11-27-2007, 06:04 PM
Q: Approximately what percentage of brain tumors arise from metastasis?
A: 0.5
Q: Are basal cell carcinomas invasive?
A: Locally invasive but rarely metastasize
Q: Are Ewing's sarcomas likely to metastasize?
A: Yes. They are extremely aggressive with early metastasis. However, they are responsive to chemotherapy.
Q: Are meningiomas resectable?
A: Yes
Q: Are squamous cell carcinomas of the skin invasive?
A: Locally invasive but rarely metastasize
Q: Are the majority of adult tumors supratentorial or infratentorial?
A: Supratentorial
Q: Are the majority of childhood tumors supratentorial or infratentorial?
A: Infratentorial
Q: Common histopathology often seen in squamous cell carcinomas of the skin?
A: Keratin pearls
Q: Define anaplasia
A: Abnormal cells lacking differentiation; like primitive cells of the same tissue. Often equated with undifferentiated malignant neoplasms. Tumor giant cells may be formed.
Q: Define dysplasia
A: Abnormal growth with loss of cellular orientation, shape, and size in comparison to normal tissue maturation. It is reversible but is often a preneoplastic sign.
Q: Define hyperplasia
A: Increase in the number of cells (reversible)
Q: Define metaplasia
A: One adult cell type is replaced by another (reversible). It is often secondary to irritation and/or environmental exposure (e.g. squamous metaplasia in the trachea and bronchi of smokers)
Q: Define neoplasia
A: Clonal proliferation of cells that is uncontrolled and excessive
Q: Do oncogenes cause a gain or loss of function?
A: Gain of function
Q: Do tumor suppressor genes cause a gain or loss of function?
A: Loss of function. Both alleles must be lost for expression of disease
Q: Does a melanoma have a significant risk of metastasis?
A: Very significant risk! The depth of the tumor often correlates with the risk of metastasis.
Q: From what cells do meningiomas most commonly arise?
A: Arachnoid cells external to the brain
Q: Give 2 examples of a benign tumor of epithelial origin.
A: 1. Adenoma 2. Papilloma
Q: Give 2 examples of a malignant tumor of epithelial origin.
A: 1. Adenocarcinoma 2. Papillary carcinoma
Q: Give 2 examples of malignant tumors of blood cell (mesenchymal) origin.
A: 1. Leukemia 2. Lymphoma
Q: Give an example of a benign tumor of blood vessel (mesenchymal) origin.
A: Hemangioma
Q: Give an example of a benign tumor of bone (mesenchymal) origin.
A: Osteoma
Q: Give an example of a benign tumor of more than one cell type.
A: Mature teratoma
Q: Give an example of a benign tumor of skeletal muscle (mesenchymal) origin.
A: Rhabdomyoma
Q: Give an example of a benign tumor of smooth muscle (mesenchymal) origin.
A: Leiomyoma
Q: Give an example of a malignant tumor of blood vessel (mesenchymal) origin.
A: Angiosarcoma
Q: Give an example of a malignant tumor of bone (mesenchymal) origin.
A: Osteosarcoma
Q: Give an example of a malignant tumor of more than one cell type.
A: Immature teratoma
Q: Give an example of a malignant tumor of skeletal muscle (mesenchymal) origin.
A: Rhabdomysarcoma
Q: Give an example of a malignant tumor of smooth muscle (mesenchymal) origin.
A: Leiomyosarcoma
Q: Give an example of a neoplasm associated with Down's Syndrome.
A: Acute Lymphoblastic Leukemia (ALL)
Q: How are tumor markers used?
A: Tumor markers are used to confirm diagnosis, to monitor for tumor recurrence, and to monitor the response to therapy. They should not be used as a primary tool for diagnosis.
Q: How is prostatic adenocarcinoma most commonly diagnosed?
A: Digital rectal exam (detect hard nodule) or by prostate biopsy
Q: How often do primary brain tumors undergo metastasis?
A: Very rarely
Q: In what population is osteochondroma most often found?
A: Usually men under the age of 25
Q: In which age group is prostatic adenocarcinoma most common?
A: Men over the age of 50
Q: Is malignant transformation in osteochondroma common?
A: Malignant transformation to chondrosarcoma is rare
Q: Name 1 common tumor staging system.
A: TNM system T= size of tumor, N=node involvement, and M=metastases
Q: Name 3 herniation syndromes that can cause either coma or death when the herniations compress the brainstem
A: 1. Downward transtentorial (central) herniation 2. Uncal herniation 3. Cerebellar tonsillar herniation into the foramen magnum
Q: Name 4 factors that predispose a person to osteosarcoma.
A: 1. Paget's disease of bone 2. Bone infarcts 3. Radiation 4. Familial retinoblastoma
Q: Name 4 possible routes of herniation in the brain
A: 1. Cingulate herniation under the falx cerebri 2. Downward transtentorial (central) herniation 3. Uncal herniation 4. Cerebellar tonsillar herniation into the foramen magnum
Q: Name 5 primary brain tumors with peak incidence in adulthood.
A: 1. Meningioma 2. Glioblastoma multiforme 3. Oligodendroglioma 4. Schwannoma 5. Pituitary adenoma
Q: Name 5 primary brain tumors with peak incidence in childhood.
A: 1. Medulloblastoma 2. Hemangioblastoma 3. Ependymomas 4. Low-grade astrocytoma 5. Craniopharyngioma
Q: Name 5 sites from which tumor cells metastasize to the brain.
A: 1. Lung 2. Breast 3. Skin (melanoma) 4. Kidney (renal cell carcinoma) 5. GI
Q: Name a common histopathological sign of basal cell carcinoma nuclei
A: The nuclei of basal cell tumors have 'palisading' nuclei
Q: Name a population at a greater risk for melanoma.
A: Fair-skinned people (blue eyes and red hair have also been considered as factors)
Q: Name the 5 primary tumors that metastasize to the liver
A: 1. Colon 2. Stomach 3. Pancreas 4. Breast 5. Lung
Q: Name two of the most common sites of metastasis after the regional lymph nodes
A: The liver and the lung
Q: Name two presenting sequelae of a pituitary adenoma.
A: 1. Bitemporal hemianopsia (due to pressure on the optic chiasm) 2. Hypopituitarism
Q: On which chromosome is the p53 gene located?
A: 17p
Q: On which chromosome is the Rb gene located?
A: 13q
Q: On which chromosomes are the BRCA genes located?
A: BRCA 1 is on 17q and BRCA 2 is on 13q
Q: Out of the 6 primary tumors that metastasize to bone, which two are the most common?
A: Metastasis from the breast and prostate are the most common
Q: What 2 cancers are associated with EBV?
A: 1. Burkitt's lymphoma 2. Nasopharyngeal carcinoma
Q: What 2 neoplasms are associated with AIDS?
A: 1. Aggressive malignant lymphomas (non-Hodgkins) 2. Kaposi's sarcoma
Q: What 2 neoplasms are associated with Autoimmune disease (e.g. Hashimoto's thyroiditis, myasthenia gravis, etc.)?
A: Benign and malignant thymomas
Q: What 2 neoplasms are associated with Paget's disease of bone?
A: 1. Secondary osteosarcoma 2. Fibrosarcoma
Q: What 2 neoplasms are associated with Tuberous sclerosis (facial angiofibroma, seizures, and mental retardation)?
A: 1. Astrocytoma 2. Cardiac rhabdomyoma
Q: What are 2 characteristic findings in carcinoma in situ?
A: 1. Neoplastic cells have not invaded the basement membrane 2. High nuclear:cytoplasmic ratio and clumped chromatin
Q: What are 2 characteristic findings of an invasive carcinoma?
A: 1. Cells have invaded the basement membrane using collagenases and hydrolases 2. Able to metastasize if they reach blood or lymphatic vessels.
Q: What are 2 neoplasms associated with Xeroderma pigmentosum?
A: 1. Squamous cell carcinoma of the skin 2. Basal cell carcinoma of the skin
Q: What are 3 disease findings associated with Alkaline Phosphatase?
A: 1. Metastases to bone 2. Obstructive biliary disease 3. Paget's disease of bone
Q: What are 6 primary tumors that metastasize to bone?
A: 1. Kidney 2. Thyroid 3. Testes 4. Lung 5. Prostate 6. Breast
Q: What are a common histopathological finding of meningiomas?
A: Psammoma bodies. These are spindle cells concentrically arranged in a whorled pattern.
Q: What are ependymomas?
A: Ependymal cell tumors most commonly found in the 4th ventricle. May cause hydrocephalus
Q: What are the steps in the progression of neoplasia?
A: 1. Normal 2. Hyperplasia 3. Carcinoma In Situ/Preinvasive 4. Invasion
Q: What are two signs of bone metastases in prostatic adenocarcinoma?
A: An increase in serum alkaline phosphatase and PSA (prostate-specific antigen)
Q: What are two useful tumor markers in prostatic adenocarcinoma?
A: Prostatic acid phosphatase and prostate-specific antigen (PSA)
Q: What can be associated with the risk of melanoma?
A: Sun exposure
Q: What cancer is associated with HBV and HCV (Hep B and C viruses)?
A: Hepatocellular carcinoma
Q: What cancer is associated with HHV-8 (Kaposi's sarcoma-associated herpes virus)?
A: Kaposi's carcinoma
Q: What cancer is associated with the HTLV-1 virus?
A: Adult T-cell leukemia
Q: What cancers are commonly associated with HPV (human papilloma virus)?
A: Cervical carcinoma, penile, and anal carcinoma
Q: What causes the local effect of a mass?
A: Tissue lump or tumor
Q: What causes the local effect of a nonhealing ulcer?
A: Destruction of epithelial surfaces (e.g. stomach, colon, mouth, bronchus)
Q: What causes the local effect of a space-occupying lesion?
A: Raised intracranial pressure in brain neoplasms. Also seen with anemia due to bone marrow replacement.
Q: What causes the local effect of bone destruction?
A: Pathologic fracture or collapse of bone
Q: What causes the local effect of edema?
A: Venous or lymphatic obstruction
Q: What causes the local effect of hemorrhage?
A: Caused by ulcerated area or eroded vessel
Q: What causes the local effect of inflammation of a serosal surface?
A: Pleural effusion, pericardial effusion, or ascites
Q: What causes the local effect of obstruction in the biliary tree?
A: Jaundice
Q: What causes the local effect of obstruction in the bronchus?
A: Pneumonia
Q: What causes the local effect of obstruction in the left colon?
A: Constipation
Q: What causes the local effect of pain?
A: Any site with sensory nerve endings. Remember that tumors in the brain are usually painless.
Q: What causes the local effect of perforation of an ulcer in the viscera?
A: Peritonitis or free air
Q: What causes the local effect of seizures?
A: Tumor mass in the brain.
Q: What causes the localized loss of sensory or motor function?
A: Compression or destruction of nerve (e.g. recurrent laryngeal nerve by lung or thyroid cancer causes hoarseness)
Q: What causes the paraneoplastic effect gout?
A: Hyperuricemia due excess nucleic acid turnover (secondary to cytotoxic therapy of various neoplasms)
Q: What causes the paraneoplastic effect of Cushing's disease?
A: ACTH or ACTH-like peptide (secondary to small cell lung carcinoma)
Q: What causes the paraneoplastic effect of hypercalcemia?
A: PTH-related peptide, TGF-a, TNF-a, IL-2 (secondary to squamous cell lung carcinoma, renal cell carcinoma, breast carcinoma, multiple myeloma, and bone metastasis)
Q: What causes the paraneoplastic effect of Lambert-Eaton syndrome?
A: Antibodies against presynaptic Ca2+ channels at NMJ (Thymoma, bronchogenic carcinoma)
Q: What causes the paraneoplastic effect of Polycythemia?
A: Erythropoietin (secondary to renal cell carcinoma)
Q: What causes the paraneoplastic effect of SIADH?
A: ADH or ANP (secondary to small cell lung carcinoma and intracranial neoplasms)
Q: What chemical carcinogen is commonly associated with the centrilobar necrosis and fatty acid change?
A: CCL4
Q: What chemical carcinogen is commonly associated with the esophagus and stomach?
A: Nitrosamines
Q: What chemical carcinogen is commonly associated with the lungs?
A: Asbestos (Causes mesothelioma and bronchogenic carcinoma)
Q: What chemical carcinogen is commonly associated with the skin (squamous cell)?
A: Arsenic
Q: What chemical carcinogen(s) are commonly associated with the liver?
A: Aflatoxins and vinyl chloride
Q: What is a chondrosarcoma?
A: Malignant cartilaginous tumor.
Q: What is a common genetic finding in Ewing's sarcoma?
A: 11;22 translocation
Q: What is a common gross pathological sign seen in Ewing's sarcoma?
A: Characteristic 'onion-skin' appearance of bone
Q: What is a common origin of a chondrosarcoma?
A: May be of primary origin or from osteochondroma
Q: What is a common sign found on the x-ray of a person with osteosarcoma?
A: Codman's triangle (from elevation of periosteum)
Q: What is a craniopharyngioma?
A: Benign childhood tumor. Often confused with pituitary adenoma because both can cause bitemporal hemianopsia. Calcification of the tumor is common.
Q: What is a Ewing's sarcoma?
A: Anaplastic small cell malignant tumor.
Q: What is a giant cell tumor?
A: Locally aggressive benign tumor around the distal femur, proximal tibial region.
Q: What is a gross pathological sign of basal cell carcinoma?
A: Pearly papules
Q: What is a helpful mnemonic to remember the neoplasm associated with Down's Syndrome?
A: We ALL go DOWN together.
Q: What is a helpful mnemonic to remember the site of metastasis to the brain?
A: Lots of Bad Stuff Kills Glia
Q: What is a helpful mnemonic to remember the types of cancer that metastasize to the liver?
A: Cancer Sometimes Penetrates Benign Liver
Q: What is a helpful mnemonic to remember what tumors metastasize to bone?
A: BLT with a Kosher Pickle
Q: What is a Hemangioblastoma?
A: Most often a cerebellar tumor. Associated with von Hippel Lindau syndrome when found with retinoblastoma.
Q: What is a low-grade astrocytoma?
A: Diffusely infiltrating glioma. In children, it is most commonly found in the posterior fossa.
Q: What is a medulloblastoma?
A: Highly malignant cerebellar tumor. A form of primitive neuroectodermal tumor (PNET). Can compress 4th ventricle causing hydrocephalus
Q: What is a neoplasm associated with actinic keratosis?
A: Squamous cell carcinoma of the skin
Q: What is a neoplasm associated with Barrett's esophagus (chronic GI reflux)?
A: Esophageal adenocarcinoma
Q: What is a neoplasm commonly associated with chronic atrophic gastritis, pernicious anemia, and postsurgical gastric remnants?
A: Gastric adenocarcinoma
Q: What is an oligodendroglioma?
A: A relatively rare, slow growing, benign tumor.
Q: What is CEA (carcinoembryonic antigen)?
