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Pathology > Unit 3 - Neurology, Ophthalmology, Otolaryngology > Flashcards

Unit 3 - Neurology, Ophthalmology, Otolaryngology Flashcards

1
Q

Most common cause of Rhinitis

A

Rhinovirus or adenovirus (he said adeno in video, rhino is written in book)

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2
Q

Allergic Rhinitis is what type of hypersensitivity reaction?

A

Type I

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3
Q

Protrusion of edematous, inflamed nasal mucosa

A

Nasal Polyp

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4
Q

3 diseases associated with Nasal Polyps

A

Repeated bouts of Rhinitis (most common)
Cystic Fibrosis
Aspirin-intolerant asthma

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5
Q

What is an angiofibroma and which age group is it most common in?

A

Benign tumor of nasal mucosa composed of large blood vessels and fibrous tissue
Adolescent males

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6
Q

How does an angiofibroma present?

A

Profuse epistaxis

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7
Q

What virus is Nasopharyngeal Carcinoma associated with and which populations is it seen in?

A

EBV

African children, Chinese adults

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8
Q

Most common cause of acute epiglottitis

A

H. influenzae type b

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9
Q

What is Laryngotracheobronchitis and what is the most common cause?

A

AKA Croup
Inflammation of upper airway
Parainfluenza virus

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10
Q

How does croup present?

A

Hoarse “barking” cough

Inspiratory stridor

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11
Q

What is tissue is a vocal cord nodule composed of?

A

Degenerative (myxoid) connective tissue

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12
Q

How do you treat a vocal cord nodule?

A

Rest - due to excessive use

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13
Q

What is a laryngeal papilloma?

A

Benign papillary tumor of the vocal cord

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14
Q

What causes a laryngeal papilloma and how does presentation differ in adults vs. kids?

A

Due to HPV 6 & 11
Adults - single papilloma
Children - multiple papillomas

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15
Q

Risk factors for laryngeal carcinoma

A

Alcohol, tobacco

Rarely comes from laryngeal papilloma

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16
Q

Why does a cleft lip or palate form?

A

Because the 5 facial prominences fail to fuse during development

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17
Q

Painful, superficial ulceration of oral mucosa characterized by grayish base surrounded by erythema

A

Aphthous Ulcer

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18
Q

What is Behcet Syndrome?

A

Recurrent aphthous ulcers, genital ulcers, and uveitis

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19
Q

What causes Behcet Syndrome and what usually predisposes one to it?

A

Caused by immune complex vasculitis involving small vessels

Comes after viral infection

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20
Q

Where does HSV-1 remain dormant and what causes reactivation?

A

Dormant in ganglia of trigeminal nerve

Stress and sunlight cause reactivation

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21
Q

2 precursor lesions of oral squamous cell carcinoma

A

Oral Leukoplakia - white plaque that cannot be scraped away

Erythroplakia - red plaque, vascularized leukoplakia

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22
Q

Which is more indicative of squamous cell dysplasia, oral leukoplakia or erythroplakia?

A

Erythroplakia

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23
Q

How does Mumps present?

A

Bilateral inflamed parotid glands

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24
Q

What enzyme is characteristically increased in Mumps?

A

Serum amylase

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25
Q

3 complications of Mumps

A

Orchitis
Pancreatitis
Aseptic Meningitis

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26
Q

What is Sialadenitis?

A

Inflammation of the salivary gland

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27
Q

What is the most common cause of Sialadenitis?

A

Obstructing stone leading to Staph Aureus infection - unilateral

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28
Q

Most common tumor of the salivary gland

A

Pleomorphic adenoma (benign)

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29
Q

Where does a pleomorphic adenoma usually arise and how does it present?

A

Arises in parotid gland

Painless**, circumscribed mass at angle of jaw

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30
Q

Benign cystic tumor of salivary gland that has abundant lymphocytes and germinal centers (lymph-like stroma)

A

Warthin Tumor

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31
Q

Where does a Warthin Tumor usually arise?

A

Parotid gland

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32
Q

Most common malignant tumor of salivary gland

A

Mucoepidermoid Carcinoma

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33
Q

Where does a Mucoepidermoid Carcinoma usually arise?

