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GER MS2 Unit 1 > Pathoma > Flashcards

Pathoma Flashcards

1
Q

bartholin cyst

A
  • cystic dilation of bartholin gland
  • presents as unilateral, paiful cystic lesion adjacent to vagina
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2
Q

condyloma

A
  • warty neoplasm
  • most commonly due to HPV 6, 11 (low risk)
  • characterized by koilocytic change
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3
Q

koilocytes

A
  • characterizing feature of HPV-infected cells
  • “empty cell”; actively synthesizing virus (infectious)
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4
Q

lichen sclerosis

A
  • thinning of epidermis and fibrosis of dermis
  • presents as leukoplakia with parchment-like vulvar skin
  • benign; associated with slightly increased risk for SCC
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5
Q

lichen simplex chronicus

A
  • hyperplasia of vulvar squamous epithelium
  • presents as leukoplaki with thick, leathery vulvar skin
  • benign; no increased risk of SCC
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6
Q

vulvar carcinoma

A
  • carcinoma arisng from squamous epithelium lining the vulva
  • relatively rare
  • presents as leukoplakia (biopsy to distinguish from other cuases)
  • HPV related due to HPV 16, 18→VIN
    • ​reproductive age
  • Non-HPV related from long-standing lichen sclerosis
    • ​elderly
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7
Q

extramammary paget disease

A
  • malignant epithelial cells of epidermis of vulva
  • presents as erythematous, pruritic, ulcerated vulvar skin
  • represents CIS usually without underlyng carcinoma
    • unlike Paget’s disease of nipple
  • Distinguish from melanoma
    • ​Paget cells: PAS+, keratin+, S100-
    • melanoma: PAS-, keratin-, S100+
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8
Q

adenosis

A
  • focal persistance of columnar epithelium in upper vagina
  • increased incidence in women exposed to DES in utero
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9
Q

clear cell adenocarcinoma

A
  • malignant proliferation of glands with clear cytoplasm
  • rare; complication of DES-associated vaginal adenosis
  • not HPV related
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10
Q

embryomal rhabdomyosarcoma

A
  • malignant mesenchymal proliferation of immature skeletal muscle
  • rare; presents as grape-like mass protruding from vagina/penis in <5 y.o.​​
  • rhabdomyoblast (characteristic cell) has cytoplasmic cross-striations
    • desmin+ and myogenin+
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11
Q

vaginal carcinoma

A
  • carcinoma arising from squamous lining of vaginal mucosa
  • high risk HPV (16,18, 31, 33)→VAIN
  • lymphatic involvement is embryonal
    • lower 1/3→inguinal nodes (urogenital sinus derived)
    • upper 2/3→regional iliac nodes (mullerian duct derived)
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12
Q

healthy cervix

A
  • exocervix (visible): nonkeratinizing squamous
  • endocervix: single layer of columnar cells
  • transformation zone: portion of cervix where more cancer originates
    • junction moves up the canal with age
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13
Q

HPV

A
  • STD DNA virus that infects lower genital tracts esp. transformation zone of cervix
  • infection usually eradicated by acute inflammation
  • persistant infection→increased risk for CIN
  • high risk: 16,18,31,33
    • loss of tumor suppression (E6→degrades p53; E7→inactivates Rb)
  • low risk: 6, 11
  • quadvalent vaccine: L1 protein (DNA for viral capsule); protects against: 6,11,16,18
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14
Q

CIN

A
  • koilocytic change, disordered cellular maturation, nuclear atypia, and increased mitotic activity in cervical epithelium
  • classically progresses through CIN1,2,3,CIS→invasive SCC
    • takes approx. 10-20 years
    • progession not inevitable but harder to regress the higher the grade of dysplasia
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15
Q

cervical carcinoma

A
  • invasive carcinoma that arises from cervical epithelium
    • 80% SCC, 15% adenocarcinoma
  • MC seen in middle-aged women
  • presents with vaginal bleeding
  • risk factor: high risk HPV, smoking, immunodeficiency
    • AIDS defining illness
  • advanced tumors→anterior uterine wall→bladder→hydronephrosis with postrenal failure→death
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16
Q

pap smear

A
  • gold standard for screening of cervical carcinoma
    • 21-30: every 3 yrs
    • 30-65: pap &HPV testing or pap alone every 5 yrs
  • high grade dysplasia characterized by cells with hyperchromatic nucle and high nuclear to cytoplasmic ratio
  • abnormal result followed by colposcopy and biopsy
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17
Q

healthy endometrium

A
  • proliferative phase: estrogen driven
  • secretory phase: progesterone driven
  • menstrual phase: loss of progesterone support
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18
Q

asherman syndome

A

overaggressive D&C→ secondary amenorrhea due to loss of basalis (regenerative layer) and scarring

