO, pulm compliance; nml or inc FEV1/FVC, resp rate; hypercapnia, hypoxemia, intrapulm shunts

Question 6

what similar findings do you see b/w interstitial/nonspecific/cryptogenic PNA? what unique finding for cryptogenic?

Answer 6

PFT: restrictive, HRCT: traction bronchiectasis, patchy opac, reticular marks, ground glass; bibasilar inspiratory crackles; clubbing for interstitial & nonspecific PNA. lung bx: granulation tissue in alveoli/ducts

Question 7

forms of CWP vs silicon vs asbestos vs sarcoid vs hypersensitivity pneumonitis vs pulm alveolar proteinosis

Answer 7

anthracosis (upper zone, lower lobes), simple (upper lobes), complicated (>1cm) vs acute, chronic (birefringent, whirled collagen nodules) vs pleural plaques, asbestosis, malig mesothel (TNFa, IL1B, TGFB, PDGF) vs schaumann bodies, asteroid bodies; delayed Th1 -> IL2, IFNy -> noncaseating vs T3HS; acute (fibrin exudate), chronic (non nec granuloma) vs congen (loss of fxn GMCSF), autoimmune, 2o

Question 8

immunohisto markers for adenoca vs lung SCC vs lung lg cell ca? unique PNA for SCC? unique characteristics for lg cell ca vs small cell ca?

Answer 8

CK7, SPA, TTF1; neg CK20 vs p40/60, CK5/6, desmoglein; neg TTF1 vs neg p40, TTF1, mucin. lipid PNA in bronchial tree. lack glandular & squamous, collection of poorly diff ca, >4cm white periph tumors in chest wall & pleura vs most aggressive, neuroendo granules w/ central electrodense core, antiYo/Hu for subacute degen, antiHu for limbic encephalitis, Ca2+ channels for Lamb-Eat syndrome

Question 9

paraneoplastic syndromes for adenoca vs SCC vs small cell ca. pancoast tumors cause what 2 syndromes?

Answer 9

Trousseau, pulm hypertrophic osteoarthropathy, acanthosis vs hyperCa2+ vs SIADH, Cushing. pancoast syndrome (brachial plexus, ulnar n), Horner’s (stellate ganglion)

Question 10

pulm thromboembol has what kind of conseq? sx vs dx

Answer 10

resp (alveolar dead space), hemo (inc flow & resistance), pulm infarct (rare b/c dual supply from bronchial aa). sinus tach, dyspnea, CP, frxn rub, DVT vs V/Q scan, CTA, ABG, CXR Hampton

Question 11

pulm HTN: pre vs post capillary. idio sporadic vs idio fam vs + LHD vs + lung dz + pulm thromboembol. sxs? CXR

Answer 11

pulm remodel -> pulm resistance vs inc pulm venous pressure -> LHD. yep vs BMPR2 vs inc pulm arterial pressure vs obstruct/restrictive, sleep apnea, kyphoscoliosis, altitude vs resolves but residual thrombus in walls. medial hypertrophy, intimal hyperplasia, plexiform lesion; R heart fail sxs. lg central vessels & R heart

Question 12

characteristic vs genetics vs sporadic of pulm venoocclusive dz. sxs?

Answer 12

intimal fib, medial hypertrophy, group 1 PAH vs EIF2AK4 vs CMV/EBV/measles, chemo, occupation, smoke. R heart fail

Question 13

what kind of rxn = Goodpasture? main sx? sx vs CXR of idio pulm hemosiderosis

Answer 13

T2Hs -> circ igG against lung & kid detected by immunofluorescence. crescent glomerulonephritis: fib nec of glomular capillaries & prolif Bowman w/ macs & fibrin. hemoptysis, anemia, fail to thrive; no nec, vasulitis, inflam vs alveolar infiltrate in lower lungs

Question 14

def of bronchitis. pathogenesis? Reid index & ab/nl range for bronchitis. key clin pres? anti/elastase & A1AT defic hypothesis for what?

Answer 14

chronic cough >3mo for 2 consec yrs. smoke -> inc mucus, mucus gland hyperplasia, dec mucociliary clear -> resp infxn esp H flu & Pseudo -> purulent hypersecretion. thickness of mucus gland v wall; <0.4 good, >0.5 bad. cor pulmonale. emphysema

Question 15

which tumor has juvenile & adult onset? resp papilloma order most freq locations? 4 causes of laryngeal ca? laryngeal ca order most freq locations? 5 forms of laryngeal ca? clin pres of supra/sub/glottic laryngeal ca? tx for I/II vs III/IV laryngeal ca?

Answer 15

resp papilloma. larynx > oral cavity > trachea > bronchi. smoke, alc, GERD, HPV. true vocal cords > supra > subglottic. subglottic (circumferential, fungating), preinvasive (simple sq hyperplasia), invasive (exo/endophytic), sCC (well/mod/poor differentiated), verrucous. odynophagia, dysphagia, neck mass/T3-4/hoarse. rads, surg vs tot laryngectomy + adjuvant chemo

Question 16

genetics & other cause for nasopharyngeal ca? 3 subtypes? clin pres vs mets vs tx?