A

Parotid gland - involves facial nerve

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34
Q

Pathology of Myasthenia Gravis

A

Autoantibodies are produced against ACh receptor at neuromuscular junction

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35
Q

Which muscles do Myasthenia Gravis classically affect and what worsens and improves the weakness?

A

Eye muscles
Improves with rest
Worsens with use

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36
Q

Which 2 things can improve the symptoms of Myasthenia Gravis?

A

Anticholinesterase agents

Thymectomy if associated with thymic hyperplasia or thymoma

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37
Q

Pathology of Lambert-Eaton Syndrome

A

Antibodies produced against presynaptic Ca+ channel of neuromuscular junction leading to impaired ACh release

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38
Q

How does Lambert-Eaton Syndrome arise?

A

As a paraneoplastic syndrome most commonly due to small cell carcinoma of lung

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39
Q

What are the clinical features of Lambert Eaton Syndrome?

A

Proximal muscle weakness that improves with use
Eyes are usually spared
Anticholinesterase agents do not improve symptoms

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40
Q

The wall of the neural tube forms _____ tissue, the hollow lumen forms _____ and ______, and the neural crest forms the ______.

A

Wall - central nervous system tissue
Lumen - ventricles, spinal cord canal
Crest - peripheral nervous system

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41
Q

Absence of fetal skill and brain leading to maternal polyhydramnios

A

Anencephaly

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42
Q

How can you detect neural tube defects during prenatal care?

A

Levels of alpha-fetoprotein (AFP) are elevated in amniotic fluid and maternal blood

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43
Q

What is Spina Bifida?

A

Failure of posterior vertebral arch to close - results in vertebral defect

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44
Q

Congenital stenosis of channel that drains CSF from 3rd ventricle into 4th ventricle

A

Cerebral Aqueduct Stenosis

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45
Q

Most common cause of hydrocephalus in newborns

A

Cerebral Aqueduct Stenosis

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46
Q

What is the Dandy-Walker malformation?

A

Congenital failure of the cerebellar vermis to develop

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47
Q

How does Dandy-Walker malformation present?

A

Massively dilated 4th ventricle with absent cerebellum

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48
Q

Congenital downward displacement of cerebellar vermis and tonsils through the foramen magnum

A

Arnold-Chiari Malformation Type II

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49
Q

What are 2 common associations with Arnold-Chiari malformation?

A

Meningomyelocele and syringomyelia

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50
Q

What is Syringomyelia?

A

Cystic degeneration of spinal cord

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51
Q

What spinal levels does Syringomyelia usually occur at?

A

C8 - T1

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52
Q

How does Syringomyelia present?

A

Loss of pain and temperature in “cape like” distribution

Spares fine touch and position sense

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53
Q

If syrinx expands in syringomyelia, which other spinal tracts can it affect and what are the associated symptoms?

A

Anterior horn - damages LMN, leading to muscle atrophy, weakness, decreased muscle tone, impaired reflexes

Lateral horn of hypothalamospinal tract - horner syndrome with ptosis, miosis, and anhidrosis

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54
Q

What is Poliomyelitis?

A

Damage to anterior motor horn due to poliovirus infection

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55
Q

How does Poliomyelitis present?

A

LMN signs - flaccid paralysis with muscle atrophy, fasciculations, weakness with decreased muscle tone, impaired reflexes, negative Babinski sign

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56
Q

Inherited (autosomal recessive) degeneration of anterior motor horn

A

Werdnig-Hoffman Disease

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57
Q

How does Werdnig-Hoffman Disease present?

A

Floppy baby - death within few years after birth

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58
Q

Degenerative disorder of upper and lower motor neurons of corticospinal tract

A

Amyotrophic Lateral Sclerosis (ALS)

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59
Q

What is an early sign of ALS and how is it differentiated from Syringomyelia?

A

Early sign is atrophy and weakness of hands

No sensory impairment in ALS - different from Syringomyelia

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60
Q

What is Friedreich Ataxia?

A

Degenerative disorder of cerebellum and spinal cord

61
Q

What are the symptoms associated with Friedreich Ataxia?

A

Ataxia, loss of vibratory sense and proprioception, muscle weakness in lower extremities, loss of deep tendon reflexes

62
Q

What causes Freidreich Ataxia?