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19
Q

anovulatory cycle

A

lack of ovulation→estrogen driven proliferation without subsequent progesterone driven secretory phase

  • growth on top of growth→overgrowth of blood supply
  • common cause of dysfunctional bleeding esp. during menarche and menopause
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20
Q

acute vs. chronic endometritis

A
  • acute: bacterial infection usually due to retained parts of conception→fever, abnormal bleeding, pain
  • chronic: chronic inflammation characterized by plasma cells; usually due to retained parts of conception, chronic pelvic inflammatory disease (e.g., chlamydia), IUD, TB→bleeding, pain, infertility
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21
Q

endometrial polyp

A
  • hyperplastic protrusion of endometrium
  • can arise as side effect of tamoxifen (anti-estrogenic effect on breast, weak pro-estrogenic effects on endometrium)
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22
Q

endometriosis

A
  • endometrial glands and stroma outside of uterine endometrium
    • most likely due to retrograde menstruation
  • MC site of involvement is ovary→ chocolate cysts
    • fallopian tube→ gun-powder nodules→ increased risk for ectopic pregnancy
  • increased risk for carcinoma at site of endometriosis
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23
Q

endometrial hyperplasia

A
  • hyperplasia of endometrial glands relative to stroma as a result of unopposed estrogen
  • presents as postmenopausal bleeding
  • classified based on growth (simple vs. complex) and degree of atypia
    • atypia→cancer/cancer associated→hysterectomy
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24
Q

endometrial carcinoma

A
  • malignant proliferation of endometrial glands
  • MC invasive carcinoma of female genital tract (but unlikely killer)
  • hyperplasia (75%): related to estrogen exposure; ~60 y.o.; endometrioid histology
  • sporadic (25%): no evident precursor lesion; ~70 y.o.; serous histology characterized by papillary structures with psammoma body
    • p53 mutation is common→aggressive
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25
Q

psamomma body

A

concentrically layered calcifications that occur with:

  • papillary carcinoma of thyroid
  • meningioma
  • serous tumors of endometrium or ovary
  • mesothelioma
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26
Q

leiomyoma (fibroids)

A
  • benign neoplasic proliferation of smooth muscle in myometrium; MC tumor in women
  • related to estrogen exposure
    • premenopause
    • often occur in multiples
    • enlarge during pregnancy, shrink after menopause
  • appear as well-defined white whorled masses
  • MC symptom: nothing
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27
Q

leomyosarcoma

A
  • malignant proliferation of smooth muscle of myometrium
  • arises de novo
  • seen in postmenopausal women
  • appears as single yellowish lesion with areas of necrosis and hemorrhage
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28
Q

healthy ovarian follicle

A
  • functional unit of ovary; consists of oocyte + granulosa and theca cells
  • LH→ theca→ androgen production
  • FSH→ granulosa→ conversion of androgen to estradiol
    • estradiol surge→ LH surge→ ovulation
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29
Q

polycystic ovarian disease

A

multiple ovarian follicular cysts due to hormone imbalance (increased LH, low FSH; LH:FSH>2)

