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Pathology IV > Quiz 5 > Flashcards

Quiz 5 Flashcards

1
Q

Process that results when a nerve fiber is cut or crushed, where the part of axon separated from neuron’s cell body degenerates distal to the injury:

A

Wallerian degeneration

usu begins within 24-36 hrs of injury

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2
Q

PNS dz is divided into 2 main categories:

A
  • mononeuropathies - affect single peripheral nerve

* polyneuropathies - more than one peripheral nerve, and often diffusely affect PNS

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3
Q

MC cranial mononeuropathies:

A
  • VII (facial)
  • V (trigeminal)
  • III (occulomotor)
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4
Q

Acute idiopathic facial nerve neuropathy, aka _________ is the MC cranial nerve neuropathy. The main sx is:

A

Bell’s Palsy
unliateral facial weakness - abrupt onset preceded / accompanied by pain on the affected side.
Mb Hx of URI in the past 1-3wks

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5
Q

Bell’s palsy is an (upper/lower) motor neuron condition and affects the (upper/lower) face. It is thought to be post-infx or via direct viral infx, with _______ being the suspected etiologic agent.

A

lower
both
HSV1

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6
Q

85% of pts w/Bell’s palsy recover fully in 1 year. Clinical features assoc w/poor prognosis include:

A
  • old age
  • complete palsy (vs weakness)
  • hyperacusis (sound sensitivity)
  • altered taste
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7
Q

Distinctive facial pain syndrome in which pt experiences intense, paroxysmal pain, ranging from infrequent to dozens of times daily:

A

Trigeminal neuralgia (tic douloureux)

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8
Q

Trigeminal neuralgia mb caused by:

A

blood vessel compression of trigeminal n. roots at pons

if caused by tumor - called secondary TN

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9
Q

MC blood vessel responsible for trigeminal neuralgia:

A

superior cerebellar artery

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10
Q

Since they control most of the eye movements, cranial nerves ___ ___ and ___ are usu tested together.

A

CN III, IV, and VI

tested by EOMs

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11
Q

CN III palsy is characterized by:

A

“down ‘n out” sx - lateral, downward deviated gaze

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12
Q

Mononeuropathies of limb nerves are MC related to:

A

physical nerve compression:

  • carpal tunnel syndrome
  • ulnar neuropathy
  • brachial plexus neuropathy
  • peroneal neuropathy
  • meralgia paresthetica
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13
Q

MC sx of Carpal Tunnel:

A

intermittent numbness of thumb/index/middle/1/2 ring finger
(often at night)

may lead to constant numbness, atrophy, weakness

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14
Q

Condition characterized by sensory symptoms in lateral cutaneous nerve distribution of the thigh, with combo of sensory loss, prickling paresthesia, and hypersensitivity over the anterolateral thigh:

A

Meralgia paresthetica

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15
Q

Meralgia paresthetica is usu attributed to:

A

compression of the lateral cutaneous n. by inguinal lig as it passes from retroperitoneum to anterior thigh.
(more common in obese)

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16
Q

MC peripheral neuropathy common in DM:

A

polyneuropathy -

  • distal
  • symmetrical
  • sensorimotor
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17
Q

Classic diabetic neuropathy distribution:

A

“glove-and-stocking” - combo of sensory loss, numbness, and burning

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18
Q

______ and _____ to nerves mb the most important underlying cause of diabetic polyneuropathy, but another proposed mechanism is chronic _________ leading to accumulation of _______ and the depletion of _______ in the affected nerves, leading to altered conduction in axon.

A

ischemia and hypoxia
hyperglycemia
sorbitol
inositol

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19
Q

The chief pathologic finding in uremic neuropathy is ____________, which is most abundant in the most distal aspects of the PNS. Risk is related to duration and severity of _____________, and improvements are usu seen in:

A

axonal degeneration
renal failure
dialysis and renal transplant

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20
Q

MC immune or inflammatory polyneuropathy and MC cause of acute generalized paralysis in the US:

A

Guillan-Barre syndrome (GBS)

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21
Q

MC first sx of GBS:

A

prickling parasthesia - from feet, spreading up legs

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22
Q

Condition in which the fundamental pathologic event is stripping of myelin from axons by macrophages, which slows or blocks nerve impulse conduction, causing weakness and sensory loss:

A

chronic inflammatory demyelinating polyradiculoneuropathy (CIDP)

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23
Q

(Similar/contrary) to GBS, the onset of CIDP is insidious, and autonomic and respiratory involvement is (common/unusual).