A

Genetic - AR, GAA repeat in frataxin gene

Results in iron buildup and free radical damage

63
Q

At what ages does Freidreich Ataxia present and what is it associated with?

A

Early childhood

Hypertrophic cardiomyopathy

64
Q

What is Meningitis?

A

Inflammation of leptomeningees (pia + arachnoid)

65
Q

Classic triad of Meningitis

A

Headache, nuchal rigidity, fever

Photophobia, vomiting, and mental status may also be present

66
Q

How do you diagnose Meningitis?

A

Lumbar puncture (between L4 and L5)

67
Q

What are the CSF findings in bacterial meningitis, viral meningitis, and fungal meningitis?

A

Bacterial - neutrophils with decreased CSF glucose
Viral - lymphocytes with normal CSF glucose
Fungal - lymphocytes with decreased CSF glucose

68
Q

Complications of bacterial meningitis

A

Death (herniation), hydrocephalus, hearing loss, seizures

69
Q

4 major etiologies causing global cerebral ischemia

A
  1. ) Low perfusion (atherosclerosis)
  2. ) Acute decrease in blood flow (cardiogenic shock)
  3. ) Chronic hypoxia (anemia)
  4. ) Repeated episodes of hypoglycemia (insulinoma)
70
Q

Clinical differences between mild, moderate, and severe global cerebral ischemia

A

Mild - transient confusion with prompt recovery
Moderate - infarcts in watershed areas and vulnerable areas (cerebellar signs, long term memory damage)
Severe - diffuse necrosis, survival leads to vegetative state

71
Q

What is the definition of an Ischemic Stroke?

A

Regional ischemia to the brain resulting in focal neurologic deficits lasting > 24 hours

72
Q

How does an ischemic stroke differ from a TIA?

A

TIA 24 hours

73
Q

Subtypes of ischemic strokes and what are they caused by?

A

Thrombotic Stroke - due to rupture of atherosclerotic plaque

Embolic Stroke - due to thromboemboli

Lacunar Stroke - occurs secondary to hyaline arteriolosclerosis, complication of hypertension

74
Q

Where in blood vessels does atherosclerosis usually develop and what type of infarct does a thrombotic stroke result in?

A

Develops at branch points of arteries

Pale infarct in periphery of cortex

75
Q

What is the most common source of emboli in an embolic stroke?

A

Left side of heart (a fib)

76
Q

Which artery does an embolic stroke usually involve and what type of infarct does it result in?

A

Middle Cerebral Artery

Hemorrhagic infarct at periphery of cortex

77
Q

Which vessels does a lacunar stroke most commonly involve and what type of infarct does it result in?

A

Lenticulostriate vessels

Small cystic areas of infarction

78
Q

Ischemic stroke results in _______ _______

A

Liquefactive necrosis

79
Q

What is an Intracerebral Hemorrhage and what is it classically caused by?

A

Bleeding into brain parenchyma

Due to rupture of Charcot-Bouchard microaneurysms of the lenticulostriate vessels

80
Q

How does Intracerebral Hemorrhage clinically present?

A

Severe headache, nausea, vomiting, eventual coma

81
Q

What is a Subarachnoid Hemorrhage and what is it most commonly caused by?

A

Bleeding into subarachnoid space

Most commonly due to rupture of berry aneurysm

82
Q

How does a Subarachnoid Hemorrhage present clinically?

A 
Sudden headache (worst headache of my life)
Nuchal rigidity
83
Q

What is an Epidural Hematoma and what is it classically caused by?

A

Collection of blood between dura and skull

Due to fracture of temporal bone with rupture of middle meningeal artery

84
Q

What is a Subdural Hematoma and what is it classically caused by?

A

Collection of blood underneath dura (covers brain)

Due to tearing of bridging veins that lie between dura and arachnoid - seen with trauma

85
Q

How would a subdural vs. epidural hematoma present on CT and in terms of neurological signs?

A

Subdural - crescent shaped lesion on CT, progressive neurological signs
Epidural - lens shaped lesion on CT, lucid interval may precede neurological signs

86
Q

What is a complication of both epidural and subdural hematomas?