  • excess androgen production→hirsutism
  • androgen→ estrone in adipose tissue→decreases FSH→cystic degeneration of follicles
    • high levels of estrone increase risk for endometrial cancer
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30
Q

surface epithelial tumors of ovary

A
  • MC type of ovarian tumor (70%); clinically present late with vague symptoms→poor prognosis
    • tend to spread locally
    • use CA125 to monitor treatment response
  • derived from coelomic epithelium
  • 2 MC subtypes are serous and mucinous
    • benign tumors (cystadenomas): single cyst with simple flat lining; occur in premenopausal women
    • malignant tumors (cystadenocarcinomas): complex cysts with shaggy lining; occur in postmenopausal women
    • borderline tumors: mixed features, still carry metastatic potential
  • endometrioid tumor: usually malignant; may arise from endometriosis
  • brenner tumor: usually benign; composed of bladder-like epithelium
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31
Q

germ cell tumors

A
  • 2nd MC type of ovarian tumor (15%)
  • tumor sbtypes mimic normal germ tissues
    • fetal: cystic teratoma, emryonal carcinoma
    • oocyte: dysgerminoma
    • yold sac: endodermal sinus tumor
    • placenta: choriocarcinoma
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32
Q

cystic teratoma

A
  • MC germ cell tumor in females; usually benign
    • ​malignant if immature tissue or somatic malignancy is present in the tumor
    • struma ovarii: teratoma composed of thyroid
  • cystic; composed of fetal tissue derived from 2-3 embryologic layers
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33
Q

dysgerminoma

A
  • composed of large cells with clear cytoplasm and central nulclei (resemble oocyte)
    • serum LDH may be elevated
  • malignant but responds well to radiotherapy
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34
Q

endodermal sinus tumor

A
  • MC germ cell tumor in children
  • malignant tumor that mimics the yolk sac
    • presence of Schiller-Duval bodies (glomerulus-like)
    • serum AFP may be elevated
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35
Q

choriocarcinoma

A
  • malignant; small hemorrhagic tumor that mimics placental tissue except villi are absent
    • early hematogenous spread→tiny tumor in ovary with massive tumors elsewhere
    • high ß-hCG
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36
Q

embryonal carcinoma

A

malignant tumor composed of large primitive cells; aggressive with early metastasis

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37
Q

sex-cord stromal tumors

A
  • granulosa-theca cell tumor: often produces estrogen→ signs of estrogen excess
    • post menopause is most common setting→endometrial hyperplasia with abnormal bleeding
  • sertoli leydig cell tumor: mimics sex-cord stromal cells of testicle, has characteristic Reinke crystals; may produce androgen
  • fibroma: benign tumor of fibroblasts, associated with Meigs syndrome (pleural effusions and ascites)
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38
Q

krukenberg tumor

A

metastatic mucinous tumor that involves both ovaries; most commonly due to metastatic gastric carcinoma

  • bilaterality helps distinguish from primary mucinous carcinoma of ovary
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39
Q

pseudomyxoma peritonei

A

massive amounts of mucus in peritoneum (jelly belly) due to a mucnous tumor of appendix usually with metastasis to the ovary

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40
Q

ectopic pregnancy

A
  • implantation of fertilized ovum at a site other than uterine wall (MC: lumen of fallopian tube)
  • key risk factor: scarring from PID or endometriosis
  • lower quadrant abdominal pain a few weeks after missed period
  • surgical emergency
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41
Q

spontaneous abortion

A
  • miscarriage of fetus <20 wks gestation
  • common (1/4 of recognizable pregnancies); MC due to chromosomal abnormalities (esp. trisomy 16)
  • vaginal bleeding, cramps, passage of fetal tissue
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42
Q

placenta previa

A

implantation of placenta in lower uterine segment→placenta overlies cervial os; often requires C-section

43
Q

placental abruption

A

separation of placenta from decidua prior to delivery of fetus; common cause of stillbirth

44
Q

placental accreta

A

“placenta gets stuck” due to improper implantaion of placent into myometrium with little/no intervening decidua

45
Q

what are 8 common teratogens and their effects?

A
  1. alcohol: MCC of mental retardation, facial abnormalities, microcephaly
  2. cocaine: intrauterine growth retardation and placental abruption
  3. thalidomide: limb defects
  4. cigarette smoke: intrauterine growth retardation
  5. isotretinoin: spontaneous abortion, hearing/visual impairment
  6. tetracycline: discolored teeth
  7. warfarin: fetal bleeding
  8. phenytoin: digit hypoplasia, cleft lip/palate
46
Q

preeclampsia

A
  • pregnancy induced HTN, proteinuria, and edema usually in 3rd trimester
  • due to abnormality of maternal-fetal vascular interface in placenta (resolves with delivery)
    • seizures=eclampsia
  • HELLP is preeclampsia involving liver (hemolysis, elevated liver enzymes, low platelets)
  • HELLP and eclampsia warrant immediate delivery
47
Q