A

Contrary
unusual

usu pattern of CIDP is slow worsening over months, producing chronic moderate disability.

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24
Q

Polyneuropathy characterized by amyloid deposition in nerve:

Occurs in 2 settings:

A

amyloid neuropathy:

  • systemic amyloidosis
  • familial amyloidosis

dx by nerve biopsy

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25
Q

T/F: Neuropathy is usu the MC of disability in primary amyloidosis unlike familial amyloid patients where neuropathy is generally less severe.

A

false / opposite

MC cause of disability in familial amyloid pts.

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26
Q

T/F: Neurologic deficits that mb seen as a consequence of paraneoplastic syndromes are a result of metastasis to involved nerve(s).

A

false - are NOT a result of mets

believed to be immunologic response

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27
Q

Toxic neuropathies tend to begin ________ and progress over _______________.

A

distally
weeks to months
* from chemicals, drugs, natural compounds

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28
Q

Main feature of toxic neuropathy:

A

axonal degeneration

* biopsy not helpful *

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29
Q

Danish beer is supplemented with:

A

thiamine and pyridoxine - unlikely that deficiency is the cause of ethanol neuropathy (cause unclear)

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30
Q

Characteristic of chronic alcoholic neuropathy:

A
  • distal
  • usu painful (burning, stabbing)
  • dec sensation in feet (mb hands)
  • loss of ankle reflexes
  • mild distal weakness
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31
Q

T/F: Drug-induced neuropathy is a common problem.

A

true - esp in a hospital-based practice!

careful drug Hx important in work-up

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32
Q

In some drug related neuropathies, the patient experiences the phenomenon known as “coasting”, which is:

A

neuropathy continues to worsen for weeks after exposure to the drug has ceased.

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33
Q

Peripheral neuropathy d/t lead exposure is predominantly (sensory/motor), with a predilection for the (upper/lower) limbs.

A

motor

upper

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34
Q

Polyneuropathy can be a manifestation seen in famine victims or as a result of ________ related to ________. Exact cause is unclear, although it is often though to relate to one of the __ vitamins.

A

malnutrition
malabsorption
B

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35
Q

Paralytic illness caused by neurotoxins of anaerobic, spore-forming bacterium:

A

Botulism - Clostridium botulinum

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36
Q

Botulinum neurotoxins work by:

A

inducing blockage of voluntary motor and autonomic cholinergic neuromuscular junctions -> prevent motor fiber stimulation

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37
Q

Infectious dzs assoc w/ PNS neuropathies:

A
  • leprosy - MC
  • HIV/AIDS
  • lyme dz
  • VZV
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38
Q

Most prevalent tick-borne illness in the US:

A

Lyme dz - named for Lyme, CT where outbreak was recognized in ‘75.
Vector - Ixodes spp. tick

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39
Q

T/F: B. burgdorferi is a gram-neg bacteria that is rapidly reproducing.

A

false

does not hold any stain - unclassified
slow reproducing - once in 12-24 hours!

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40
Q

Characteristic rash of Lyme dz:

A

erythema migrans - target lesion

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41
Q

T/F: Unlike pts with Bell’s palsy, BL facial neuropathy is MC in pts with Lyme disease.

A

TRUE

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42
Q

MC viral pathogen affecting the PNS:

A

VZV - usu after childhood exposure, virions lay dormant in dorsal root or cranial ganglia. Reactivation = shingles.

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43
Q

Classic herpes zoster (shingles) manifestation:

A
  • dematomal pain
  • vesicular eruption 3-14 days later
  • last 7-10 days, area left depigmented, scarred
  • mb weakness, sensory loss
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44
Q

Histopathology of herpes zoster:

A
  • multinucleated giant cell

* nuclear accentuation

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45
Q

Herpes zoster ophthalmica is often preceded by a lesion:

A

on the tip of the nose (Hutchinson’s sign)

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46
Q

Examination of the ____ should be performed on all shingles pts with face/nose involvement, dt likelihood of ________.