A: Very nonspecific antigen produced by 70% of colorectal and pancreatic cancers and by gastric and breast carcinoma
Q: What is considered a precursor to squamous cell carcinoma?
A: Actinic keratosis
Q: What is considered to be a precursor to malignant melanoma?
A: Dysplastic nevus
Q: What is meant by the term tumor grade?
A: Histologic appearance of the tumor. Usually graded I-IV based on degree of differentiation and number of mitoses per high-power field.
Q: What is meant by the term tumor stage?
A: Based on site an size of primary lesion, spread to regional lymph nodes, and presence of metastases.
Q: What is the characteristic appearance of a giant cell tumor on an x-ray?
A: Characteristic 'double bubble' or 'soap bubble' appearance
Q: What is the common histopathology associated with Ependymomas?
A: Characteristic perivascular rosettes. Rod-shaped blepharoblasts (basal ciliary bodies) found near the nucleus.
Q: What is the common histopathology associated with Hemangioblastoma?
A: Foamy cells and high vascularity are characteristic. Can produce EPO and lead to polycythemia.
Q: What is the common histopathology associated with medulloblastomas?
A: Rosettes or perivascular pseudorosette pattern of cells
Q: What is the common histopathology associated with oligodendrogliomas?
A: Fried egg' appearance of cells in tumor. Often calcified.
Q: What is the common histopathology associated with schwannoma?
A: Antoni A=compact palisading nuclei; Antoni B=loose pattern
Q: What is the common histopathology found in Glioblastoma multiforme?
A: Pseudopalisading' tumor cells border central areas of necrosis and hemorrhage
Q: What is the differentiation pattern of normal cells?
A: Basal to apical differentiation
Q: What is the histopathology commonly associate with giant cell tumors?
A: Spindle-shaped cells with multi-nucleated giant cells.
Q: What is the most common benign bone tumor?
A: Osteochondroma
Q: What is the most common location of basal cell carcinoma of the skin?
A: Usually found in sun-exposed areas of the body.
Q: What is the most common location of osteosarcoma?
A: Commonly found in the metaphysis of long bones
Q: What is the most common organ to 'send' metastases?
A: The lung is the most common origin of metastases. The breast and stomach are also big sources.
Q: What is the most common organ to receive metastases?
A: Adrenal glands. This is due to their rich blood supply. The medulla usually receives metastases first and then the rest of the gland.
Q: What is the most common population to have chondrosarcoma?
A: Men age 30-60 years old
Q: What is the most common primary brain tumor?
A: Glioblastoma multiforme (grade IV astrocytoma)
Q: What is the most common primary malignant tumor of bone?
A: Osteosarcoma
Q: What is the most common type of pituitary adenoma?
A: Prolactin secreting
Q: What is the most likely population to have Ewing's sarcoma?
A: Boys under 15 years old.
Q: What is the origin of a craniopharyngioma?
A: Derived from the remnants of Rathke's pouch
Q: What is the origin of a Pituitary adenoma?
A: Rathke's pouch
Q: What is the origin of the Schwannoma?
A: Schwann cell origin. Often localized to the 8th cranial nerve (acoustic schwannoma). Bilateral schwannoma found in NF2.
Q: What is the peak incidence of giant cell tumor?
A: 20-40 years old
Q: What is the peak incidence of osteosarcoma?
A: Men 10-20 years old
Q: What is the prognosis for Glioblastoma multiforme?
A: Prognosis is grave. Usually only have a year life expectancy.
Q: What is the second most common primary brain tumor?
A: Meningioma
Q: What is the third most common primary brain tumor?
A: Schwannomas
Q: What neoplasias are associated with a-fetoprotein?
A: Hepatocellular carcinoma and nonseminomatous germ cell tumors of the testis.
Q: What neoplasias are associated with B-hCG?
A: Hydatidiform moles, Choriocarcinomas, and Gestational trophoblastic tumors.
Q: What neoplasias are associated with CA-125?
A: Ovarian and malignant epithelial tumors
Q: What neoplasias are associated with S-100?
A: Melanoma, neural tumors, and astrocytomas
Q: What neoplasm is associated with Cirrhosis (due to alcoholism, Hep B, or Hep C)
A: Hepatocellular carcinoma
Q: What neoplasm is associated with Dysplastic nevi?
A: Malignant melanoma
Q: What neoplasm is associated with Immunodeficiency states?
A: Malignant lymphomas
Q: What neoplasm is associated with Plummer-Vinson syndrome (atrophic glossitis, esophageal webs, and anemia; all due to iron deficiency)
A: Squamous cell carcinoma of the esophagus
Q: What neoplasm is associated with ulcerative colitis?
A: Colonic adenocarcinoma
Q: What oncogene is associated with breast, ovarian, and gastric carcinomas?
A: erb-B2
Q: What oncogene is associated with Burkitt's lymphoma?
A: c-myc
Q: What oncogene is associated with colon carcinoma?
A: ras
Q: What oncogene is associated with Follicular and undifferentiated lymphomas (inhibits apoptosis)?
A: bcl-2
Q: What tumor marker is associated with Prostatic carcinoma?
A: PSA (Prostatic acid phosphatase)
Q: What tumor suppressor gene is associated with Retinoblastoma and osteosarcoma?
A: Rb gene
Q: What type of metastases are common in the late stages of prostatic adenocarcinoma?
A: Osteoblastic metastases in bone
Q: What type of neoplasm is associated with Acanthosis nigricans (hyperpigmentation and epidermal thickening)
A: Visceral malignancies (stomach, lung, breast, and uterus)
Q: What type of skin cancer is associated with excessive exposure to sunlight or arsenic exposure?
A: Squamous cell carcinoma
Q: Where are chondrosarcomas usually located?
A: Pelvis, spine, scapula, humerus, tibia, or femur.
Q: Where are Ewing's sarcomas most commonly found?
A: Diaphysis of long bones, pelvis, scapula, and ribs
Q: Where are Glioblastoma multiformes found?
A: Cerebral hemispheres
Q: Where do giant cell tumors most commonly occur?
A: At epiphyseal end of long bones
Q: Where do meningiomas most commonly occur?
A: Convexities of hemispheres and parasagital region
Q: Where do oligodendrogliomas most often occur?
A: Most often found in the frontal lobes
Q: Where do osteochondromas commonly originate?
A: Long metaphysis
Q: Where do squamous cell carcinomas most commonly occur?
A: Hands and face
Q: Where does prostatic adenocarcinoma most commonly arise?
A: From the posterior lobe (peripheral zone) of the prostate gland
Q: Which has more prognostic value: tumor stage or grade?
A: Stage
Q: Which is more common: metastasis to bone or primary tumors of bone?
A: Metastatic bone tumors are far more common than primary tumors
Q: Which is more common: metastasis to the liver or primary tumors of the liver?
A: Metastasis to the liver is more common
Q: Which tumor suppressor gene is associated with most human cancers and the Li-Fraumeni syndrome?
A: p53
Q: Which tumor suppressor genes are associated with breast and ovarian cancer?
A: BRCA 1 and 2
PATH_CNS
Q: Define epilepsy.
A: Epilepsy is a disorder of recurrent seizures.
Q: Define syrinx.
A: Tube, as in syringe
Q: Describe a myoclonic seizure.
A: Quick,repetitive jerks
Q: Describe a tonic-clonic seizure.
A: Alternating stiffening and movement (grand mal)
Q: Describe a tonic seizure.
A: Stiffening
Q: Describe an absence seizure.
A: A blank stare (petit mal- it's in 1st aid this way!!)
Q: Describe an atonic seizure.
A: drop' seizures
Q: Describe Broca's aphasia.
A: Broca's is nonfluent aphasia with intact comprehension.
A: BROca's is BROken speech.
Q: Describe Horner's syndrome.
A: Sympathectomy of face (lesion above T1). Interruption of the 3-neuron oculosympathetic pathway.
Q: Describe Wernicke's aphasia.
A: Wernicke's is fluent aphasia with impaired comprehension.
A: Wernicke's is Wordy but makes no sense.
Q: How do patients present with a subarachnoid hemorrhage?
A: Worst headache of my life'
Q: How do pts present with MS?
A: -Optic neuritis (sudden loss of vision)
A: - MLF syndrome (internuclear ophthalmoplegia)
A: -Hemiparesis
A: -Hemisensory symptoms
A: -Bladder/bowel incontinence
Q: How does it spread?
A: Through the bloodstream to the CNS
Q: How does Werdnig-Hoffman disease present?
A: At birth as a 'floppy baby'
Q: How is Huntington's disease inherited?
A: Autosomal dominant
Q: How is the polio virus transmitted?
A: Fecal-oral route
Q: How is the prevalence of MS geographically distributed?
A: Higher prevalence with greater distance from the Equator
Q: In what persons is subdural hemorrhage often seen?
A: Elderly individuals, alcoholics, and blunt trauma
Q: T/F. Partial seizures can not generalize.
A: False- Partial seizures can generalize.
Q: What are 2 common organisms that target the brain in AIDS pts?
A: 1. Toxo!Toxo!Toxo!
A: 2. Cryptococcus
Q: What are 2 degenerative diseases of the cerebral cortex?
A: 1. Alzheimer's
A: 2. Pick's disease
Q: What are 2 degenerative diseases that affect the basal ganglia and brain stem?
A: 1. Huntington's disease
A: 2. Parkinson's disease
Q: What are 3 degenerative disorders of the motor neuron?
A: 1. Amyotrophic lateral sclerosis (ALS)
A: 2. Werdnig-Hoffman disease
A: 3. Polio
Q: What are associated with Guillain-Barre?
A: 1. Infections (herpesvirus or C. jejuni)
A: 2. Inoculations
A: 3. Stress
Q: What are neurofibrillary tangles?
A: Abnormally phosphorylated tau protein
Q: What are some demyelinating and dysmyelinating diseases?
A: 1. Multiple sclerosis (MS)
A: 2. Progressive multifocal leukoencephalopathy (PML)
A: 3. Postinfectious encephalomyelitis
A: 4. Metachromatic Leukodystrophy
A: 5. Guillain-Barre syndrome
Q: What are the 4 types of intracranial hemorrhages?
A: 1. Epidural hematoma
A: 2. Subdural Hematoma
A: 3. Subarachnoid hemorrhage
A: 4. Parenchymal hematoma
Q: What are the 5 types of generalized seizures?
A: 1. Absence
A: 2. Myoclonic
A: 3. Tonic-clonic
A: 4. Tonic
A: 5. Atonic
Q: What are the clinical symptoms of Huntington's disease?
A: Dementia, chorea
Q: What are the clinical symptoms of Parkinson's disease?
A: TRAP= Tremor (at rest)
A: cogwheel Rigidity
A: Akinesia
A: Postural instability
A: (you are TRAPped in your body)
Q: What are the clinical symptoms of Tabes dorsalis?
A: -Charcot joints
A: -Shooting pain
A: -Argyll-Robertson Pupils
A: -Absence of deep tendon reflexes
Q: What are the common causes of seizures in adults?
A: -Tumors
A: -Trauma
A: -Stroke
A: -Infection
Q: What are the common causes of seizures in children?
A: -Genetic
A: -Infection
A: -Trauma
A: -Congenital
A: -Metabolic
Q: What are the common causes of seizures in the elderly?
A: -Stroke
A: -Tumor
A: -Trauma
A: -Metabolic
A: -Infection
Q: What are the lab findings in Guillain-Barre syndrome?
A: Elevated CSF protein with normal cell count ('albumino-cytologic dissociation')
Q: What are the lab findings in poliomyelitis?
A: -CSF with lymphocytic pleocytosis with slight elevation of protein
A: -Virus recovered from stool or throat
Q: What are the pathological signs of glioblastoma multiforme (GBM)?
A: -Necrosis
A: -Hemorrhage
A: -Pseudo-palisading
Q: What are the signs of LMN lesions seen in poliomyelitis?
A: -Muscle weakness and atrophy
A: -Fasciculations
A: -Fibrillation
A: -Hyporeflexia
Q: What are the symptoms of Horner's?
A: 1. Ptosis
A: 2. Miosis
A: 3. Anhidrosis and flushing of affected side of face
Q: What are the symptoms of poliomyelitis?
A: -Malaise
A: -Headache
A: -Fever
A: -Nausea
A: -Abdominal pain
A: -sore throat
Q: What area of the brain is affected by generalized seizures?
A: Diffuse area
Q: What artery is compromised in an epidural hematoma?
A: Middle meningeal artery
Q: What blood vessels are affected in subdural hemorrhages?
A: Rupture of bridging veins
Q: What causes a parenchymal hematoma?
A: -HTN
A: -Amyloid angiopathy
A: -Diabetes Mellitus
A: -Tumor
Q: What causes poliomyelitis?
A: Poliovirus
Q: What chemical can Parkinson's disease be linked to?
A: MPTP, a contaminant in illicit street drugs
Q: What clinical symptoms are present with syringomyelia?
A: Bilateral pain and temperature loss in the upper extremities with preservation of touch sensation
Q: What clinical symptoms are present?
A: -Symmetric ascending muscle weakness beginning in the distal lower extremities
A: -Facial diplegia in 50% of cases
A: -Autonomic fx may be severely affected
Q: What congenital malformation is often associated with syringomyelia?
A: Arnold Chiari Malformation
Q: What damage does cryptococcus cause in the brain?
A: Periventricular calcifications
Q: What damage does toxoplasma cause in the brain?
A: Diffuse (intracerebral) calcifications
Q: What diseases are berry aneurysms associated with?
A: -Adult polycystic kidney disease
A: -Ehlers-Danlos syndrome
A: -Marfan's syndrome
Q: What do partial seizures affect?
A: One area of the brain
Q: What does rupture of a berry aneurysm lead to?
A: Stroke
Q: What does the spinal tap show in a subarachnoid hemorrhage?
A: Bloody or xanthochromic
Q: What event is the rupture of the middle meningeal artery secondary to?
A: Temporal bone fracture
Q: What genes is the familial form of Alzheimer's associated with?
A: Genes are chromosomes 1, 14, 19 and 21
Q: What is a complex partial seizure?
A: Impaired awareness
Q: What is a degenerative disorder of the Spinocerebellar tract?
A: Friedrich's ataxia (olivopontocerebellar atrophy)
Q: What is anhidrosis?
A: Absence of sweating
Q: What is another name for Guillain-Barre syndrome?
A: Acute idiopathic polyneuritis
Q: What is another symptom of Werdnig-Hoffman disease?
A: Tongue fasciculations
Q: What is another term for Broca's aphasia?
A: Expressive aphasia
Q: What is another term for Wernicke's aphasia?
A: Receptive aphasia
Q: What is miosis?
A: Pupil constriction
Q: What is PML associated with?
A: JC virus
Q: What is ptosis?
A: Slight drooping of the eyelids
Q: What is the classic triad of MS?