SIDS

A
  • death of healthy infant (1mo-1yr) without obvious cause; usually occurs during sleep
  • risk factors: sleeping on stomach, second-hand smoke, prematurity
48
Q

hydatidiform mole

A
  • abnormal conception characterized by swollen and edematous villi with prolifersation of trophoblasts (grow abnomal placental tissue instead of a baby)
  • uterus expands but is much larger and ß-hCG is much higher than expected date of gestation
  • presents in 2nd trimester with passage of grape-like masses through vagina→D&C
    • monitor ß-hCG to ensure adequate removal and screen for choriocarcinoma
49
Q

partial vs. complete hydatidiform mole

A
  • partial: normal ovum, fetal tissue, normal and hydropic villi, focal proliferation around hydropic villi, minimal risk for choriocarcinoma
  • complete: empty ovum, no fetal tissue, hydropic villi, difuse, circumferential proliferation around hydropic villi, 2-3% risk of choriocarcinoma
50
Q

normal breast tissue

A
  • modified sweat gland derived from skin; develops along milk line
  • luminal cell layer: inner cell layer lining ducts and lobules
  • myoepithelial cell layer: outer cell layer lining ducts and lobules
51
Q

acute mastitis

A
  • bacterial infection of the breast usually due to S. aureus
  • associated with breast-feeding
  • purulent discharge
52
Q

periductal mastitis

A
  • inflammation of subareolar ducts usually seen in smokers
    • relative vit. A deficiency→ lose ability to mainitain this highly specialized epithelium→ squamous metaplasia→ keratin production and blockage→ subareolar mass with nipple retraction
  • not associated with lactation
53
Q

mammary duct ectasia

A

inflammation with dilation of the subareolar ducts→ green-brown nipple discharge; rare

54
Q

fat necrosis of the breast

A
  • usually related to trauma
  • presents as a mass or abnormal calcifcation on mammography
  • biopsy: necrotic fat with associated calcifications and giant cells
55
Q

fibrocystic change

A
  • MC change in premenopausal breast, thought to be hormone mediated
  • presents as vague irregularity (“lumpy breasts”)
  • cysts have blue dome appearance on gross exam
  • benign but some fibrocystic-related changes are associated with increased risk for invasive carcinoma
    • fibrosis, cysts, apocrine metaplasia: no increased risk
    • ductal hyperplasia and sclerosing adenosis: 2x risk
    • atypical hyperplasia: 5x risk
56
Q

intraductal papilloma

A
  • benign papillary growth, usually into a large duct
  • characterized by fibrovascular projections lined by epithelial (luminal) and myoepithelial cells
  • presents as bloody nipple discharge in premenopausal woman
  • must be distinguished from papillary carcinoma
57
Q

intraductal papilloma vs. papillary carcinoma

A
  • intraductal papilloma
    • 2 types of cells (luminal and myoepithelial)
    • premenopausal woman
  • papillary carcinoma
    • epithelial cells only
    • post menopausal women
58
Q

fibroadenoma

A
  • tumor of fibrous tissue and glands
  • MC benign neoplasm of breast, MC tumor in premenopausal women
  • well-circumscribed, mobile marble-like mass
  • estrogen sensitive
59
Q

phyllodes tumor

A
  • fibroadenoma-like tumor with overgrowth of fibrous component
  • leaf-like projections seen on biopsy
  • can be malignant
60
Q

breast cancer

A
  • represents only 10% of breast lumps
  • MC carcinoma of women by incidence
  • 2nd MC cause of cancer mortality in women
61
Q