A

eye

corneal ulceration

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47
Q

When shingles is assoc w/facial paralysis it is called:

A

Ramsay-Hunt syndrome

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48
Q

When Schwann cells (that myelinate axons) proliferate out of control, the resultant bundle of cells is called a:

A

schwannoma

benign but detrimental when tumor compresses nerve

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49
Q

Benign primary intracranial tumor of the myelin-forming cells of the vestibulocochlear nerve (CN VIII):

A

vestibular schwannoma - aka acoustic neuroma

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50
Q

Common, benign spindle cell tumor of peripheral nerves:

A

neurofibroma

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51
Q

MC nerve affected with neurofibroma type I:

A

CN VIII

unilateral, look for cafe au lait skin spots

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52
Q

Neurofibroma type II is the result of mutation of protein ______ and manifests with bilateral _____________.

A

merlin
neuromas and hearing loss
hallmark - usu around age 20

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53
Q

Histopathology of perineuromas:

A
  • elongated cells
  • parallel bundles
  • no atypia
  • rare mitotic figures
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54
Q

Malignant tumor that usu arises from major nerves in the neck, forearm, lower leg, or buttocks:

A

malignant peripheral nerve sheath tumor (MPNST)

50% assoc w/underlying neurofibromatosis / 50% de novo

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55
Q

Histopathology of MPNST:

A
  • increased cellularity

* disordered arrangement

56
Q

The brain devotes most of its volume and energy to processing received __________ and initiating/coordinating ___________.

A

sensory inputs

motor outputs

57
Q

From outside in, the meningial layers are:

A

dura mater
arachnoid mater
pia mater

58
Q

The CSF fills the space between which layers?

A

arachnoid and pia

59
Q

Birth defects involving what organ are the MC?

A

brain

although defects leading to infant death it is #3, after heart and lungs

60
Q

Absence of brain formation:

A

Anencephaly (neural tube defect)

61
Q

Diminished forebrain size:

A

Microcephaly

62
Q

Absence of gyri:

A

Agyri

63
Q

Increased number of smaller than normal, shallow gyri:

A

Polymicrogyri

64
Q

Enlarged abnormal gyri:

A

Macrogyri / pachygyri

65
Q

Anencephaly has dropped to 1 in 10K incidence d/t:

A

maternal folic acid supplementation

66
Q

Some causes of microcephaly:

A
  • fetal alcohol syndrome
  • trisomy 18 (Edward’s syndrome)
  • congenital Rubella
  • congenital HIV

persons w/Down’s have dec volume w/ disproportionate small cerebellum, larger sub-cortical grey matter

67
Q

MC cause of hydrocephalus:

A

obstruction of normal CSF flow

* mb 2° to malformations, tumors, hemorrhage, infx

68
Q

Failure of normal closure of the vertebral column and/or overlying skin over the dorsal aspect of the spinal cord:

A

Spina bifida

  • occulta
  • myelocele
  • myelomeningocele
69
Q

Spina bifida occulta:

A

missing a portion of a posterior vertebral body.

70
Q

Meningocele:

A

herniation of the meninges but not cord.

71
Q

Myelomeningocele:

A

herniation of the meninges and spinal cord.

72
Q

100% of pts with myelomeningocele have:

A

tethered cord - result of scar tissue post surgical repair

73
Q

AFP can be measured in:

A
  • serum
  • urine
  • amniotic fluid
74
Q

Maternal AFP is typically measured at:

A

14-16 weeks gestation

75
Q

T/F: AFP is considered to be the fetal form of serum albumin.

A

true

the function of AFP in adults in unknown

76
Q

Principle tumors that secrete AFP:

A
  • non-seminomatous germ cell tumors
  • neuroblastoma
  • hepatoblastoma
  • hepatocellular carcinoma
77
Q

Maternal AFP elevation mb seen in:

A
  • multiple gestation
  • placental abruption (separation)
  • neural tube defects
  • abdominal wall defects
  • miscalculation of gestational age
  • MTHFR genetic variant mothers
78
Q

Low maternal AFP mb seen in:

A
  • Down syndrome

* Trisomy 18

79
Q

T/F: Developmental deficits and brain injury in children with congenital heart disease is a serious problem and mb seen in more than 1/3 of these newborns.

A

true - In the U.S., ~30K are born/year with congenital heart dz, and ~50% will require open-heart surgery.
unclear if brain injury occurs prior/during/after cardiac surg.