A: SIN
A: 1. Scanning speech
A: 2. Intention Tremor
A: 3. Nystagmus
Q: What is the common name for ALS?
A: Lou Gehrig's disease
Q: What is the course of a subdural hemorrhage?
A: Venous bleeding (less pressure) with delayed onset of symptoms
Q: What is the course of MS?
A: In most pts, the course is remitting and relapsing
Q: What is the incidence of brain tumors in adults?
A: Metastases> Astrocytoma (including glioblastoma)> Meningioma
Q: What is the incidence of brain tumors in children?
A: Astrocytoma> Medulloblastoma> Ependymoma
Q: What is the most common cause of dementia in the elderly?
A: Alzheimer's disease
Q: What is the most common complication of a berry aneurysm?
A: Rupture of the aneurysm
Q: What is the most common site for a berry aneurysm?
A: The bifurcation of the anterior communicating artery
Q: What is the pathogenesis of Guillain-Barre syndrome?
A: Inflammation and demyelination of peripheral nerves and motor fibers of ventral roots (sensory effect less severe than motor)
Q: What is the pathogenesis of Tabes dorsalis?
A: Degeneration of the dorsal columns and dorsal roots due to tertiary syphilis.
Q: What is the pathology of Alzheimer's?
A: Associated with senile plaques (beta-amyloid core) and neurofibrillary tangles
Q: What is the pathology of Huntington's disease?
A: Atrophy of the caudate nucleus
Q: What is the pathology of MS?
A: -Periventricular plaques
A: -Preservation of axons
A: -Loss of oligodendrocytes
A: -Reactive astrocytic gliosis
A: -Increased protein (IgA) in CSF
Q: What is the pathology of Parkinson's disease?
A: Associated with Lewy bodies and depigmentation of the substantia nigra
Q: What is the pathology of Pick's disease?
A: Associated with Pick bodies, intracytoplasmic inclusion bodies
Q: What is the pathology of poliomyelitis?
A: Destruction of anterior horn cells, leading to LMN destruction
Q: What is the pathology of syringomyelia?
A: Softening and cavitation around the central canal of the spinal cord.
Q: What is the prognosis for a pts diagnosed with a GBM?
A: Very poor
Q: What is the second most common cause of dementia in the elderly?
A: Multi-infarct dementia
Q: What is the shape of GBMs?
A: Butterfly' glioma
Q: What is the usual cause of a subarachnoid hemorrhage?
Q: What neural deficits are present in Tabes dorsalis?
A: Impaired proprioception and locomotor ataxia
Q: What neural tracts are damaged?
A: Crossing fibers of the spinothalamic tract
Q: What neurons are affected in ALS?
A: Both the upper and lower motor neurons
Q: What neurons are affected in Polio?
A: Lower motor neurons only
Q: What seizures are categorized as simple partial?
A: Awareness intact
A: -Motor
A: -Sensory
A: -Autonomic
A: -Psychic
Q: What tumor is Horner's syndrome associated with?
A: Pancoast's tumor
Q: Where are most brain tumors located in adults?
A: 70% are supratentorial (cerebral hemispheres)
Q: Where are most childhood brain tumors located?
A: 70% below tentorium (cerebellum)
Q: Where do berry aneurysms occur?
A: At the bifurcations in the Circle of Willis
Q: Where does it initially replicate?
A: The oropharynx and small intestine
Q: Where does the 3 neuron oculosympathetic pathway project from?
A: The hypothalamus
Q: Where does the 3 neuron oculosympathetic pathway project to?
A: 1. Interomediolateral column of the spinal cord
A: 2. Superior cervical (sympathetic) ganglion
A: 3. To the pupil, smooth muscles of the eyelids and the sweat glands
Q: Where is Broca's area located?
A: Inferior frontal gyrus
Q: Where is Pick's disease specific for?
A: The frontal and temporal lobes
Q: Where is the aopE-4 allele located?
A: Chromosome 19
Q: Where is the most common site of syringomyelia?
A: C8-T1
Q: Where is the p-App gene located?
A: 21
Q: Where is Wernicke's area located?
A: Superior Temporal Gyrus
Q: Which demyelinating disease is seen in 2-4% of AIDS patients?
A: PML
PATH_KIDNEY
Q: Define renal failure.
A: Failure to make urine and excrete nitrogenous wastes
Q: How do you calculate anion gap?
A: Na-(Cl + HCO3) = 8-12 mEq/L
Q: How do you treat minimal change disease?
A: Responds well to steroids
Q: How does acute poststreptococcal glomerulonephritis resolve?
A: Spontaneously
Q: How does renal cell carcinoma spread metastically?
A: Invades the IVC and spreads hematogenously
Q: How does transitional cell carcinoma present?
A: Hematuria
Q: How does Wilms' tumor present?
A: Huge, palpable flank mass
Q: In what epidemiological group is renal cell carcinoma most common?
A: Men ages 50-70
Q: T/F: Ammonium magnesium phosphate kidney stones are radiopaque
A: TRUE
Q: T/F: Calcium kidney stones are radiopaque.
A: TRUE
Q: T/F: Calcium kidney stones do not recur.
A: FALSE
Q: T/F: Cystine kidney stones are radiopaque.
A: FALSE, cystine stones are radiolucent
Q: T/F: Transitional cell carcinoma is cured by surgical removal.
A: False, transitional cell carcinoma often recurs after removal
Q: T/F: Uric acid kidney stones are radiopaque
A: FALSE, uric acid stones are radiolucent
Q: What additional sx are seen in a pt with acute streptococcal glomerulonephritis?
A: Peripheral and periorbital edema
Q: What age group is poststreptococcal glomerulonephritis most common?
A: Children
Q: What are 4 causes of hypoventilation?
A: 1. Acute lung disease
A: 2. Chronic lung disease
A: 3. Opioids, narcotics, sedatives
A: 4. Weakening of respiratory muscles
Q: What are the 2 forms of renal failure?
A: Acute and chronic
Q: What are the 2 main symptoms present in Goodpasture's syndrome?
A: Hemoptysis, hematuria
Q: What are the 4 major types of kidney stones?
A: 1. Calcium
A: 2. Ammonium magnesium phosphate
A: 3. Uric acid
A: 4. Cystine
Q: What are the 5 nephritic syndromes?
A: Acute poststreptococcal glomerulonephritis
A: Rapidly progressive (crescentic) glomerulonephritis
A: Goodpasture's syndrome
A: Membranoproliferative glomerulonephritis
A: Berger's disease
Q: What are the 5 nephrotic syndromes?
A: 1. Membranous glomerulonephritis
A: 2. Minimal change disease (lipoid nephrosis)
A: 3. Focal segmental glomerular sclerosis
A: 4. Diabetic nephropathy
A: 5. SLE
Q: What are the causes and signs of calcium ion deficiency?
A: -Kids- rickets
A: -Adults- osteomalacia
A: -Contributes to osteoporosis
A: -Tetany
Q: What are the causes and signs of phosphate toxicity?
A: -Low serum calcium ion
A: -can cause bone loss
A: -renal stones
Q: What are the causes of chloride ion deficiency?
A: Secondary to emesis, diuretics, renal disease
Q: What are the causes of metabolic acidosis?
A: -Diabetic ketoacidosis
A: -Diarrhea
A: -Lactic Acidosis
A: -Salicylate OD
A: -Acetazolamide OD
Q: What are the causes of respiratory acidosis?
A: -COPD
A: -Airway obstruction
Q: What are the causes of respiratory alkalosis?
A: -High altitude
A: -Hyperventilation
Q: What are the characteristics of acute poststreptococcal glomerulonephritis seen with immunofluorescence?
A: Granular pattern
Q: What are the characteristics of acute poststreptococcal glomerulonephritis seen with the electron microscope?
A: Subepithelial humps
Q: What are the characteristics of acute poststreptococcal glomerulonephritis seen with the light microscope?
A: Glomeruli enlarged and hypercellular
A: neutrophils
A: 'lumpy-bumpy'
Q: What are the characteristics of rapidly progressive (crescentic) glomerulonephritis seen on LM and IF?
A: Crescent-moon shape
Q: What are the clinical features of renal cell carcinoma?
A: -Hematuria
A: -Palpable mass
A: -Secondary polycythemia
A: -Flank pain
A: -Fever
Q: What are the clinical symptoms of a nephritic syndrome?
A: I' = inflammation; hematuria, hypertension, oligouria, azotemia
Q: What are the clinical symptoms of nephrotic syndromes?
A: O = proteinuria
A: Hypoalbuminuria
A: Generalized edema
A: Hyperlipidemia
Q: What are the consequences of renal failure?
A: 1. Anemia
A: 2. Renal osteodystrophy
A: 3. Hyperkalemia
A: 4. Metabolic acidosis
A: 5. Uremia
A: 6. Sodium and water excess
A: 7. Chronic pyelonephritis
A: 8. HTN
Q: What are the factors associated metabolic alkalosis?
A: -Increased pH
A: -Increased PCO2
A: -Increased HCO3-
Q: What are the factors associated with metabolic acidosis?
A: -Decreased pH
A: -Decreased PCO2
A: -Decreased HCO3-
Q: What are the factors associated with respiratory acidosis?
A: -Decreased pH
A: -Increased PCO2
A: -Increased HCO3-
Q: What are the factors associated with respiratory alkalosis?
A: -Increased pH
A: -Decreased PCO2
A: -Decreased HCO3-
Q: What are the functions of calcium ion?
A: -Muscle contraction
A: -Neurotransmitter release
A: -Bones, teeth
Q: What are the functions of sodium ion?
A: -Extracellular fluid
A: -Maintains plasma volume
A: -Nerve/muscle function
Q: What are the functions of the chloride ion?
A: -Fluid/electrolyte balance
A: -Gastric acid
A: -HCO3/Cl shift in RBC
Q: What are the functions of the magnesium ion?
A: -Bones, teeth
A: -Enzyme cofactor
Q: What are the functions of the phosphate ion?
A: -ATP
A: -nucleic acids
A: -Phosphorylation
A: -Bones, teeth
Q: What are the functions of the potassium ion?
A: -Intracellular fluid
A: -Nerve/muscle function
Q: What are the signs of magnesium ion deficiency?
A: -Diarrhea
A: -Alcoholism
Q: What are the signs of magnesium ion toxicity?
A: -Decreased reflexes
A: -Decreased respirations
Q: What are the signs of phosphate deficiency?
A: -Kids- rickets
A: -Adults- osteomalacia
Q: What are the signs of potassium ion toxicity?
A: -EKG changes
A: -Arrhythmia
Q: What bugs cause ammonium magnesium phosphate kidney stones?
A: Urease-positive bugs such as Proteus vulgaris or Staphylococcus
Q: What calcium molecules form calcium kidney stones?
A: Calcium oxalate or calcium phosphate or both
Q: What can excess Na and water cause?
A: CHF and pulmonary edema
Q: What can the hyperkalemia associated with renal failure lead to?
A: Cardiac arrhythmias
Q: What causes metabolic alkalosis?
A: 1. Vomiting
A: 2. Diuretic use
A: 3. Antacid use
A: 4. Hyperaldosteronism
Q: What causes renal osteodystrophy?
A: Failure of active vitamin D production
Q: What characteristics of Berger's disease are seen with IF and EM?
A: Mesangial deposits of IgA
Q: What characteristics of focal segmental glomerular sclerosis are seen with the LM?
A: Segmental sclerosis and hyalinosis
Q: What characteristics of Goodpasture's syndrome are seen with IF?
A: Linear pattern
A: Anti-glomerular basement membrane antibodies
Q: What characteristics of Membranoproliferative glomerulonephritis are seen with the EM?
A: subendothelial humps
A: 'tram track'
Q: What characteristics of membranous glomerulonephritis are seen with IF?
A: Granular pattern
Q: What characteristics of membranous glomerulonephritis are seen with the EM?
A: Spike and Dome'
Q: What characteristics of membranous glomerulonephritis are seen with the LM?
A: Diffuse capillary and basement membrane thickening
Q: What characteristics of minimal change disease are seen with the EM?
A: Foot process effacement
Q: What characteristics of minimal change disease are seen with the LM?
A: Normal glomeruli
Q: What characteristics of SLE are seen with the LM?
A: Wire-loop appearance with extensive granular subendothelial basement-membrane deposits in membranous glomerulonephritis pattern
Q: What defines metabolic acidosis?
A: -pH less than 7.4
A: -PCO2 less than 40 mm Hg
Q: What defines metabolic alkalosis with compensation?
A: -pH greater than 7.4
A: -PCO2 greater than 40 mm Hg
Q: What defines respiratory acidosis?
A: -pH less than 7.4
A: -PCO2 greater than 40mm Hg
Q: What defines respiratory alkalosis?
A: -pH greater than 7.4
A: -PCO2 less than 40 mm Hg
Q: What diseases often cause uric acid kidney stones?
A: Diseases with increased cell proliferation and turnover, such as leukemia and myeloproliferative disorders
Q: What disorders can lead to hypercalcemia and thus kidney stones?
A: 1. Cancer
A: 2. Increased PTH
A: 3. Increased vitamin D
A: 4. Milk-alkali syndrome
Q: What disorders cause an increased anion gap?
A: 1. Renal failure
A: 2. Lactic acidosis
A: 3. Ketoacidosis (DM)
A: 4. Aspirin ingestion
Q: What disorders cause metabolic acidosis and normal anion gap?
A: 1. Diarrhea
A: 2. Glue sniffing
A: 3. Renal tubular acidosis
A: 4. Hyperchloremia
Q: What disorders make up the WAGR complex?
A: Wilms' tumor
A: Aniridia
A: Genitourinary malformation
A: mental-motor Retardation
Q: What does potassium deficiency cause?
A: -Weakness
A: -Paralysis
A: -Confusion
Q: What factors are associated with transitional cell carcinoma?
A: Exposure to cyclophosphamide, smoking, phenacetin, and aniline dyes
Q: What genetic disorder and mutation are associated with renal cell carcinoma?
A: Renal cell carcinoma is associated with von Hippel-Lindau and gene deletion in chromosome 3
Q: What genetic disorder is associated with Wilms' tumor?
A: Deletion of tumor suppression gene WT-1 on chromosome 11
Q: What is a common cause of adult nephrotic syndrome?
A: Membranous glomerulonephritis
Q: What is acute renal failure often due to?
A: Hypoxia
Q: What is Berger's disease?
A: IgA nephropathy
A: -Mild disease
A: -Often postinfectious
Q: What is chronic failure due to?
A: HTN and diabetes
Q: What is the 2nd most common type of kidney stone?
A: Ammonium magnesium phosphate
Q: What is the cause of magnesium ion deficiency?
A: Secondary to malabsorption
Q: What is the cause of metabolic alkalosis?
A: Vomiting
Q: What is the cause of potassium ion deficiency?
A: Secondary to injury, illness or diuretics
Q: What is the cause of sodium deficiency?