DCIS

A
  • malignant proliferation of cells in ducts with no invasion of basement membrane
  • often detected as calcification on mammography
  • histological stubtypes based on architecture
    • camedo type: high-grade cells with necrosis and dysrophic calcification in center of ducts
62
Q

paget’s disease of the breast

A
  • DCIS that extends up to the ducts to involve the skin of the nipple
  • 50% of the time it is assocated with underlying invasive cancer
63
Q

invasive ductal carcinoma

A
  • invasive carcinoma that classical forms duct-like structures
  • MC invasive carcinoma of the breast (>80%)
  • presents as mass on exam or mammography
  • biopsy shows duct-like structures in desmoplastic stroma (reaction to invasive tumor)
    • tubular: lack myoepithelial cells (actin-)
    • mucinous: tumor cells in mucus pool
    • medullary: large high-grade cells growing in sheets with associated lymphocytes and plasma cells
    • inflammatory: carcinoma in dermal lympatics, poor prognosis
64
Q

lobular carcinoma

A
  • malignant proliferation of cells in lobules with no invasion of basement membrane; often multifocal and bilateral
  • does not produce mass or calcification (usually discovered incidentally)
  • characterized by dyscohesive cells lacking E-cadherin
  • treat with tamoxifen; lower risk of progression to invasive carcinoma than DCIS
65
Q

invasive lobuar carcinoma

A
  • invasive carcinoma that characteristically grows in single-file pattern
  • cells may exhibit signet-ring morphology
  • no duct formation (lack of E-cadherin)
66
Q

prognostic and predictive factors of breast cancer

A
  • metastasis is the most important prognostic factor but because most patient present before then, spread to axillary nodes is the most useful prognostic factor
  • ER+/PR+: associated with response to antiestrogenic agents
  • HER2/neu gene amplification: associated with response to tastuzumab
  • triple negative tumrors have poor prognosis
67
Q

hereditary breast cancer

A
  • 10% of breast cancers
  • clincally features suggestive: multiple first degree relatives with BC, tumor at early age, multiple tumors
  • BRCA1: associated with breast and ovarian cancer
    • particularly medullary carcinoma of breast and serous carcinoma of ovary or fallopian tube
  • BRCA2: associated with brast carcinoma in males
68
Q

male breast cancer

A
  • rare (1% of all breast cancers)
  • presents as subareolar mass in older males
  • MC subtype is invasive ductal carcinoma
  • associated with BRCA2 and klinefelter syndrome
69
Q

achondroplasia

A
  • activating mutation in FGFR3 inhibits cartilage proliferation in the growth plate
  • poor endochondral bone formation, intramembranous formation ok
  • short extremities with normal sized head/chest
  • common cause of dwarfism
70
Q

osteogenesis imperfecta

A
  • congenital defect of bone formation→ structurally weak bone
  • MC due to AD defect in college type I synthesis
  • clinical features: multiple fractures of bone (no bruising), blue sclera, hearing loss
71
Q

osteopetrosis

A
  • defect of bone resorption→ abnormally thick, heavy bone that fractures easily
  • due to poor osteoclast function
  • multiple genetic variants; carbonic anhydrase II mutation→ loss of acidic microenvironment needed for resorption
  • clinical features: fractures, bony replacement of marrow (myelophthisic process)→ anemia and thrombocytopenia, renal tubular acidosis in CAII mutation
  • treatment: bone marrow transplant (osteoclasts derived from monocytes)
72
Q

rickets

A
  • due to low vitamin D in children→ abnormal bone mineralization, also leads to random osteoid deposition
  • MC <1 y.o. presents with pigeon breast deformity, frontal bossing, rachitic rosary, bowed legs
73
Q

osteomalacia

A
  • low vitamin D in adults→ inadequate mineralization leading to weak bone with increased risk of fracture
  • low serum Ca, low serum PO4, high PTH, high alk phos (rises whenever there is activation of osteoblasts)
74
Q

osteoporosis

A
  • reduction in trabecular bone mass→ porous bone
  • MC forms are senile and postmenopausal
  • peak bone mass attained by 30 y.o. based on genetics, diet, exercise; lose <1% each year
  • clinical features: bone pain and fractures in weight bearing areas (e.g, vertebrae), normal labs, diagnose with DEXA scan
  • prevention: exercise, vitamin D, Ca2+
  • treatment: bisphosphonates (induce osteoclast apoptosis)
  • ER therapy
  • do not use glucocorticoids (worsen osteoporosis)
75
Q

paget disease of bone

A
  • imbalance between osteoclast and osteoblast function; usually seen >60 y.o.
  • etiology unknown (viral?)
  • localized process
  • osteoclastic→ mixed osteoblastic/clastic→ osteoblastic
    • result is thick, sclerotic bone that fractures easily (looks like puzzle pieces)
  • clinical features: bone pain, increasing hat size, lion-like facies, MCC of isolated alk phos
  • treatment: calcitonin (inhibits clast function) and bisphosphonates (inhibits blast function)
  • can lead to high output cardiac failure and osteosarcoma
76
Q