80
Q

Group of permanent disorders of the development of movement and posture, which cause activity limitation, attributed to non-progressive disturbances in the developing fetal or infant brain:

A

Cerebral palsy

  • during pregnancy - 75%
  • during birth - 10%
  • after birth - 15%
81
Q

Intrauterine development of CP has been assoc with :

A

maternal infx

  • Strep. throat
  • maternal CNS infx
82
Q

After birth, CP mb caused by:

A
  • severe jaundice
  • encephalitis
  • meningitis
  • toxins (lead)
  • physical injury (SBS)
  • brain hypoxia
83
Q

MC type of CP:

A

spastic - 70-80% of cases

84
Q

At a cellular level, damage to the brain in spastic CP affects the nervous systems ability to receive ______________ in the brain area affected.

A

gamma amino butyric acid

85
Q

The MC finding on autopsy of newborns / infants with CP is:

A

periventricular leukomalacia - PVL

necrosis around the ventricles d/t hypoxia and anoxia

86
Q

Children with PVL have higher levels of:

A
  • nystagmus
  • strabismus
  • optic nerve hypoplasia
  • refractive error
87
Q

Aseptic meningitis is a term for (non-/bacterial) meningitis, which the other is often called:

A

non-bacterial

bacterial = purulent meningitis

88
Q

MC cause of meningitis:

A

viral infx - usu resolve w/out tx

89
Q

2nd MC cause of meningitis:

A

bacterial infx - often results in death or brain damage

90
Q

MC presenting sx of meningitis:

A

1st - Headache
2nd - neck stiffness

  • rapidly spreading petechial rash mb 1st in MM *
91
Q

MC bacterial cause of meningitis in neonates:

A
    • E. coli **
  • Streptococcus group B
  • Listeria monocytogenes
92
Q

MC bacterial cause of meningitis in infants/children:

A
    • Neisseria meningococci **
  • strep pneumoniae
  • H. influenza (HiB) (peak@6-9mos)
93
Q

MC bacterial cause of meningitis in adolescents/adults:

A
    • Neisseria meningococci **

* strep pneumoniae

94
Q

MC bacterial cause of meningitis in older adults (65+):

A
    • Strep pneumoniae **
  • Neisseria meningococci
  • Listeria monocytogenes
  • mycobacteria
95
Q

If meningitis pt is immunocompromised, also test for:

A
  • toxoplasmosis
  • EBV
  • CMV
  • JC virus
  • fungal infx
96
Q

Who is at particular risk for infx by encapsulated organisms such a Neisseria meningitis and H. flu?

A

Pts without a spleen!!

97
Q

CSF is typically drawn btw what spinal vertebrae?

A

Lumbar 3 and 4

98
Q

Which strain is latex agglutination most sensitive for:

A 
** H. influenza (HiB) **
also test for
- strep pneumoniae
- N meningitidis
- E coli
- GBS
99
Q

Meningococcal meningitis (MM) is another name for:

A

Neisseria meningitidis meningitis

100
Q

Histopathology of meningococcal meningitis:

A
  • gram neg diplococci in a neutrophil

* prominent dilated blood vessels

101
Q

Complications of MM:

A
  • permanent brain damage
  • possible mental retardation
  • hydrocephalus
  • deafness
  • muscle paralysis
  • myocarditis
  • Waterhouse-Friderichsen syndrome
  • death
102
Q

Gross inspection of MM:

A

yellow-tan clouding of meninges d/t exudate (acute)

103
Q

CSF analysis in bacterial meningitis shows:

A
  • possible high WBCs w/PMN predominance
  • low glucose
  • usu gram + / culture +
104
Q

Describe the rash of MM:

A
  • mb first sx
  • rapid spreading
  • small irreg red/purple spots
  • trunk/LE/mucous membranes/conjunctiva/palms/soles
105
Q

HiB meningitis may follow a ____ and spreads:

A

URI

from resp tract to blood to meninges

106
Q

Risk factors for HiB meningitis:

A
  • recent URI/OME/sinusitis/pharyngitis
  • family members w/HiB infx
  • daycare
  • Native American / Eskimo race
107
Q

Pt who recover from HiB meningitis may have long term:

A
  • hearing loss
  • seizures
  • mental retardation
  • hydrocephalus
  • learning disorders
  • behavioral problems
  • speech / language development abn
108
Q

What is aseptic meningitis?