A: Secondary to injury or illness
Q: What is the compensatory mechanism of metabolic alkalosis?
A: Hypoventilation
Q: What is the compensatory mechanism of respiratory alkalosis?
A: Renal HCO3- secretion
Q: What is the compensatory response to metabolic acidosis?
A: Hyperventilation
Q: What is the compensatory response to respiratory acidosis?
A: Renal HCO3- reabsorption
Q: What is the course of membranoproliferative glomerulonephritis?
A: Slowly progresses to renal failure
Q: What is the course of rapidly progressive (crescentic) glomerulonephritis?
A: Rapid course to renal failure from one of many causes
Q: What is the Henderson-Hasselbalch equation?
A: pH = pKa + log [(HCO3-)/(0.03*PCO2)]
Q: What is the most common cause of childhood nephrotic syndrome?
A: Minimal change disease (lipoid nephrosis)
Q: What is the most common renal malignancy of early childhood (ages 2-4)?
A: Wilms' tumor
Q: What is the most common renal malignancy?
A: Renal cell carcinoma
Q: What is the most common tumor of the urinary tract system?
A: Transitional cell carcinoma
Q: What is the primary disturbance in respiratory acidosis?
A: Increased PCO2
Q: What is the primary disturbance of metabolic acidosis?
A: HCO3- decrease
Q: What is the primary disturbance of metabolic alkalosis?
A: Increased HCO3-
Q: What is the primary disturbance of respiratory alkalosis?
A: Decreased PCO2
Q: What is the sign of calcium ion toxicity?
A: Delirium
Q: What is the sign of sodium ion toxicity?
A: Delirium
Q: What lesions are seen on the LM in diabetic nephropathy?
A: Kimmelstiel-Wilson lesions
Q: What might an elevated anion gap indicate?
A: MUD PILES
A: 1. Methanol
A: 2. Uremia (chronic renal failure)
A: 3. Diabetic ketoacidosis
A: 4. Paraldehyde or Phenformin
A: 5. Iron tablets or INH
A: 6. Lactic acidosis (CN-, CO, shock)
A: 7. Ethanol or Ethylene glycol
A: 8. Salicylates
Q: What paraneoplastic syndromes are associated with renal cell carcinoma?
A: Ectopic EPO, ACTH, PTHrP, and prolactin
Q: What severe complications may kidney stones lead to?
A: Hydronephrosis
A: Pyelonephritis
Q: What social factor increases the incidence of renal cell carcinoma?
A: Smoking
Q: What type of hypersensitivity contributes to the pathogenesis of Goodpasture's syndrome?
A: Type II hypersensitivity
Q: Where can transitional cell carcinoma occur?
A: -Renal calyces
A: -Renal pelvis
A: -Ureters
A: -Bladder
Q: Where does renal cell carcinoma originate?
A: Renal tubule cells, polygonal clear cells
Q: Which kidney stone is often secondary to cystinuria?
A: Cystine
Q: Which kidney stone is strongly associated with gout?
A: Uric acid kidney stones
Q: Which of the nephrotic syndromes are worse in HIV pts?
A: Focal segmental glomerular sclerosis
Q: Which type of kidney stones constitute the majority of kidney stones (80-85%)?
A: Calcium
Q: Why are ammonium magnesium phosphate kidney stones often associated with UTIs?
A: Ammonium magnesium phosphate stones can form large struvite calculi that can be a nidus for UTIs
Q: Why does renal failure cause anemia?
A: Failure of EPO production
Q: Why does renal failure cause metabolic acidosis?
A: Due to decreased acid secretion and decreased generation of HCO3-
PATH_LUNGS
Q: An FEV1/FVC ratio greater than 80% indicates what form of pulmonary disease?
A: Restrictive lung disease
Q: Are bronchogenic carcinoma metastases common?
A: Yes, very common
Q: Decreased FEV1/FVC ratio are the hallmark of what kind of pulmonary disease?
A: COPD
Q: How does interstitial fibrosis create a restrictive lung disease?
A: It causes increased recoil (decreased compliance), thereby limiting alveolar expansion.
Q: How does lung cancer commonly present? (5)
A: - Cough
A: - Hemoptysis
A: - Bronchial obstruction
A: - Wheezing
A: - Pneumonic 'coin' lesion on x-ray
Q: How does surfactant deficiency cause NRDS?
A: It leads to an increase in surface tension, resulting in alveolar collapse
Q: How to you treat NRDS?
A: - Maternal steroids before birth
A: - Artificial surfactant for infant
Q: Identify: ivory-white pleural plaques in the lung.
A: Ferruginous bodies
Q: In COPD, are lung volumes increased, decreased, or normal?
A: Increased (increasedTLC, increased FRC, increased RV)
Q: In restrictive lung disease, are lung volumes increased, decreased, or normal?
A: Decreased
Q: In what occupations is asbestosis most commonly seen? (2)
A: Shipbuilders and plumbers
Q: Name three 'triggers' of asthma.
A: - Viral URIs
A: - Allergens
A: - Stress
Q: Name three characteristics of Horner's syndrome?
A: - Ptosis
A: - Miosis
A: - Anhidrosis
Q: Name two extrapulmonary (poor breathing mechanics) causes of restrictive lung disease.
A: - Poor muscular effort: polio, myasthenia gravis
A: - Poor apparatus: scoliosis
Q: Name two pulmonary (poor lung expansion) causes of restrictive lung disease.
A: - Defective alveolar filling: pneumonia, ARDS, pulmonary edema
A: - Interstitial fibrosis
Q: Patients with asbestosis are at increased risk for what? (2)
A: Pleural mesothelioma and bronchogenic carcinoma
Q: T/F Bronchiectasis is associated with bronchial obstruction, cystic fibrosis, and poor ciliary motility.
A: True
Q: T/F In obstructive (not restrictive) lung disease, FEV1 and FVC are reduced.
A: False, FEV1 and FVC are reduced in both
Q: T/F Restricted lung expansion causes decreased total lung capacity and increased vital capacity.
A: False, decreased VC and TLC
Q: T/F Smokers with asbestosis have a decreased risk of developing cancer.
A: False, it increases synergistically
Q: What are asbestos fibers coated with hemosiderin in the lung?
A: Ferruginous bodies
Q: What are the characteristics of lobar pneumonia?
A: Intra-alveolar exudate -> consolidation; may involve entire lung
Q: What are the clinical findings of chronic bronchitis? (3)
A: - Wheezing
A: - Crackles
A: - Cyanosis
Q: What are the clinical findings of emphysema? (4)
A: - Dyspnea
A: - Decreased breath sounds
A: - Tachycardia
A: - Decreased I/E ratio
Q: What are the symptoms and complications of interstitial lung fibrosis?
A: - Symptoms: gradual progressive dyspnea and cough
A: - Complications include cor pulmonale (can be seen in diffuse interstitial pulmonary fibrosis and bleomycin toxicity)
Q: What bronchogenic carcinoma is associated with ectopic hormone production (ADH, ACTH) and may lead to Lambert-Eaton syndrome?
A: Small cell carcinoma
Q: What bronchogenic carcinoma is associated with ectopic PTH-related peptide production?
A: Squamous cell carcinoma
Q: What bronchogenic carcinoma is most common?
A: Adenocarcinoma
Q: What bronchogenic carcinoma is thought not to be related to smoking?
A: Bronchioalveolar carcinoma
Q: What bronchogenic carcinomas are clearly linked to SSmoking?
A: SSquamous cell carcinoma and SSmall cell carcinoma
Q: What bronchogenic carcinomas usually express tumors that arise centrally? (2)
A: - Squamous cell carcinoma
A: - Small cell carcinoma
Q: What bronchogenic carcinomas usually express tumors that arise peripherally? (3)
A: - Adenocarcinoma
A: - Bronchioalveolar carcinoma
A: - Large cell carcinoma--undifferentiated
Q: What carcinoma occurs in the apex of the lung and may affect the cervical sympathetic, causing Horner's syndrome?
A: Pancoast's tumor
Q: What causes bronchiectasis?
A: Chronic necrotizing infection of bronchi
Q: What causes neonatal respiratory distress syndrome (NRDS)?
A: Surfactant deficiency
Q: What cells make surfactant and when is it made most abundantly in fetuses?
A: Type II pneumocytes most abundantly after 35th week of gestation
Q: What COPD has a productive cough for greater than three months in two years and hypertrophy of mucus-secreting glands in the bronchioles (Reid index greater than 50%)?
A: Chronic bronchitis
Q: What COPD is characterized by dilated airways, purulent sputum, recurrent infections, and hemoptysis?
A: Bronchiectasis
Q: What COPD is due to an enlargement of air spaces and decreased recoil resulting from destruction of alveolar walls?
A: Emphysema
Q: What COPD is due to bronchial hyperresponsiveness which causes reversible bronchoconstriction?
A: Asthma
Q: What does inhaled asbestos do to the lungs?
A: It causes diffuse pulmonary interstitial fibrosis
Q: What is the composition of surfactant:
A: Dipalmitoyl phosphatidylcholine
Q: What is the difference in FEV1/FVC ratios between obstructive and restrictive lungs diseases?
A: FEV1 and FVC are reduced in both, but in obstructive the FEV1 is more dramatically reduced, resulting in a decreased FEV1/FVC ratio
Q: What is the leading cause of cancer death?
A: Lung cancer
Q: What is the SPHERE (acronym) of complications associated with lung cancer?
A: Superior vena caval syndrome
A: Pancoast's tumor
A: Horner's syndrome
A: Endocrine (paraneoplastic)
A: Recurrent laryngeal symptoms (hoarseness)
A: Effusions (pleural or pericardial)
Q: What kind of pulmonary diseases are caused by a inhibition of air flow resulting in air trapping in the lungs?
A: Obstructive lung diseases (COPD)
Q: What organisms are is the most frequent cause of lobar pnuemonia?
A: Pneumococcus
Q: What organisms are the most frequent cause of bronchopnuemonia? (4)
A: - S. aureus
A: - H. flu
A: - Klebsiella
A: - S. pyogenes
Q: What organisms are the most frequent cause of interstitial (atypical) pnuemonia? (3)
A: - Viruses (RSV, adenoviruses)
A: - Mycoplasma
A: - Legionella
Q: What specific type of emphysema is caused by alpha-1-antitrypsin deficiency?
A: Panacinar emphysema (and liver cirrhosis)
Q: What specific type of emphysema is caused by smoking?
A: Centriacinar emphysema
Q: What test is used to measure in utero lung maturity?
A: The lecithin-to-sphingomyelin ratio in the amniotic fluid, usually less than 1.5 in neonatal respiratory distress syndrome
Q: What type of lung cancer can cause carcinoid syndrome?
A: Carcinoid tumor
Q: What type of pneumonia is characterized by acute inflammatory infiltrates from bronchioles into adjacent alveoli with a patchy distribution affecting more than one lobe?
A: Bronchopneumonia
Q: What type of pneumonia is characterized by diffuse patchy inflammation localized to interstial areas at alveolar walls and involves more than one lobe?
A: Interstitial (atypical) pneumonia
Q: Where does bronchogenic carcinoma commonly metastasize and how does it present? (3)
A: - Brain (epilepsy)
A: - Bone (pathologic fracture)
A: - Liver (jaundice, hepatomegaly)
Q: Why does alpha-1-antitrypsin deficiency cause emphysema?
A: Increased elastase activity
PATH_RHEUMATIC DISEASEA
Q: Define Ankylosing spondylitis?
A: Chronic inflammatory disease of spine & large joints, sacroilitis, uveitis, & aortic regurgitation
Q: Define Ankylosing spondylitis?
A: Chronic inflammatory disease of spine & large joints, sacroilitis, uveitis, & aortic regurgitation
Q: Define Celiac sprue
A: Autoimmune-mediated intolerance of gliadin (wheat) leading to steatorrhea.
Q: Define Celiac sprue
A: Autoimmune-mediated intolerance of gliadin (wheat) leading to steatorrhea.
Q: Define Gout.
A: Precipitation of monosodium urate crystals into joints due to hyperuricemia.
Q: Define Gout.
A: Precipitation of monosodium urate crystals into joints due to hyperuricemia.
Q: Define Scleroderma
A: Excessive fibrosis & collagen deposition throughout the body; commonly sclerosis of the skin, but also of CV & GI systems & kidney
Q: Define Scleroderma
A: Excessive fibrosis & collagen deposition throughout the body; commonly sclerosis of the skin, but also of CV & GI systems & kidney
Q: Define Sicca syndrome.
A: dry eyes, dry mouth, nasal & vaginal dryness, chronic bronchitis, reflux esophagitis
Q: Define Sicca syndrome.
A: dry eyes, dry mouth, nasal & vaginal dryness, chronic bronchitis, reflux esophagitis
Q: In what population is ankylosing sponsylitis more commonly found?
A: males (10-30 year old)
Q: In what population is ankylosing sponsylitis more commonly found?
A: males (10-30 year old)
Q: In what population is Celiac sprue more commonly found?
A: Assoc. w/ people of northern European descent
Q: In what population is Celiac sprue more commonly found?
A: Assoc. w/ people of northern European descent
Q: In what population is Goodpasture's syndrome more commonly found?
A: Men 20-40 y/o
Q: In what population is Goodpasture's syndrome more commonly found?
A: Men 20-40 y/o
Q: In what population is gout more commonly found?
A: Men
Q: In what population is gout more commonly found?
A: Men
Q: In what population is Osteoarthritis more commonly found?
A: Common in older patients
Q: In what population is Osteoarthritis more commonly found?
A: Common in older patients
Q: In what population is pseudogout more commonly found?
A: > 50 y/o, both sexes equally
Q: In what population is pseudogout more commonly found?
A: > 50 y/o, both sexes equally
Q: In what population is Reiter's syndrome more commonly found?
A: Strong predilection for males
Q: In what population is Reiter's syndrome more commonly found?
A: Strong predilection for males
Q: In what population is Rheumatoid arthritis more commonly found & what the common autoimmune factor present?
A: - Common in females
A: - 80% of RA pt's have positive rheumatoid factor (anti-IgG Ab)
Q: In what population is Rheumatoid arthritis more commonly found & what the common autoimmune factor present?
A: - Common in females
A: - 80% of RA pt's have positive rheumatoid factor (anti-IgG Ab)
Q: In what population is sarcoidosis more commonly found?
A: black females
Q: In what population is sarcoidosis more commonly found?
A: black females
Q: In what population is scleroderma more commonly found?
A: 75% female
Q: In what population is scleroderma more commonly found?
A: 75% female
Q: In what population is Sjogren's syndrome more commonly found?
A: females between the ages of 40 & 60
Q: In what population is Sjogren's syndrome more commonly found?
A: females between the ages of 40 & 60
Q: In what population is SLE more commonly found?
A: 90% are female & between ages 14 & 45. More common & severe in black females
Q: In what population is SLE more commonly found?