osteomyelitis

A
  • infection of marrow and bone, MCC by bacteria
    • children: transient bacteremia seeds metaphysis
    • adults: open-wound bacteremia seeds epiphysis
  • S. aureus (90% cases)
  • salmonella (sickle cell disease)
  • pseudomonas (diabetes or IVDA)
  • clinical features: bone pain with systemic signs of infection, lytic focus (abscess) surrounded by sclerosis of bone on x-ray
  • diagnoses with blood cultures
77
Q

avascular (aseptic) necrosis

A
  • ischemic necrosis of bone and bone marrow
  • caused by trauma or fracture (MC), sickle cell anemia, caisson disease (gas embolism)
  • osteoarthritis and fracture are major complications
78
Q

osteoma

A
  • benign tumor of bone; MC on facial bones
  • associated with Gardner syndrome (familial adenomatous polyposis)
79
Q

osteoid osteoma

A
  • benign tumor of osteoblasts that produce osteoid surrounded by a rim of reactive bone
  • MC in <25 y.o.; diaphysis of long bone
  • bony mass <2cm with radiolucent core
  • bone pain that resolves with aspirin; worse at night
80
Q

osteoblastoma

A
  • >2cm bony mass with radiolucent core
  • arises in vertebrae
  • presents with bone pain that does not respond to aspirin
81
Q

osteochondroma

A
  • MC benign tumor of bone
  • tumor of bone with overlying cartilage cap
  • arises from lateral projection of metaphysis; bone is continuous with marrow space
  • overlying cartilage can transform to chondrosarcoma (rare)
82
Q

osteosarcoma

A
  • malignant proliferation of osteoblasts; arises in metaphysis of long bones (usually distal femur)
  • peak incidence in teens, less commonly in elderly
  • presents with pathologic fracture or bone pain with swelling
  • imaging: destructive mass with sunburst appearance and codman triangle (lifting of periosteum)
  • biopsy: pleomorphic cells that produce osteoid
83
Q

giant cell tumor

A
  • tumor comprisd of multinucleated giant cells and stromal cells arisng in epiphysis of long bones
  • occurs in yong adults; benign but aggressive
  • soap buddle appearance on x-ray
84
Q

ewing sarcoma

A
  • malignant proliferation of poorly differentiated cells derived from neuroectoderm
  • arises in diaphysis of long bones in males <15 y.o
  • onion skin appearance on x-ray
  • biopsy: round blue cells that resemble lymphocytes
  • can be confused with lymphoma or chronic osteomyelitis
  • 11;22 translocation is characteristic
85
Q

(en)chondroma

A
  • benign tumor of cartilage, usually arising in medulla (enchondroma) of small bones (chondroma grow from periosteum of bone)
  • usually asymptomatic, incidentally found
  • tumors are radiolucent
86
Q

chondrosarcoma

A
  • malignant cartilage-forming tumor that arises in medulla of pelvis or central skeleton
  • endosteal scalloping on x-ray
87
Q

chondroblastoma

A
  • occurs in teens
  • radiolucent tumor; can reoccur
  • chicken wire calcification on histology
88
Q

degenerative joint disease (osteoarthritis)

A
  • MC type of arthritis; progressive degeneration of articular cartilage (type II collagen) due to wear and tear
  • age is major risk factor; obesity and trauma
  • presents with joint stiffness in morning that worsens during dat
  • pathologic features
    • disruption of cartilage lining articular surface; joint mice
    • eburnation of subchondral bone
    • osteophytes in DIP (heberden) and PIP (bouchard)
89
Q

rheumatoid arthritis

A
  • chronic, systemic autoimmune disease
  • MC in women of late childbearing age; associated with HLA-DR4
  • synovitis leading to pannus formation→ destruction of cartilage and akylosis of joint
  • morning stiffness that improves with activity
  • symmetical involvement of joints
  • rheumatoid nodules in skin and visceral organs
  • baker cyst
  • labs: IgM autoantibody against Fc of IgG
90
Q