A

Herniation (lethal)

87
Q

Displacement of brain tissue due to mass effect or increased intracranial pressure

A

Herniation

88
Q

What is a Tonsillar Herniation and what does it lead to?

A

Displacement of cerebellar tonsils into foramen magnum

Compression of brainstem leads to cardiopulmonary arrest

89
Q

What is a Subfalcine Herniation and what does it lead to?

A

Displacement of cingulate gyrus under the falx cerebri

Compression of anterior cerebral artery leads to infarction

90
Q

What is a Uncal Herniation and what does it lead to?

A

Displacement of temporal lobe uncus under the tentorium cerebelli
Compression of CN III - down and out eye, dilated pupil
Compression of posterior cerebral artery - infarction of occipital lobe
Rupture of paramedian artery - Duret (brainstem) hemorrhage

91
Q

____ myelinate CNS, _____ myelinate PNS

A

Oligodendrocytes; Schwann cells

92
Q

Inherited mutations in enzymes necessary for the production or maintenance of myelin

A

Leukodystrophies

93
Q

What is the most common Leukodystrophy?

A

Metachromatic Leukodystrophy (deficiency of arylsulfatase)

94
Q

_______ (leukodystrophy) is due to deficiency of galactocerebrosidase

A

Krabbe Disease

95
Q

_____ (leukodystrophy) is due to impaired addition of CoA to long chain fatty acids

A

Adrenoleukodystrophy

96
Q

Autoimmune destruction of CNS myelin and oligodendrocytes

A

Multiple Sclerosis

97
Q

Most common chronic CNS disease of young adults

A

Multiple Sclerosis

98
Q

How does Multiple Sclerosis present and what are some clinical features?

A

Presents as relapsing neurological deficits with periods of remission

Features - blurred vision in one eye, vertigo, scanning speech, internuclear ophthalmoplegia, hemiparesis or unilateral loss of sensation, blower extremity loss of sensation or weakness, bowel/bladder/sexual dysfunction

99
Q

How do you make a diagnosis of Multiple Sclerosis?

A

MRI & Lumbar Puncture
MRI - plaques
LP - increased lymphocytes, increased Ig with oligoclonal IgG bands on electrophoresis, myelin basic protein

100
Q

How do you acutely and chronically treat Multiple Sclerosis?

A

Acute attacks - high dose steroids

Chronic - interferon beta

101
Q

What is Subacute Sclerosing Panencephalitis and what is it due to?

A

Progressive, debilitating encephalitis leading to death

Due to slowly progressing, persistent infection of brain by measles virus

102
Q

JC virus infection of oligodendrocytes leading to death

A

Progressive Multifocal Leukoencephalopathy

103
Q

What is Central Pontine Myelinolysis and what is it due to?

A

Focal demyelination of the pons (anterior brainstem)

Due to rapid IV correction of hyponatremia

104
Q

How does Central Pontine Myelinolysis present clinically?

A

“Locked in” syndrome - acute bilateral paralysis

105
Q

Group of disorders characterized by loss of neurons within the gray matter

A

Degenerative Disorders/Dementias

106
Q

Degenerative disease of cortex

A

Alzheimers Disease

107
Q

Most common cause of dementia

A

Alzheimers Disease

108
Q

Clinical features of Alzheimers Disease

A

Slow onset memory loss and progressive disorientation
Loss of learned motor skills and language
Changes in behavior and personality
Patients become mute and bedridden
Focal neurological deficits in later disease

109
Q

Common cause of death in Alzheimers Disease

A

Infection

110
Q

____ allele increases risk of Alzheimers, _____ allele decreases risk

A

e4; e2

Both part of apolipoprotein E

111
Q

What mutations are familial cases of Alzheimers associated with?

A

Presenilin 1 and Presenilin 2

112
Q

What are the neuritic plaques in Alzheimers composed of?

A

A(Beta) amyloid with entangled neuritic processes

113
Q

Morphological features of Alzheimers

A

Cerebral atrophy with narrowing of gyri, widening of sulci, dilation of ventricles
Neuritic plaques
Neurofibrillary tangles (tau protein)
Loss of cholinergic neurons in nucleus basalis of Meynert

114
Q

What is Vascular Dementia?