A: 90% are female & between ages 14 & 45. More common & severe in black females
Q: What are the 2 major categories of scleroderma & what findings are they assoc w/?
A: Diffuse scleroderma: widespread skin involvement, rapid progression, early visceral involvement. Assoc. w/ anti-Scl-70 Ab
Q: CREST syndrome:
A: Calcinosis, Raynaud's phenomenon, Esophageal dysmotility, Sclerodactyly & Telangiectasia; limited skin involvement, often confined to fingers & face. More benign clinical course - assoc w/ anticentromere Ab
Q: What are the 2 major categories of scleroderma & what findings are they assoc w/?
A: Diffuse scleroderma: widespread skin involvement, rapid progression, early visceral involvement. Assoc. w/ anti-Scl-70 Ab
Q: CREST syndrome:
A: Calcinosis, Raynaud's phenomenon, Esophageal dysmotility, Sclerodactyly & Telangiectasia; limited skin involvement, often confined to fingers & face. More benign clinical course - assoc w/ anticentromere Ab
Q: What are the associated sx's & risks for Sjogren's syndrome?
A: - Parotid enlargement
A: - incr risk of B-cell lymphoma
A: - Assoc. w/ RA
Q: What are the associated sx's & risks for Sjogren's syndrome?
A: - Parotid enlargement
A: - incr risk of B-cell lymphoma
A: - Assoc. w/ RA
Q: What are the characteristic findings in Celiac sprue?
A: Blunting of villi, lymphocytes in the lamina propria, & abnormal D-xylose test
Q: What are the characteristic findings in Celiac sprue?
A: Blunting of villi, lymphocytes in the lamina propria, & abnormal D-xylose test
Q: What are the common characteristics of Sarcoidosis?
A: immune-mediated, widespread noncaseating granulomas & elevated serum ACE levels
Q: What are the common characteristics of Sarcoidosis?
A: immune-mediated, widespread noncaseating granulomas & elevated serum ACE levels
Q: What are the common gross findings in Goodpasture's syndrome?
A: pulmonary hemorrhages, renal lesions, hemoptysis, hematuria, crescentic glomerulonephritis
Q: What are the common gross findings in Goodpasture's syndrome?
A: pulmonary hemorrhages, renal lesions, hemoptysis, hematuria, crescentic glomerulonephritis
Q: What can cause gout?
A: Lesch-Nyan disease, PRPP excess, decreased excretion of uric acid, or G6PD deficiency. Also assoc. w/ the use of thiazide diuretics which competitively ingibit the secretion of uric acid.
Q: What can cause gout?
A: Lesch-Nyan disease, PRPP excess, decreased excretion of uric acid, or G6PD deficiency. Also assoc. w/ the use of thiazide diuretics which competitively ingibit the secretion of uric acid.
Q: What causes pseudogout?
A: deposition of calcium pyrophosphate crystals w/in the joint space
Q: What causes pseudogout?
A: deposition of calcium pyrophosphate crystals w/in the joint space
Q: What CV disease state can be caused by SLE?
A: SLE causes LSE (Libman-Sacks Endocarditis): vavular vegetations found on both sides of valve (mitral valve stenosis) & do not embolize
Q: What CV disease state can be caused by SLE?
A: SLE causes LSE (Libman-Sacks Endocarditis): vavular vegetations found on both sides of valve (mitral valve stenosis) & do not embolize
Q: What drugs can induce a commonly reversible SLE-like syndrome?
A: - procainamide
A: - INH
A: - phenytoin
A: - hydralazine
Q: What drugs can induce a commonly reversible SLE-like syndrome?
A: - procainamide
A: - INH
A: - phenytoin
A: - hydralazine
Q: What immune marker aids in dx?
A: 90% of cases are assoc w/ B27 (gene which codes for HLA MHC-I)
Q: What immune marker aids in dx?
A: 90% of cases are assoc w/ B27 (gene which codes for HLA MHC-I)
Q: What is characteristic about gout crystals?
A: needle-shaped & negatively berefringent.
Q: What is characteristic about gout crystals?
A: needle-shaped & negatively berefringent.
Q: What is characteristic about pseudogout crystals?
A: basophilic, rhomboid crystals
Q: What is characteristic about pseudogout crystals?
A: basophilic, rhomboid crystals
Q: What is Reiter's syndrome?
A: a seronegative spondyloarthropath w/ a HLA-B27 link
Q: What is Reiter's syndrome?
A: a seronegative spondyloarthropath w/ a HLA-B27 link
Q: What is the 'classic triad' for Reiter's syndrome?
A: 1. Urethritis (Can't pee)
A: 2. Conjunctivities & ant. uveitis (Can't see)
A: 3. Arthritis (Can't climb a tree)
Q: What is the 'classic triad' for Reiter's syndrome?
A: 1. Urethritis (Can't pee)
A: 2. Conjunctivities & ant. uveitis (Can't see)
A: 3. Arthritis (Can't climb a tree)
Q: What is the 'classic triad' for Sjogren's syndrome?
A: 1. dry eyes (conjunctivitis, xerophthalmia)
A: 2. dry mouth (dysphagia, xerostomia)
A: 3. arthritis
Q: What is the 'classic triad' for Sjogren's syndrome?
A: 1. dry eyes (conjunctivitis, xerophthalmia)
A: 2. dry mouth (dysphagia, xerostomia)
A: 3. arthritis
Q: What is the classic pathology for Osteoarthritis?
A: Mechanical: wear & tear of joints leads to destruction of articular cartilage, subchondral bone formation, sclerosis, osteophytes, eburnation, & Heberden's nodes (DIP)
Q: What is the classic pathology for Osteoarthritis?
A: Mechanical: wear & tear of joints leads to destruction of articular cartilage, subchondral bone formation, sclerosis, osteophytes, eburnation, & Heberden's nodes (DIP)
Q: What is the classic pathology for Rheumatoid arthritis?
A: Autoimmune: inflammatory d/o affecting synovial joints, w/ pannus formation in joints (MCP, PIP), subcutaneous rheumatoid nodules, ulnar deviation, subluxation.
Q: What is the classic pathology for Rheumatoid arthritis?
A: Autoimmune: inflammatory d/o affecting synovial joints, w/ pannus formation in joints (MCP, PIP), subcutaneous rheumatoid nodules, ulnar deviation, subluxation.
Q: What is the Classic presentation for Osteoarthritis?
A: pain in weight-bearing joints after use (e.g.- at the end of the day), improving w/ rest. No systemic sx's
Q: What is the Classic presentation for Osteoarthritis?
A: pain in weight-bearing joints after use (e.g.- at the end of the day), improving w/ rest. No systemic sx's
Q: What is the classic presentation for Rheumatoid arthritis?
A: morning stiffness improving w/ use, symmetric joint involvement & systemic symptoms: fever, fatigue, pleuritis, pericarditis
Q: What is the classic presentation for Rheumatoid arthritis?
A: morning stiffness improving w/ use, symmetric joint involvement & systemic symptoms: fever, fatigue, pleuritis, pericarditis
Q: What is the common immunologic finding for Goodpasture's syndrome?
A: Anti-glomerular basement membrane antibodies produce linear staining on immunofluorescence
Q: What is the common immunologic finding for Goodpasture's syndrome?
A: Anti-glomerular basement membrane antibodies produce linear staining on immunofluorescence
Q: What is the common tx for gout?
A: allopurinol, probenecid, colchicine, & NSAID's.
Q: What is the common tx for gout?
A: allopurinol, probenecid, colchicine, & NSAID's.
Q: What is the common tx for pseudogout?
A: no tx
Q: What is the common tx for pseudogout?
A: no tx
Q: What is the descriptive acrynym for Sarcoidosis?
A: GRAIN
A: Gammaglobulinemia
A: Rheumatoid arthritis
A: ACE incr.
A: Interstitial fibrosis
A: Noncaseating granulomas
Q: What is the descriptive acrynym for Sarcoidosis?
A: GRAIN
A: Gammaglobulinemia
A: Rheumatoid arthritis
A: ACE incr.
A: Interstitial fibrosis
A: Noncaseating granulomas
Q: What is the useful memory tool for Goodpasture's syndrome?
A: there are TWO Good Pastures for this disea
A: 0.5
Q: Are basal cell carcinomas invasive?
A: Locally invasive but rarely metastasize
Q: Are Ewing's sarcomas likely to metastasize?
A: Yes. They are extremely aggressive with early metastasis. However, they are responsive to chemotherapy.
Q: Are meningiomas resectable?
A: Yes
Q: Are squamous cell carcinomas of the skin invasive?
A: Locally invasive but rarely metastasize
Q: Are the majority of adult tumors supratentorial or infratentorial?
A: Supratentorial
Q: Are the majority of childhood tumors supratentorial or infratentorial?
A: Infratentorial
Q: Common histopathology often seen in squamous cell carcinomas of the skin?
A: Keratin pearls
Q: Define anaplasia
A: Abnormal cells lacking differentiation; like primitive cells of the same tissue. Often equated with undifferentiated malignant neoplasms. Tumor giant cells may be formed.
Q: Define dysplasia
A: Abnormal growth with loss of cellular orientation, shape, and size in comparison to normal tissue maturation. It is reversible but is often a preneoplastic sign.
Q: Define hyperplasia
A: Increase in the number of cells (reversible)
Q: Define metaplasia
A: One adult cell type is replaced by another (reversible). It is often secondary to irritation and/or environmental exposure (e.g. squamous metaplasia in the trachea and bronchi of smokers)
Q: Define neoplasia
A: Clonal proliferation of cells that is uncontrolled and excessive
Q: Do oncogenes cause a gain or loss of function?
A: Gain of function
Q: Do tumor suppressor genes cause a gain or loss of function?
A: Loss of function. Both alleles must be lost for expression of disease
Q: Does a melanoma have a significant risk of metastasis?
A: Very significant risk! The depth of the tumor often correlates with the risk of metastasis.
Q: From what cells do meningiomas most commonly arise?
A: Arachnoid cells external to the brain
Q: Give 2 examples of a benign tumor of epithelial origin.
A: 1. Adenoma 2. Papilloma
Q: Give 2 examples of a malignant tumor of epithelial origin.
A: 1. Adenocarcinoma 2. Papillary carcinoma
Q: Give 2 examples of malignant tumors of blood cell (mesenchymal) origin.
A: 1. Leukemia 2. Lymphoma
Q: Give an example of a benign tumor of blood vessel (mesenchymal) origin.
A: Hemangioma
Q: Give an example of a benign tumor of bone (mesenchymal) origin.
A: Osteoma
Q: Give an example of a benign tumor of more than one cell type.
A: Mature teratoma
Q: Give an example of a benign tumor of skeletal muscle (mesenchymal) origin.
A: Rhabdomyoma
Q: Give an example of a benign tumor of smooth muscle (mesenchymal) origin.
A: Leiomyoma
Q: Give an example of a malignant tumor of blood vessel (mesenchymal) origin.
A: Angiosarcoma
Q: Give an example of a malignant tumor of bone (mesenchymal) origin.
A: Osteosarcoma
Q: Give an example of a malignant tumor of more than one cell type.
A: Immature teratoma
Q: Give an example of a malignant tumor of skeletal muscle (mesenchymal) origin.
A: Rhabdomysarcoma
Q: Give an example of a malignant tumor of smooth muscle (mesenchymal) origin.
A: Leiomyosarcoma
Q: Give an example of a neoplasm associated with Down's Syndrome.
A: Acute Lymphoblastic Leukemia (ALL)
Q: How are tumor markers used?
A: Tumor markers are used to confirm diagnosis, to monitor for tumor recurrence, and to monitor the response to therapy. They should not be used as a primary tool for diagnosis.
Q: How is prostatic adenocarcinoma most commonly diagnosed?
A: Digital rectal exam (detect hard nodule) or by prostate biopsy
Q: How often do primary brain tumors undergo metastasis?
A: Very rarely
Q: In what population is osteochondroma most often found?
A: Usually men under the age of 25
Q: In which age group is prostatic adenocarcinoma most common?
A: Men over the age of 50
Q: Is malignant transformation in osteochondroma common?
A: Malignant transformation to chondrosarcoma is rare
Q: Name 1 common tumor staging system.
A: TNM system T= size of tumor, N=node involvement, and M=metastases
Q: Name 3 herniation syndromes that can cause either coma or death when the herniations compress the brainstem
A: 1. Downward transtentorial (central) herniation 2. Uncal herniation 3. Cerebellar tonsillar herniation into the foramen magnum
Q: Name 4 factors that predispose a person to osteosarcoma.
A: 1. Paget's disease of bone 2. Bone infarcts 3. Radiation 4. Familial retinoblastoma
Q: Name 4 possible routes of herniation in the brain
A: 1. Cingulate herniation under the falx cerebri 2. Downward transtentorial (central) herniation 3. Uncal herniation 4. Cerebellar tonsillar herniation into the foramen magnum
Q: Name 5 primary brain tumors with peak incidence in adulthood.
A: 1. Meningioma 2. Glioblastoma multiforme 3. Oligodendroglioma 4. Schwannoma 5. Pituitary adenoma
Q: Name 5 primary brain tumors with peak incidence in childhood.
A: 1. Medulloblastoma 2. Hemangioblastoma 3. Ependymomas 4. Low-grade astrocytoma 5. Craniopharyngioma
Q: Name 5 sites from which tumor cells metastasize to the brain.
A: 1. Lung 2. Breast 3. Skin (melanoma) 4. Kidney (renal cell carcinoma) 5. GI
Q: Name a common histopathological sign of basal cell carcinoma nuclei
A: The nuclei of basal cell tumors have 'palisading' nuclei
Q: Name a population at a greater risk for melanoma.
A: Fair-skinned people (blue eyes and red hair have also been considered as factors)
Q: Name the 5 primary tumors that metastasize to the liver
A: 1. Colon 2. Stomach 3. Pancreas 4. Breast 5. Lung
Q: Name two of the most common sites of metastasis after the regional lymph nodes
A: The liver and the lung
Q: Name two presenting sequelae of a pituitary adenoma.
A: 1. Bitemporal hemianopsia (due to pressure on the optic chiasm) 2. Hypopituitarism
Q: On which chromosome is the p53 gene located?
A: 17p
Q: On which chromosome is the Rb gene located?
A: 13q
Q: On which chromosomes are the BRCA genes located?
A: BRCA 1 is on 17q and BRCA 2 is on 13q
Q: Out of the 6 primary tumors that metastasize to bone, which two are the most common?
A: Metastasis from the breast and prostate are the most common
Q: What 2 cancers are associated with EBV?
A: 1. Burkitt's lymphoma 2. Nasopharyngeal carcinoma
Q: What 2 neoplasms are associated with AIDS?
A: 1. Aggressive malignant lymphomas (non-Hodgkins) 2. Kaposi's sarcoma
Q: What 2 neoplasms are associated with Autoimmune disease (e.g. Hashimoto's thyroiditis, myasthenia gravis, etc.)?