A

Pt with ssx of meningitis with negative CSF culture

  • viral
  • fungal
  • TB
  • meds
  • epidural abscess
109
Q

What two enteroviruses account for 1/2 of the cases of aseptic meningitis?

A

Coxsackie B and echovirus

others:

  • VZV
  • polio
  • mumps
  • rabies
  • HIV
  • HSV 1 and 2
  • EBV
  • CMV
110
Q

HSV type ___ can cause meningitis in children, especially _______, and adults.

A

types 1 and 2

infants

111
Q

______________ is a yeast that may cause meningitis, particularly in _____________ people.

A 
Cryptococcus neoformans
immunocompromised
* AIDS
* lymphoma
* diabetes
112
Q

MC life threatening fungal pathogen that infects AIDS pts:

A

cryptococcus neoformans

  • soil fungi
  • MC in Africa
  • primarily affects lungs
  • usu no neck stiffness
  • mb papilledema (1/3)
113
Q

Dx of Cryptococcal meningitis involves:

A
  • yeast on CSF stain with INDIA INK
  • CSF culture
  • CSF + for cryptococcus antigen
114
Q

Histopathology of cryptococcus neoformans:

A

** encapsulated cells (India ink) **

115
Q

Most cases of viral encephalitis arise as a complication of:

A

common systemic viral infections (2-12 days post infx)

116
Q

Name seasonal viral meningitis/encephalitis correlations:

A
  • arboviruses - spring/summer
  • enteroviruses - late summer
  • mumps / varicella - spring
  • HSV - not seasonal
117
Q

MC cause of viral meningitis in children:

Previous MC cause:

A

Enteroviruses (present)

Mumps (past)

118
Q

MC cause of viral meningitis in adults:

2nd MC:

A

** Enteroviruses **

HSV type 2

119
Q

T/F: Enterovirus refers to the sx of infx.

A

false - refers to mode of transmission, mostly asx

120
Q

MC cause of sporadic encephalitis in developed countries:

A

HSV
type 2 - almost all adult cases
type 1 - more commonly in infants, infx via vaginal birth

121
Q

Encephalitis d/t HSV infx characteristically involves the _________ lobes.

A

temporal

122
Q

Gold standard for dx of carcinomatous meningitis:

A

detection of tumor cells in CSF

123
Q

MC non-hematologic cancers that mets to CNS:

A
  • lung
  • breast
  • melanoma
    mb also head/neck/GI/GU
124
Q

MC histologic type of carcinomatous meningitis:

A

adenocarcinoma

125
Q

MC cerebral sx in carcinomatous meningitis:

MC cranial nerve sx:

A

headache

diplopia

126
Q

T/F: Fever is often present with carcinomatous meningitis.

A

false - rarely unless there is a supervening infx

127
Q

Describe the protective and harmful characteristics of brain abscess.

A

Protective - area of infx becomes enclosed in a membrane.

Harmful - mass effect, puts pressure on surrounding tissue.

128
Q

Histopathology of Aspergillus brain abscess:

A

slender hyphae which branch at 45° angles

129
Q

Brain abscesses are MC in what decades?

Higher in what populations?

A

first 4

AIDS and other immunocompromised

130
Q

T/F: In 80-90% of brain abscesses, only one organism is identified.

A

false - usu more than one

mb bacterial, fungal, or parasitic

131
Q

MC organism found in brain abscesses:

gram stain MC in infants:

A

streptococcal

gram -

132
Q

MC neuro-parasitic infx in humans is a CNS infx by larvae of the pork tapeworm, Taenia solium:

A

Neurocysticercosis

133
Q

Neurocysticercosis has a worldwide distribution, but MC in:

A
  • Central and Latin America
  • Mexica
  • Asia
  • Africa
  • Spain
  • Portugal
  • Eastern Europe
134
Q

The only definitive host of T. solium is:

A

humans (pig is intermediate)

135
Q

Describe the mechanism of neurocysticercosis infx.

A

pig ingests eggs, which grow in GI, burrow into circulation, and encyst in tissues/brain. humans ingest tapeworms and are infected.
* humans can be intermediate host also, if ingest eggs, which can then burrow into brain => neurocysticercosis

136
Q

CT of neurocysticercosis:

A

multiple, small nodular, and annular areas of abn enhancement in brain parenchyma.

137
Q

Diet not working?

A

swallow a tapeworm!

the end!!

Pathology IV (6 decks)

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