A

Multifocal infarction and injury due to hypertension, atherosclerosis, or vasculitis

115
Q

Degenerative disease of frontal and temporal cortex that spares the parietal and occipital lobes

A

Pick Disease

116
Q

What is Pick Disease characterized by?

A

Round aggregates of tau protein in neurons of cortex

117
Q

Degenerative loss of dopaminergic neurons in substantia nigra of basal ganglia

A

Parkinsons Disease

118
Q

Clinical features of Parkinson’s Disease

A

T - tremor at rest, disappears with movement
R - rigidity (cogwheel rigidity)
A - akinesia/bradykinesia (slowing of voluntary movement, expressionless face)
P - postural instability and shuffling gait

119
Q

What type of inclusions are found in the neurons in substantia nigra in Parkinsons Disease?

A

alpha-synuclein inclusions (Lewy Bodies)

120
Q

What is Huntingtons Disease?

A

Degeneration of GABAergic neurons in the caudate nucleus of the basal ganglia

121
Q

What causes Huntington Disease?

A

AD disorder characterized by CAG repeats in huntingtin gene

122
Q

How does Huntington Disease present?

A

Chorea that can progress to dementia and depression

123
Q

What is normal pressure hydrocephalus?

A

Increased CSF resulting in dilated ventricles

124
Q

How does normal pressure hydrocephalus present?

A

Wet, Wobbly, Wacky

Urinary incontinence, gait instability, dementia

125
Q

How do you treat normal pressure hydrocephalus?

A

Ventriculoperitoneal shunting

126
Q

What are the Spongiform Encephalopathies caused by?

A

Beta-pleated conformation of the prion protein, degenerative disease

127
Q

3 types of Spongiform Encephalopathies

A

Creutzfeldt-Jakob Disease - most common, usually sporadic, presents with rapidly progressive dementia with ataxia and startle myoclonus

Variant CJD - related to exposure to bovine spongiform encephalopathy

Familial Fatal Insomnia - inherited form, severe insomnia and exaggerated startle response

128
Q

Common sources of metastatic CNS tumors

A

Lungs, breast, kidneys

129
Q

In adults, primary tumors are usually ______ whereas in children, primary tumors are usually _____ [locations]

A

Supretentorial; infratentorial

130
Q

Most common primary malignant CNS tumor in adults

A

Glioblastoma Multiforme

131
Q

Malignant, high grade tumor of astrocytes

A

Glioblastoma Multiforme

132
Q

Histological characterization of Glioblastoma Multiforme

A

Center of necrosis surrounded by pseudopalisading tumor cells which are GFAP positive

133
Q

Benign tumor of arachnoid cells

A

Meningioma

134
Q

Most common benign CNS tumor in adults

A

Meningioma

135
Q

Histology of Meningioma

A

Whorled pattern sometimes with psammoma bodies

136
Q

Benign tumor of schwann cells

A

Schwannoma

137
Q

Tumor cells in Schwannoma are ____ positive

A

S-100

138
Q

Malignant tumor of oligodendrocytes

A

Oligodendroglioma

139
Q

What does imaging reveal on an Oligodendroglioma?

A

Calcified tumor in the white matter

140
Q

Benign tumor of astrocytes

A

Pilocytic Astrocytoma

141
Q

Most common CNS tumor in children

A

Pilocytic Astrocytoma

142
Q

Biopsy of Pilocytic Astrocytoma shows ____ fibers, ____ bodies, and tumor cells that are ___ positive

A

Rosenthal Fibers, eosinophilic granular bodies, GFAP positive

143
Q

Malignant tumor derived from granular cells of the cerebellum (neuroectoderm)

A

Medulloblastoma

144
Q

In which population does a Medulloblastoma usually arise and what is the prognosis?

A

Children, poor prognosis - rapidly spreads via CSF

145
Q

Malignant tumor of ependymal cells seen in children

A

Ependymoma

146
Q

Where does an ependymoma most commonly arise?

A

4th ventricle

147
Q

Benign tumor that arises from epithelial remnants of Rathke’s pouch

A

Craniopharyngoma

148
Q

How does a craniopharyngoma present?

A

Supratentorial mass in children/young adults

May compress optic chiasm leading to bilateral hemianopsia

Pathology (4 decks)

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