seronegative spondyloarthropathies

A
  • characterized by no RF, axial skeletal involvement, HLA-B27 association
  • akylosing spondyloarthritis: sacroiliac joints and spine in young amles
    • low back pain; eventually leads to bamboo spin
    • extraarticular manifestations: uveitis and aortitis
  • reactive arthritis: can’t see can’t pee can’t climb a tree; young males after GI bug or chlamydia
  • psoriatic arthritis: 10% of psoriasis→ sausage fingers and toes
91
Q

infectious arthritis

A
  • N. gonorrhoeae: young adults, MCC
  • S. aureus: older children and adults
  • classical involves single joint, usually knee
  • presents as a warm joint with limited range of motion
92
Q

gout

A
  • deposition of monosodium urate crystals in tissues due to hyperuricemia (overproduction or decreased excretion of uric acid);
  • synovial fluid: needle shaped crystals with negative birefringence
  • primary: unknown etiology
  • secondary: leukemia and myeloproliferative disorders; lesch-nyhan syndrome (x-linked HGPRT deficiency); renal insufficiency
  • acute: podagra; alcohol or meat may precipitate
  • chronic: tophi in soft tissue/joints; renal failure
93
Q

pseudogout

A
  • mimics gout clinically but is due to calcium pyrophosphate dihydrate deposits
  • synovial fluid shows rhomboid crystals with weakly positive birefringence
94
Q

dermatomyositis

A
  • inflammatory disorder of skin and skeletal muscle
  • biopsy: perimysial inflammation (CD4 T cells) with perifascicular atrophy
  • unknown etiology; some association with carcinoma
  • bilateral proximal weakness, rash of upper eyelids (heliotrope rash), malar rash, gottron papules on elbows/ knees
  • labs: increased CK; ANA+ and antiJo+
95
Q

polymyositis

A
  • inflammatory disorder of skeletal muscle
  • resembles dermatomyositis but no skin involvement
  • biopsy: endomysial inflammation (CD8 T cells) with necrotic muscle fibers
96
Q

x-linked muscular dystrophy

A
  • muscle wasting and replacement of skeletal muscle by adipose tissue
  • duchenne: deletion of dystrophin gene→ proximal muscle weakness by 1 y.o.; calf pseudohypertrophy; death from cardiac or respiratory failure
  • becker: mutated dystrophin gene (clinically milder disease)
97
Q

lipoma

A
  • benign tumor of adipose tissue
  • MC benign soft tissue tumor in adults
98
Q

liposarcoma

A
  • malignant tumor of adipose tissue
  • MC malignant soft tissue tumor in adults
  • lipoblast is characteristic cell (very enlarged cell with nuclear vacuoles)
99
Q

rhabdomyoma

A
  • benign tumor of skeletal muscle
  • cardiac rhabdomyoma is associated with tuberous sclerosis
100
Q

rhabdomyosarcoma

A
  • malignant tumor of skeletal muscle
  • MC malignant soft tissue tumor in children
  • rhabdomyoblast is characteristic cell; desmin+
  • common site is head and neck
  • sarcoma botryoides: vaginal rhabdomyosarcoma in girls <5y.o.
101
Q

dermatofibroma

A
  • aka benign fibrous histiocytoma; common cutaneous soft tissue lesion
  • dermal proliferation of fibroblasts; sometimes occurs as a result of trauma or insect bites
  • present as firm, hyperpigmented, nodules in adults; MC on lower extremities; asymptomatic; dimple when pinched
102
Q

undifferentiated pleomorphic sarcoma

A
  • MC sarcoma in adults; diagnosis of exclusion
  • well-circumscribed mass, central necrosis
  • “cartwheel” whirled pattern of cellularity
103
Q

bone tumors by age

A
  • children: ewing sarcoma, osteosarcoma, aneurysmal bone cyst
  • young adults: giant cell tumor, lymphoma
  • adults/elderly: chondrosarcoma, myeloma/lymphoma, metastases, osteosarcoma
104
Q

bone tumors by location

A
  • metaphysis: osteosarcoma, chondrosarcoma
  • epiphysis: giant cell tumor
  • diaphysis: ewing sarcoma, chondrosarcoma

GER MS2 Unit 1 (3 decks)

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