A: Benign and malignant thymomas
Q: What 2 neoplasms are associated with Paget's disease of bone?
A: 1. Secondary osteosarcoma 2. Fibrosarcoma
Q: What 2 neoplasms are associated with Tuberous sclerosis (facial angiofibroma, seizures, and mental retardation)?
A: 1. Astrocytoma 2. Cardiac rhabdomyoma
Q: What are 2 characteristic findings in carcinoma in situ?
A: 1. Neoplastic cells have not invaded the basement membrane 2. High nuclear:cytoplasmic ratio and clumped chromatin
Q: What are 2 characteristic findings of an invasive carcinoma?
A: 1. Cells have invaded the basement membrane using collagenases and hydrolases 2. Able to metastasize if they reach blood or lymphatic vessels.
Q: What are 2 neoplasms associated with Xeroderma pigmentosum?
A: 1. Squamous cell carcinoma of the skin 2. Basal cell carcinoma of the skin
Q: What are 3 disease findings associated with Alkaline Phosphatase?
A: 1. Metastases to bone 2. Obstructive biliary disease 3. Paget's disease of bone
Q: What are 6 primary tumors that metastasize to bone?
A: 1. Kidney 2. Thyroid 3. Testes 4. Lung 5. Prostate 6. Breast
Q: What are a common histopathological finding of meningiomas?
A: Psammoma bodies. These are spindle cells concentrically arranged in a whorled pattern.
Q: What are ependymomas?
A: Ependymal cell tumors most commonly found in the 4th ventricle. May cause hydrocephalus
Q: What are the steps in the progression of neoplasia?
A: 1. Normal 2. Hyperplasia 3. Carcinoma In Situ/Preinvasive 4. Invasion
Q: What are two signs of bone metastases in prostatic adenocarcinoma?
A: An increase in serum alkaline phosphatase and PSA (prostate-specific antigen)
Q: What are two useful tumor markers in prostatic adenocarcinoma?
A: Prostatic acid phosphatase and prostate-specific antigen (PSA)
Q: What can be associated with the risk of melanoma?
A: Sun exposure
Q: What cancer is associated with HBV and HCV (Hep B and C viruses)?
A: Hepatocellular carcinoma
Q: What cancer is associated with HHV-8 (Kaposi's sarcoma-associated herpes virus)?
A: Kaposi's carcinoma
Q: What cancer is associated with the HTLV-1 virus?
A: Adult T-cell leukemia
Q: What cancers are commonly associated with HPV (human papilloma virus)?
A: Cervical carcinoma, penile, and anal carcinoma
Q: What causes the local effect of a mass?
A: Tissue lump or tumor
Q: What causes the local effect of a nonhealing ulcer?
A: Destruction of epithelial surfaces (e.g. stomach, colon, mouth, bronchus)
Q: What causes the local effect of a space-occupying lesion?
A: Raised intracranial pressure in brain neoplasms. Also seen with anemia due to bone marrow replacement.
Q: What causes the local effect of bone destruction?
A: Pathologic fracture or collapse of bone
Q: What causes the local effect of edema?
A: Venous or lymphatic obstruction
Q: What causes the local effect of hemorrhage?
A: Caused by ulcerated area or eroded vessel
Q: What causes the local effect of inflammation of a serosal surface?
A: Pleural effusion, pericardial effusion, or ascites
Q: What causes the local effect of obstruction in the biliary tree?
A: Jaundice
Q: What causes the local effect of obstruction in the bronchus?
A: Pneumonia
Q: What causes the local effect of obstruction in the left colon?
A: Constipation
Q: What causes the local effect of pain?
A: Any site with sensory nerve endings. Remember that tumors in the brain are usually painless.
Q: What causes the local effect of perforation of an ulcer in the viscera?
A: Peritonitis or free air
Q: What causes the local effect of seizures?
A: Tumor mass in the brain.
Q: What causes the localized loss of sensory or motor function?
A: Compression or destruction of nerve (e.g. recurrent laryngeal nerve by lung or thyroid cancer causes hoarseness)
Q: What causes the paraneoplastic effect gout?
A: Hyperuricemia due excess nucleic acid turnover (secondary to cytotoxic therapy of various neoplasms)
Q: What causes the paraneoplastic effect of Cushing's disease?
A: ACTH or ACTH-like peptide (secondary to small cell lung carcinoma)
Q: What causes the paraneoplastic effect of hypercalcemia?
A: PTH-related peptide, TGF-a, TNF-a, IL-2 (secondary to squamous cell lung carcinoma, renal cell carcinoma, breast carcinoma, multiple myeloma, and bone metastasis)
Q: What causes the paraneoplastic effect of Lambert-Eaton syndrome?
A: Antibodies against presynaptic Ca2+ channels at NMJ (Thymoma, bronchogenic carcinoma)
Q: What causes the paraneoplastic effect of Polycythemia?
A: Erythropoietin (secondary to renal cell carcinoma)
Q: What causes the paraneoplastic effect of SIADH?
A: ADH or ANP (secondary to small cell lung carcinoma and intracranial neoplasms)
Q: What chemical carcinogen is commonly associated with the centrilobar necrosis and fatty acid change?
A: CCL4
Q: What chemical carcinogen is commonly associated with the esophagus and stomach?
A: Nitrosamines
Q: What chemical carcinogen is commonly associated with the lungs?
A: Asbestos (Causes mesothelioma and bronchogenic carcinoma)
Q: What chemical carcinogen is commonly associated with the skin (squamous cell)?
A: Arsenic
Q: What chemical carcinogen(s) are commonly associated with the liver?
A: Aflatoxins and vinyl chloride
Q: What is a chondrosarcoma?
A: Malignant cartilaginous tumor.
Q: What is a common genetic finding in Ewing's sarcoma?
A: 11;22 translocation
Q: What is a common gross pathological sign seen in Ewing's sarcoma?
A: Characteristic 'onion-skin' appearance of bone
Q: What is a common origin of a chondrosarcoma?
A: May be of primary origin or from osteochondroma
Q: What is a common sign found on the x-ray of a person with osteosarcoma?
A: Codman's triangle (from elevation of periosteum)
Q: What is a craniopharyngioma?
A: Benign childhood tumor. Often confused with pituitary adenoma because both can cause bitemporal hemianopsia. Calcification of the tumor is common.
Q: What is a Ewing's sarcoma?
A: Anaplastic small cell malignant tumor.
Q: What is a giant cell tumor?
A: Locally aggressive benign tumor around the distal femur, proximal tibial region.
Q: What is a gross pathological sign of basal cell carcinoma?
A: Pearly papules
Q: What is a helpful mnemonic to remember the neoplasm associated with Down's Syndrome?
A: We ALL go DOWN together.
Q: What is a helpful mnemonic to remember the site of metastasis to the brain?
A: Lots of Bad Stuff Kills Glia
Q: What is a helpful mnemonic to remember the types of cancer that metastasize to the liver?
A: Cancer Sometimes Penetrates Benign Liver
Q: What is a helpful mnemonic to remember what tumors metastasize to bone?
A: BLT with a Kosher Pickle
Q: What is a Hemangioblastoma?
A: Most often a cerebellar tumor. Associated with von Hippel Lindau syndrome when found with retinoblastoma.
Q: What is a low-grade astrocytoma?
A: Diffusely infiltrating glioma. In children, it is most commonly found in the posterior fossa.
Q: What is a medulloblastoma?
A: Highly malignant cerebellar tumor. A form of primitive neuroectodermal tumor (PNET). Can compress 4th ventricle causing hydrocephalus
Q: What is a neoplasm associated with actinic keratosis?
A: Squamous cell carcinoma of the skin
Q: What is a neoplasm associated with Barrett's esophagus (chronic GI reflux)?
A: Esophageal adenocarcinoma
Q: What is a neoplasm commonly associated with chronic atrophic gastritis, pernicious anemia, and postsurgical gastric remnants?
A: Gastric adenocarcinoma
Q: What is an oligodendroglioma?
A: A relatively rare, slow growing, benign tumor.
Q: What is CEA (carcinoembryonic antigen)?
A: Very nonspecific antigen produced by 70% of colorectal and pancreatic cancers and by gastric and breast carcinoma
Q: What is considered a precursor to squamous cell carcinoma?
A: Actinic keratosis
Q: What is considered to be a precursor to malignant melanoma?
A: Dysplastic nevus
Q: What is meant by the term tumor grade?
A: Histologic appearance of the tumor. Usually graded I-IV based on degree of differentiation and number of mitoses per high-power field.
Q: What is meant by the term tumor stage?
A: Based on site an size of primary lesion, spread to regional lymph nodes, and presence of metastases.
Q: What is the characteristic appearance of a giant cell tumor on an x-ray?
A: Characteristic 'double bubble' or 'soap bubble' appearance
Q: What is the common histopathology associated with Ependymomas?
A: Characteristic perivascular rosettes. Rod-shaped blepharoblasts (basal ciliary bodies) found near the nucleus.
Q: What is the common histopathology associated with Hemangioblastoma?
A: Foamy cells and high vascularity are characteristic. Can produce EPO and lead to polycythemia.
Q: What is the common histopathology associated with medulloblastomas?
A: Rosettes or perivascular pseudorosette pattern of cells
Q: What is the common histopathology associated with oligodendrogliomas?
A: Fried egg' appearance of cells in tumor. Often calcified.
Q: What is the common histopathology associated with schwannoma?
A: Antoni A=compact palisading nuclei; Antoni B=loose pattern
Q: What is the common histopathology found in Glioblastoma multiforme?
A: Pseudopalisading' tumor cells border central areas of necrosis and hemorrhage
Q: What is the differentiation pattern of normal cells?
A: Basal to apical differentiation
Q: What is the histopathology commonly associate with giant cell tumors?
A: Spindle-shaped cells with multi-nucleated giant cells.
Q: What is the most common benign bone tumor?
A: Osteochondroma
Q: What is the most common location of basal cell carcinoma of the skin?
A: Usually found in sun-exposed areas of the body.
Q: What is the most common location of osteosarcoma?
A: Commonly found in the metaphysis of long bones
Q: What is the most common organ to 'send' metastases?
A: The lung is the most common origin of metastases. The breast and stomach are also big sources.
Q: What is the most common organ to receive metastases?
A: Adrenal glands. This is due to their rich blood supply. The medulla usually receives metastases first and then the rest of the gland.
Q: What is the most common population to have chondrosarcoma?
A: Men age 30-60 years old
Q: What is the most common primary brain tumor?
A: Glioblastoma multiforme (grade IV astrocytoma)
Q: What is the most common primary malignant tumor of bone?
A: Osteosarcoma
Q: What is the most common type of pituitary adenoma?
A: Prolactin secreting
Q: What is the most likely population to have Ewing's sarcoma?
A: Boys under 15 years old.
Q: What is the origin of a craniopharyngioma?
A: Derived from the remnants of Rathke's pouch
Q: What is the origin of a Pituitary adenoma?
A: Rathke's pouch
Q: What is the origin of the Schwannoma?
A: Schwann cell origin. Often localized to the 8th cranial nerve (acoustic schwannoma). Bilateral schwannoma found in NF2.
Q: What is the peak incidence of giant cell tumor?
A: 20-40 years old
Q: What is the peak incidence of osteosarcoma?
A: Men 10-20 years old
Q: What is the prognosis for Glioblastoma multiforme?
A: Prognosis is grave. Usually only have a year life expectancy.
Q: What is the second most common primary brain tumor?
A: Meningioma
Q: What is the third most common primary brain tumor?
A: Schwannomas
Q: What neoplasias are associated with a-fetoprotein?
A: Hepatocellular carcinoma and nonseminomatous germ cell tumors of the testis.
Q: What neoplasias are associated with B-hCG?
A: Hydatidiform moles, Choriocarcinomas, and Gestational trophoblastic tumors.
Q: What neoplasias are associated with CA-125?
A: Ovarian and malignant epithelial tumors
Q: What neoplasias are associated with S-100?
A: Melanoma, neural tumors, and astrocytomas
Q: What neoplasm is associated with Cirrhosis (due to alcoholism, Hep B, or Hep C)
A: Hepatocellular carcinoma
Q: What neoplasm is associated with Dysplastic nevi?
A: Malignant melanoma
Q: What neoplasm is associated with Immunodeficiency states?
A: Malignant lymphomas
Q: What neoplasm is associated with Plummer-Vinson syndrome (atrophic glossitis, esophageal webs, and anemia; all due to iron deficiency)
A: Squamous cell carcinoma of the esophagus
Q: What neoplasm is associated with ulcerative colitis?
A: Colonic adenocarcinoma
Q: What oncogene is associated with breast, ovarian, and gastric carcinomas?
A: erb-B2
Q: What oncogene is associated with Burkitt's lymphoma?
A: c-myc
Q: What oncogene is associated with colon carcinoma?
A: ras
Q: What oncogene is associated with Follicular and undifferentiated lymphomas (inhibits apoptosis)?
A: bcl-2
Q: What tumor marker is associated with Prostatic carcinoma?
A: PSA (Prostatic acid phosphatase)
Q: What tumor suppressor gene is associated with Retinoblastoma and osteosarcoma?
A: Rb gene
Q: What type of metastases are common in the late stages of prostatic adenocarcinoma?
A: Osteoblastic metastases in bone
Q: What type of neoplasm is associated with Acanthosis nigricans (hyperpigmentation and epidermal thickening)
A: Visceral malignancies (stomach, lung, breast, and uterus)
Q: What type of skin cancer is associated with excessive exposure to sunlight or arsenic exposure?
A: Squamous cell carcinoma
Q: Where are chondrosarcomas usually located?
A: Pelvis, spine, scapula, humerus, tibia, or femur.
Q: Where are Ewing's sarcomas most commonly found?
A: Diaphysis of long bones, pelvis, scapula, and ribs
Q: Where are Glioblastoma multiformes found?
A: Cerebral hemispheres
Q: Where do giant cell tumors most commonly occur?
A: At epiphyseal end of long bones
Q: Where do meningiomas most commonly occur?
A: Convexities of hemispheres and parasagital region
Q: Where do oligodendrogliomas most often occur?
A: Most often found in the frontal lobes
Q: Where do osteochondromas commonly originate?
A: Long metaphysis
Q: Where do squamous cell carcinomas most commonly occur?
A: Hands and face
Q: Where does prostatic adenocarcinoma most commonly arise?
A: From the posterior lobe (peripheral zone) of the prostate gland
Q: Which has more prognostic value: tumor stage or grade?
A: Stage
Q: Which is more common: metastasis to bone or primary tumors of bone?
A: Metastatic bone tumors are far more common than primary tumors
Q: Which is more common: metastasis to the liver or primary tumors of the liver?
A: Metastasis to the liver is more common
Q: Which tumor suppressor gene is associated with most human cancers and the Li-Fraumeni syndrome?
A: p53
Q: Which tumor suppressor genes are associated with breast and ovarian cancer?