Answer 16

CDK2NA, HLA A2/B46; salt & nitrosamines. keratinized (sCC + intercell bridge), unkeratin diff (cords & trabeculae), unkeratin undiff (sheets of nonneoplastic cells). 3ad: painless neck mass, nasal obstruction, ear pain, ophthalmoplegia (b/c cavern sinus) vs jugulodigastric LN > bone > liver > lung vs rads, chemo

Question 17

vicious cycle of bronchiectasis? ectatic bronchi? clin pres?

Answer 17

inflam -> dmg -> mucus stasis -> infxn. fib bronchial wall + destroyed elastin + destroyed mm & cart. cough w/ sputum, clubbing if severe

Question 18

genetics for CF? I vs II vs III/ IV? pathogenesis? dx?

Answer 18

auto rec CFTR. premature stop vs misfolded vs dec channel fxn & #. Cl- can’t leave cell -> thicker mucus, no mucociliary clear -> infxn. sweat test w/ high Cl-, new born screen for immunoreactive trypsinogen

Question 19

cause of noninflam/transudative vs inflam/exudative pleural effusion. Light’s criteria? how to determine severity?

Answer 19

inc hydrostatic pressure, dec osmotic pressure & lymph drain vs Inc vasc permeability (PNA, pleuritis), Block lymph drain from mets (lung, brca). at least 1 to meet exudative: pleural fluid protein/serum protein >0.5, pleural fluid LDH/serum LDH >0.6. obliteration of costophrenic angle

Question 20

pneumothorax: 1o spont vs 2o spont vs pneumomediastinum vs iatro vs tension w/ CXR. clin pres?

Answer 20

ruptured bleb/bullae w/o lung dz or trauma vs emphysema, lung dz/ca vs air in mediastinum from alveolar/bowel rupture vs needle aspiration/stick, central IV cath, thoracentesis, bx vs lung lacer -> progressive accum; flat ipsi hemidiaphragm, lung collapse. resp distress, hypoxemia (not hypercapnia), CXR pleural line

Question 21

what’s solitary fibrous tumor? immunostain? mesothelioma 3 types vs pathogenesis vs immunostain vs CXR?

Answer 21

NAB2, STAT6 -> mesenchymal neoplasm of fibroblast in visceral > parietal pleura. CD34 pos & keratin-neg. epitheloid, sarcomatoid, mixed vs grapes in parietal -> pleural effusion & invasion visceral -> sheets in visceral -> obliterate pleural space vs keratin 5, calretinin, Wilms protein; podoplanin for epith, CAM5.2 for sarcomatoid v actual sarcoma vs obliteration diaphragm

Question 22

genetics/pathogenesis vs types of adenoca. sCC?

Answer 22

gain of fxn EGFR, KRAs -> periphery Clara/II pneumocytes, pleural fib vs min invasive (<3cm), invasive (lepidic, micro/pap, acinar, solid - sheet/nest w/ no recog pattern, fetal - irreg tubular columnar w/ oval nuclei). TP53, PI3KCA, soX amp, FGFR amp -> partial lumen obstruction, cauliflower vs keratinizing, nonkeratin, basaloid (baso periph palisading strat sq)

Question 23

3 forms of neuroendo tumors. immunostain? benign lung tumors: sq pap vs adenoma vs hamartoma

Answer 23

typical carcinoid (low grade, 1/2 bronchi, mod eos; organoid, trab, palis, rosette), atypical carcinoid (intermed, more common for smokers), lg cell (high grade, smokers), small cell (undiff). synaptophysin & chromogranin pos. exophytic endobronchial mass in central airway vs obstruct, sessile endobronchial mass in 2/3 bronchi vs HMGA1/2 (6/12:14) mesenchymal tumor

Question 24

solitary pulm nodule. where can lung ca mets to?

Answer 24

coin lesion in lungs <3cm to infectious granuloma. found accidentally on CXR, dx by bx. liver, adrenal, bone, brain

Question 25

3 markers of asthma. pathogenesis w/ hallmark?

Answer 25

charcot-leyden crystals (6 sided crystals -> eos, degen, trap death; asthma, helminth), Curschmann spiral (cast of resp bronchioles), Creola bodies (columnar from bronchial mucosa). Lung overinflation/distension –> can’t retract → take up as much space of chest cavity as possible, cover heart; occluded bronchi/oles w/ thick mucus plug esp 2 bronchi

Question 26

4 bronchial markers for asthma. sxs of status asthmaticus. CXR vs ABG vs PFT for asthma

Answer 26

thick mucus plug -> no mucociliary clear, thick BM, eos, hypertrophic smooth mm cells. cyanosis, resp distress, intercostal retractions, abd mm exhale. hyperinflate lungs, flat diaphragm vs mild, severe, v. severe asthma attack vs done before/after bronchodilator; airflow obstruction (dec FEV1, nml FVC), reversible (inc 12% or 200mL), DLCO (nml, high), allergen skin test, RAsT

Question 27

COPD dx: ABG vs HRCT vs CXR vs PFT. blue bloater vs pink puffer

Answer 27

same w/ asthma, V/Q mismatch vs low attenuation, most sensitive vs same w/ asthma, vertical heart vs FEV1 much lower -> low FEV1/FVC & DLCO. chronic bronchitis, mucus hypersecretion, more V/Q mismatch vs emphysema, less V/Q mismatch