A: BRCA 1 and 2
PATH_CNS
Q: Define epilepsy.
A: Epilepsy is a disorder of recurrent seizures.
Q: Define syrinx.
A: Tube, as in syringe
Q: Describe a myoclonic seizure.
A: Quick,repetitive jerks
Q: Describe a tonic-clonic seizure.
A: Alternating stiffening and movement (grand mal)
Q: Describe a tonic seizure.
A: Stiffening
Q: Describe an absence seizure.
A: A blank stare (petit mal- it's in 1st aid this way!!)
Q: Describe an atonic seizure.
A: drop' seizures
Q: Describe Broca's aphasia.
A: Broca's is nonfluent aphasia with intact comprehension.
A: BROca's is BROken speech.
Q: Describe Horner's syndrome.
A: Sympathectomy of face (lesion above T1). Interruption of the 3-neuron oculosympathetic pathway.
Q: Describe Wernicke's aphasia.
A: Wernicke's is fluent aphasia with impaired comprehension.
A: Wernicke's is Wordy but makes no sense.
Q: How do patients present with a subarachnoid hemorrhage?
A: Worst headache of my life'
Q: How do pts present with MS?
A: -Optic neuritis (sudden loss of vision)
A: - MLF syndrome (internuclear ophthalmoplegia)
A: -Hemiparesis
A: -Hemisensory symptoms
A: -Bladder/bowel incontinence
Q: How does it spread?
A: Through the bloodstream to the CNS
Q: How does Werdnig-Hoffman disease present?
A: At birth as a 'floppy baby'
Q: How is Huntington's disease inherited?
A: Autosomal dominant
Q: How is the polio virus transmitted?
A: Fecal-oral route
Q: How is the prevalence of MS geographically distributed?
A: Higher prevalence with greater distance from the Equator
Q: In what persons is subdural hemorrhage often seen?
A: Elderly individuals, alcoholics, and blunt trauma
Q: T/F. Partial seizures can not generalize.
A: False- Partial seizures can generalize.
Q: What are 2 common organisms that target the brain in AIDS pts?
A: 1. Toxo!Toxo!Toxo!
A: 2. Cryptococcus
Q: What are 2 degenerative diseases of the cerebral cortex?
A: 1. Alzheimer's
A: 2. Pick's disease
Q: What are 2 degenerative diseases that affect the basal ganglia and brain stem?
A: 1. Huntington's disease
A: 2. Parkinson's disease
Q: What are 3 degenerative disorders of the motor neuron?
A: 1. Amyotrophic lateral sclerosis (ALS)
A: 2. Werdnig-Hoffman disease
A: 3. Polio
Q: What are associated with Guillain-Barre?
A: 1. Infections (herpesvirus or C. jejuni)
A: 2. Inoculations
A: 3. Stress
Q: What are neurofibrillary tangles?
A: Abnormally phosphorylated tau protein
Q: What are some demyelinating and dysmyelinating diseases?
A: 1. Multiple sclerosis (MS)
A: 2. Progressive multifocal leukoencephalopathy (PML)
A: 3. Postinfectious encephalomyelitis
A: 4. Metachromatic Leukodystrophy
A: 5. Guillain-Barre syndrome
Q: What are the 4 types of intracranial hemorrhages?
A: 1. Epidural hematoma
A: 2. Subdural Hematoma
A: 3. Subarachnoid hemorrhage
A: 4. Parenchymal hematoma
Q: What are the 5 types of generalized seizures?
A: 1. Absence
A: 2. Myoclonic
A: 3. Tonic-clonic
A: 4. Tonic
A: 5. Atonic
Q: What are the clinical symptoms of Huntington's disease?
A: Dementia, chorea
Q: What are the clinical symptoms of Parkinson's disease?
A: TRAP= Tremor (at rest)
A: cogwheel Rigidity
A: Akinesia
A: Postural instability
A: (you are TRAPped in your body)
Q: What are the clinical symptoms of Tabes dorsalis?
A: -Charcot joints
A: -Shooting pain
A: -Argyll-Robertson Pupils
A: -Absence of deep tendon reflexes
Q: What are the common causes of seizures in adults?
A: -Tumors
A: -Trauma
A: -Stroke
A: -Infection
Q: What are the common causes of seizures in children?
A: -Genetic
A: -Infection
A: -Trauma
A: -Congenital
A: -Metabolic
Q: What are the common causes of seizures in the elderly?
A: -Stroke
A: -Tumor
A: -Trauma
A: -Metabolic
A: -Infection
Q: What are the lab findings in Guillain-Barre syndrome?
A: Elevated CSF protein with normal cell count ('albumino-cytologic dissociation')
Q: What are the lab findings in poliomyelitis?
A: -CSF with lymphocytic pleocytosis with slight elevation of protein
A: -Virus recovered from stool or throat
Q: What are the pathological signs of glioblastoma multiforme (GBM)?
A: -Necrosis
A: -Hemorrhage
A: -Pseudo-palisading
Q: What are the signs of LMN lesions seen in poliomyelitis?
A: -Muscle weakness and atrophy
A: -Fasciculations
A: -Fibrillation
A: -Hyporeflexia
Q: What are the symptoms of Horner's?
A: 1. Ptosis
A: 2. Miosis
A: 3. Anhidrosis and flushing of affected side of face
Q: What are the symptoms of poliomyelitis?
A: -Malaise
A: -Headache
A: -Fever
A: -Nausea
A: -Abdominal pain
A: -sore throat
Q: What area of the brain is affected by generalized seizures?
A: Diffuse area
Q: What artery is compromised in an epidural hematoma?
A: Middle meningeal artery
Q: What blood vessels are affected in subdural hemorrhages?
A: Rupture of bridging veins
Q: What causes a parenchymal hematoma?
A: -HTN
A: -Amyloid angiopathy
A: -Diabetes Mellitus
A: -Tumor
Q: What causes poliomyelitis?
A: Poliovirus
Q: What chemical can Parkinson's disease be linked to?
A: MPTP, a contaminant in illicit street drugs
Q: What clinical symptoms are present with syringomyelia?
A: Bilateral pain and temperature loss in the upper extremities with preservation of touch sensation
Q: What clinical symptoms are present?
A: -Symmetric ascending muscle weakness beginning in the distal lower extremities
A: -Facial diplegia in 50% of cases
A: -Autonomic fx may be severely affected
Q: What congenital malformation is often associated with syringomyelia?
A: Arnold Chiari Malformation
Q: What damage does cryptococcus cause in the brain?
A: Periventricular calcifications
Q: What damage does toxoplasma cause in the brain?
A: Diffuse (intracerebral) calcifications
Q: What diseases are berry aneurysms associated with?
A: -Adult polycystic kidney disease
A: -Ehlers-Danlos syndrome
A: -Marfan's syndrome
Q: What do partial seizures affect?
A: One area of the brain
Q: What does rupture of a berry aneurysm lead to?
A: Stroke
Q: What does the spinal tap show in a subarachnoid hemorrhage?
A: Bloody or xanthochromic
Q: What event is the rupture of the middle meningeal artery secondary to?
A: Temporal bone fracture
Q: What genes is the familial form of Alzheimer's associated with?
A: Genes are chromosomes 1, 14, 19 and 21
Q: What is a complex partial seizure?
A: Impaired awareness
Q: What is a degenerative disorder of the Spinocerebellar tract?
A: Friedrich's ataxia (olivopontocerebellar atrophy)
Q: What is anhidrosis?
A: Absence of sweating
Q: What is another name for Guillain-Barre syndrome?
A: Acute idiopathic polyneuritis
Q: What is another symptom of Werdnig-Hoffman disease?
A: Tongue fasciculations
Q: What is another term for Broca's aphasia?
A: Expressive aphasia
Q: What is another term for Wernicke's aphasia?
A: Receptive aphasia
Q: What is miosis?
A: Pupil constriction
Q: What is PML associated with?
A: JC virus
Q: What is ptosis?
A: Slight drooping of the eyelids
Q: What is the classic triad of MS?
A: SIN
A: 1. Scanning speech
A: 2. Intention Tremor
A: 3. Nystagmus
Q: What is the common name for ALS?
A: Lou Gehrig's disease
Q: What is the course of a subdural hemorrhage?
A: Venous bleeding (less pressure) with delayed onset of symptoms
Q: What is the course of MS?
A: In most pts, the course is remitting and relapsing
Q: What is the incidence of brain tumors in adults?
A: Metastases> Astrocytoma (including glioblastoma)> Meningioma
Q: What is the incidence of brain tumors in children?
A: Astrocytoma> Medulloblastoma> Ependymoma
Q: What is the most common cause of dementia in the elderly?
A: Alzheimer's disease
Q: What is the most common complication of a berry aneurysm?
A: Rupture of the aneurysm
Q: What is the most common site for a berry aneurysm?
A: The bifurcation of the anterior communicating artery
Q: What is the pathogenesis of Guillain-Barre syndrome?
A: Inflammation and demyelination of peripheral nerves and motor fibers of ventral roots (sensory effect less severe than motor)
Q: What is the pathogenesis of Tabes dorsalis?
A: Degeneration of the dorsal columns and dorsal roots due to tertiary syphilis.
Q: What is the pathology of Alzheimer's?
A: Associated with senile plaques (beta-amyloid core) and neurofibrillary tangles
Q: What is the pathology of Huntington's disease?
A: Atrophy of the caudate nucleus
Q: What is the pathology of MS?
A: -Periventricular plaques
A: -Preservation of axons
A: -Loss of oligodendrocytes
A: -Reactive astrocytic gliosis
A: -Increased protein (IgA) in CSF
Q: What is the pathology of Parkinson's disease?
A: Associated with Lewy bodies and depigmentation of the substantia nigra
Q: What is the pathology of Pick's disease?
A: Associated with Pick bodies, intracytoplasmic inclusion bodies
Q: What is the pathology of poliomyelitis?
A: Destruction of anterior horn cells, leading to LMN destruction
Q: What is the pathology of syringomyelia?
A: Softening and cavitation around the central canal of the spinal cord.
Q: What is the prognosis for a pts diagnosed with a GBM?
A: Very poor
Q: What is the second most common cause of dementia in the elderly?
A: Multi-infarct dementia
Q: What is the shape of GBMs?
A: Butterfly' glioma
Q: What is the usual cause of a subarachnoid hemorrhage?
Q: What neural deficits are present in Tabes dorsalis?
A: Impaired proprioception and locomotor ataxia
Q: What neural tracts are damaged?
A: Crossing fibers of the spinothalamic tract
Q: What neurons are affected in ALS?
A: Both the upper and lower motor neurons
Q: What neurons are affected in Polio?
A: Lower motor neurons only
Q: What seizures are categorized as simple partial?
A: Awareness intact
A: -Motor
A: -Sensory
A: -Autonomic
A: -Psychic
Q: What tumor is Horner's syndrome associated with?
A: Pancoast's tumor
Q: Where are most brain tumors located in adults?
A: 70% are supratentorial (cerebral hemispheres)
Q: Where are most childhood brain tumors located?
A: 70% below tentorium (cerebellum)
Q: Where do berry aneurysms occur?
A: At the bifurcations in the Circle of Willis
Q: Where does it initially replicate?
A: The oropharynx and small intestine
Q: Where does the 3 neuron oculosympathetic pathway project from?
A: The hypothalamus
Q: Where does the 3 neuron oculosympathetic pathway project to?
A: 1. Interomediolateral column of the spinal cord
A: 2. Superior cervical (sympathetic) ganglion
A: 3. To the pupil, smooth muscles of the eyelids and the sweat glands
Q: Where is Broca's area located?
A: Inferior frontal gyrus
Q: Where is Pick's disease specific for?
A: The frontal and temporal lobes
Q: Where is the aopE-4 allele located?
A: Chromosome 19
Q: Where is the most common site of syringomyelia?
A: C8-T1
Q: Where is the p-App gene located?
A: 21
Q: Where is Wernicke's area located?
A: Superior Temporal Gyrus
Q: Which demyelinating disease is seen in 2-4% of AIDS patients?
A: PML
PATH_KIDNEY
Q: Define renal failure.
A: Failure to make urine and excrete nitrogenous wastes
Q: How do you calculate anion gap?
A: Na-(Cl + HCO3) = 8-12 mEq/L
Q: How do you treat minimal change disease?
A: Responds well to steroids
Q: How does acute poststreptococcal glomerulonephritis resolve?
A: Spontaneously
Q: How does renal cell carcinoma spread metastically?
A: Invades the IVC and spreads hematogenously
Q: How does transitional cell carcinoma present?
A: Hematuria
Q: How does Wilms' tumor present?
A: Huge, palpable flank mass
Q: In what epidemiological group is renal cell carcinoma most common?
A: Men ages 50-70
Q: T/F: Ammonium magnesium phosphate kidney stones are radiopaque
A: TRUE
Q: T/F: Calcium kidney stones are radiopaque.
A: TRUE
Q: T/F: Calcium kidney stones do not recur.
A: FALSE
Q: T/F: Cystine kidney stones are radiopaque.
A: FALSE, cystine stones are radiolucent
Q: T/F: Transitional cell carcinoma is cured by surgical removal.
A: False, transitional cell carcinoma often recurs after removal
Q: T/F: Uric acid kidney stones are radiopaque
A: FALSE, uric acid stones are radiolucent
Q: What additional sx are seen in a pt with acute streptococcal glomerulonephritis?
A: Peripheral and periorbital edema
Q: What age group is poststreptococcal glomerulonephritis most common?
A: Children
Q: What are 4 causes of hypoventilation?
A: 1. Acute lung disease
A: 2. Chronic lung disease
A: 3. Opioids, narcotics, sedatives
A: 4. Weakening of respiratory muscles
Q: What are the 2 forms of renal failure?
A: Acute and chronic
Q: What are the 2 main symptoms present in Goodpasture's syndrome?
A: Hemoptysis, hematuria
Q: What are the 4 major types of kidney stones?
A: 1. Calcium
A: 2. Ammonium magnesium phosphate
A: 3. Uric acid
A: 4. Cystine
Q: What are the 5 nephritic syndromes?
A: Acute poststreptococcal glomerulonephritis
A: Rapidly progressive (crescentic) glomerulonephritis
A: Goodpasture's syndrome
A: Membranoproliferative glomerulonephritis
A: Berger's disease
Q: What are the 5 nephrotic syndromes?
A: 1. Membranous glomerulonephritis
A: 2. Minimal change disease (lipoid nephrosis)
A: 3. Focal segmental glomerular sclerosis
A: 4. Diabetic nephropathy
A: 5. SLE
Q: What are the causes and signs of calcium ion deficiency?
A: -Kids- rickets
A: -Adults- osteomalacia
A: -Contributes to osteoporosis
A: -Tetany
Q: What are the causes and signs of phosphate toxicity?
A: -Low serum calcium ion
A: -can cause bone loss
A: -renal stones
Q: What are the causes of chloride ion deficiency?
A: Secondary to emesis, diuretics, renal disease
Q: What are the causes of metabolic acidosis?
A: -Diabetic ketoacidosis
A: -Diarrhea
A: -Lactic Acidosis
A: -Salicylate OD
A: -Acetazolamide OD
Q: What are the causes of respiratory acidosis?
A: -COPD
A: -Airway obstruction
Q: What are the causes of respiratory alkalosis?
A: -High altitude
A: -Hyperventilation
Q: What are the characteristics of acute poststreptococcal glomerulonephritis seen with immunofluorescence?
A: Granular pattern
Q: What are the characteristics of acute poststreptococcal glomerulonephritis seen with the electron microscope?
A: Subepithelial humps
Q: What are the characteristics of acute poststreptococcal glomerulonephritis seen with the light microscope?
A: Glomeruli enlarged and hypercellular
A: neutrophils
A: 'lumpy-bumpy'
Q: What are the characteristics of rapidly progressive (crescentic) glomerulonephritis seen on LM and IF?
A: Crescent-moon shape
Q: What are the clinical features of renal cell carcinoma?
A: -Hematuria
A: -Palpable mass
A: -Secondary polycythemia
A: -Flank pain
A: -Fever
Q: What are the clinical symptoms of a nephritic syndrome?
A: I' = inflammation; hematuria, hypertension, oligouria, azotemia
Q: What are the clinical symptoms of nephrotic syndromes?
A: O = proteinuria
A: Hypoalbuminuria
A: Generalized edema
A: Hyperlipidemia
Q: What are the consequences of renal failure?
A: 1. Anemia
A: 2. Renal osteodystrophy
A: 3. Hyperkalemia
A: 4. Metabolic acidosis
A: 5. Uremia
A: 6. Sodium and water excess
A: 7. Chronic pyelonephritis
A: 8. HTN
Q: What are the factors associated metabolic alkalosis?
A: -Increased pH
A: -Increased PCO2
A: -Increased HCO3-
Q: What are the factors associated with metabolic acidosis?
A: -Decreased pH
A: -Decreased PCO2
A: -Decreased HCO3-
Q: What are the factors associated with respiratory acidosis?
A: -Decreased pH
A: -Increased PCO2
A: -Increased HCO3-
Q: What are the factors associated with respiratory alkalosis?
A: -Increased pH
A: -Decreased PCO2
A: -Decreased HCO3-
Q: What are the functions of calcium ion?
A: -Muscle contraction
A: -Neurotransmitter release
A: -Bones, teeth
Q: What are the functions of sodium ion?
A: -Extracellular fluid
A: -Maintains plasma volume
A: -Nerve/muscle function
Q: What are the functions of the chloride ion?
A: -Fluid/electrolyte balance
A: -Gastric acid
A: -HCO3/Cl shift in RBC
Q: What are the functions of the magnesium ion?
A: -Bones, teeth
A: -Enzyme cofactor
Q: What are the functions of the phosphate ion?
A: -ATP
A: -nucleic acids
A: -Phosphorylation
A: -Bones, teeth
Q: What are the functions of the potassium ion?
A: -Intracellular fluid
A: -Nerve/muscle function
Q: What are the signs of magnesium ion deficiency?
A: -Diarrhea
A: -Alcoholism
Q: What are the signs of magnesium ion toxicity?
A: -Decreased reflexes
A: -Decreased respirations
Q: What are the signs of phosphate deficiency?
A: -Kids- rickets
A: -Adults- osteomalacia
Q: What are the signs of potassium ion toxicity?
A: -EKG changes
A: -Arrhythmia
Q: What bugs cause ammonium magnesium phosphate kidney stones?
A: Urease-positive bugs such as Proteus vulgaris or Staphylococcus
Q: What calcium molecules form calcium kidney stones?
A: Calcium oxalate or calcium phosphate or both
Q: What can excess Na and water cause?
A: CHF and pulmonary edema
Q: What can the hyperkalemia associated with renal failure lead to?
A: Cardiac arrhythmias
Q: What causes metabolic alkalosis?
A: 1. Vomiting
A: 2. Diuretic use
A: 3. Antacid use
A: 4. Hyperaldosteronism
Q: What causes renal osteodystrophy?
A: Failure of active vitamin D production
Q: What characteristics of Berger's disease are seen with IF and EM?
A: Mesangial deposits of IgA
Q: What characteristics of focal segmental glomerular sclerosis are seen with the LM?
A: Segmental sclerosis and hyalinosis
Q: What characteristics of Goodpasture's syndrome are seen with IF?
A: Linear pattern
A: Anti-glomerular basement membrane antibodies
Q: What characteristics of Membranoproliferative glomerulonephritis are seen with the EM?
A: subendothelial humps
A: 'tram track'
Q: What characteristics of membranous glomerulonephritis are seen with IF?
A: Granular pattern
Q: What characteristics of membranous glomerulonephritis are seen with the EM?
A: Spike and Dome'
Q: What characteristics of membranous glomerulonephritis are seen with the LM?
A: Diffuse capillary and basement membrane thickening
Q: What characteristics of minimal change disease are seen with the EM?
A: Foot process effacement
Q: What characteristics of minimal change disease are seen with the LM?
A: Normal glomeruli
Q: What characteristics of SLE are seen with the LM?
A: Wire-loop appearance with extensive granular subendothelial basement-membrane deposits in membranous glomerulonephritis pattern
Q: What defines metabolic acidosis?
A: -pH less than 7.4
A: -PCO2 less than 40 mm Hg
Q: What defines metabolic alkalosis with compensation?
A: -pH greater than 7.4
A: -PCO2 greater than 40 mm Hg
Q: What defines respiratory acidosis?
A: -pH less than 7.4
A: -PCO2 greater than 40mm Hg
Q: What defines respiratory alkalosis?
A: -pH greater than 7.4
A: -PCO2 less than 40 mm Hg
Q: What diseases often cause uric acid kidney stones?
A: Diseases with increased cell proliferation and turnover, such as leukemia and myeloproliferative disorders
Q: What disorders can lead to hypercalcemia and thus kidney stones?
A: 1. Cancer
A: 2. Increased PTH
A: 3. Increased vitamin D
A: 4. Milk-alkali syndrome
Q: What disorders cause an increased anion gap?
A: 1. Renal failure
A: 2. Lactic acidosis
A: 3. Ketoacidosis (DM)
A: 4. Aspirin ingestion
Q: What disorders cause metabolic acidosis and normal anion gap?
A: 1. Diarrhea
A: 2. Glue sniffing
A: 3. Renal tubular acidosis
A: 4. Hyperchloremia
Q: What disorders make up the WAGR complex?
A: Wilms' tumor
A: Aniridia
A: Genitourinary malformation
A: mental-motor Retardation
Q: What does potassium deficiency cause?
A: -Weakness
A: -Paralysis
A: -Confusion
Q: What factors are associated with transitional cell carcinoma?
A: Exposure to cyclophosphamide, smoking, phenacetin, and aniline dyes
Q: What genetic disorder and mutation are associated with renal cell carcinoma?
A: Renal cell carcinoma is associated with von Hippel-Lindau and gene deletion in chromosome 3
Q: What genetic disorder is associated with Wilms' tumor?
A: Deletion of tumor suppression gene WT-1 on chromosome 11
Q: What is a common cause of adult nephrotic syndrome?
A: Membranous glomerulonephritis
Q: What is acute renal failure often due to?
A: Hypoxia
Q: What is Berger's disease?
A: IgA nephropathy
A: -Mild disease
A: -Often postinfectious
Q: What is chronic failure due to?
A: HTN and diabetes
Q: What is the 2nd most common type of kidney stone?
A: Ammonium magnesium phosphate
Q: What is the cause of magnesium ion deficiency?
A: Secondary to malabsorption
Q: What is the cause of metabolic alkalosis?
A: Vomiting
Q: What is the cause of potassium ion deficiency?
A: Secondary to injury, illness or diuretics
Q: What is the cause of sodium deficiency?
A: Secondary to injury or illness
Q: What is the compensatory mechanism of metabolic alkalosis?
A: Hypoventilation
Q: What is the compensatory mechanism of respiratory alkalosis?
A: Renal HCO3- secretion
Q: What is the compensatory response to metabolic acidosis?
A: Hyperventilation
Q: What is the compensatory response to respiratory acidosis?
A: Renal HCO3- reabsorption
Q: What is the course of membranoproliferative glomerulonephritis?
A: Slowly progresses to renal failure
Q: What is the course of rapidly progressive (crescentic) glomerulonephritis?
A: Rapid course to renal failure from one of many causes
Q: What is the Henderson-Hasselbalch equation?
A: pH = pKa + log [(HCO3-)/(0.03*PCO2)]
Q: What is the most common cause of childhood nephrotic syndrome?
A: Minimal change disease (lipoid nephrosis)
Q: What is the most common renal malignancy of early childhood (ages 2-4)?
A: Wilms' tumor
Q: What is the most common renal malignancy?
A: Renal cell carcinoma
Q: What is the most common tumor of the urinary tract system?
A: Transitional cell carcinoma
Q: What is the primary disturbance in respiratory acidosis?
A: Increased PCO2
Q: What is the primary disturbance of metabolic acidosis?
A: HCO3- decrease
Q: What is the primary disturbance of metabolic alkalosis?
A: Increased HCO3-
Q: What is the primary disturbance of respiratory alkalosis?
A: Decreased PCO2
Q: What is the sign of calcium ion toxicity?
A: Delirium
Q: What is the sign of sodium ion toxicity?
A: Delirium
Q: What lesions are seen on the LM in diabetic nephropathy?
A: Kimmelstiel-Wilson lesions
Q: What might an elevated anion gap indicate?
A: MUD PILES
A: 1. Methanol
A: 2. Uremia (chronic renal failure)
A: 3. Diabetic ketoacidosis
A: 4. Paraldehyde or Phenformin
A: 5. Iron tablets or INH
A: 6. Lactic acidosis (CN-, CO, shock)
A: 7. Ethanol or Ethylene glycol
A: 8. Salicylates
Q: What paraneoplastic syndromes are associated with renal cell carcinoma?
A: Ectopic EPO, ACTH, PTHrP, and prolactin
Q: What severe complications may kidney stones lead to?
A: Hydronephrosis
A: Pyelonephritis
Q: What social factor increases the incidence of renal cell carcinoma?
A: Smoking
Q: What type of hypersensitivity contributes to the pathogenesis of Goodpasture's syndrome?
A: Type II hypersensitivity
Q: Where can transitional cell carcinoma occur?
A: -Renal calyces
A: -Renal pelvis
A: -Ureters
A: -Bladder
Q: Where does renal cell carcinoma originate?
A: Renal tubule cells, polygonal clear cells
Q: Which kidney stone is often secondary to cystinuria?
A: Cystine
Q: Which kidney stone is strongly associated with gout?
A: Uric acid kidney stones
Q: Which of the nephrotic syndromes are worse in HIV pts?
A: Focal segmental glomerular sclerosis
Q: Which type of kidney stones constitute the majority of kidney stones (80-85%)?
A: Calcium
Q: Why are ammonium magnesium phosphate kidney stones often associated with UTIs?
A: Ammonium magnesium phosphate stones can form large struvite calculi that can be a nidus for UTIs
Q: Why does renal failure cause anemia?
A: Failure of EPO production
Q: Why does renal failure cause metabolic acidosis?
A: Due to decreased acid secretion and decreased generation of HCO3-
PATH_LUNGS
Q: An FEV1/FVC ratio greater than 80% indicates what form of pulmonary disease?
A: Restrictive lung disease
Q: Are bronchogenic carcinoma metastases common?
A: Yes, very common
Q: Decreased FEV1/FVC ratio are the hallmark of what kind of pulmonary disease?
A: COPD
Q: How does interstitial fibrosis create a restrictive lung disease?
A: It causes increased recoil (decreased compliance), thereby limiting alveolar expansion.
Q: How does lung cancer commonly present? (5)
A: - Cough
A: - Hemoptysis
A: - Bronchial obstruction
A: - Wheezing
A: - Pneumonic 'coin' lesion on x-ray
Q: How does surfactant deficiency cause NRDS?
A: It leads to an increase in surface tension, resulting in alveolar collapse
Q: How to you treat NRDS?
A: - Maternal steroids before birth
A: - Artificial surfactant for infant
Q: Identify: ivory-white pleural plaques in the lung.
A: Ferruginous bodies
Q: In COPD, are lung volumes increased, decreased, or normal?
A: Increased (increasedTLC, increased FRC, increased RV)
Q: In restrictive lung disease, are lung volumes increased, decreased, or normal?
A: Decreased
Q: In what occupations is asbestosis most commonly seen? (2)
A: Shipbuilders and plumbers
Q: Name three 'triggers' of asthma.
A: - Viral URIs
A: - Allergens
A: - Stress
Q: Name three characteristics of Horner's syndrome?
A: - Ptosis
A: - Miosis
A: - Anhidrosis
Q: Name two extrapulmonary (poor breathing mechanics) causes of restrictive lung disease.
A: - Poor muscular effort: polio, myasthenia gravis
A: - Poor apparatus: scoliosis
Q: Name two pulmonary (poor lung expansion) causes of restrictive lung disease.
A: - Defective alveolar filling: pneumonia, ARDS, pulmonary edema
A: - Interstitial fibrosis
Q: Patients with asbestosis are at increased risk for what? (2)
A: Pleural mesothelioma and bronchogenic carcinoma
Q: T/F Bronchiectasis is associated with bronchial obstruction, cystic fibrosis, and poor ciliary motility.
A: True
Q: T/F In obstructive (not restrictive) lung disease, FEV1 and FVC are reduced.
A: False, FEV1 and FVC are reduced in both
Q: T/F Restricted lung expansion causes decreased total lung capacity and increased vital capacity.
A: False, decreased VC and TLC
Q: T/F Smokers with asbestosis have a decreased risk of developing cancer.
A: False, it increases synergistically
Q: What are asbestos fibers coated with hemosiderin in the lung?
A: Ferruginous bodies
Q: What are the characteristics of lobar pneumonia?
A: Intra-alveolar exudate -> consolidation; may involve entire lung
Q: What are the clinical findings of chronic bronchitis? (3)
A: - Wheezing
A: - Crackles
A: - Cyanosis
Q: What are the clinical findings of emphysema? (4)
A: - Dyspnea
A: - Decreased breath sounds
A: - Tachycardia
A: - Decreased I/E ratio
Q: What are the symptoms and complications of interstitial lung fibrosis?
A: - Symptoms: gradual progressive dyspnea and cough
A: - Complications include cor pulmonale (can be seen in diffuse interstitial pulmonary fibrosis and bleomycin toxicity)
Q: What bronchogenic carcinoma is associated with ectopic hormone production (ADH, ACTH) and may lead to Lambert-Eaton syndrome?
A: Small cell carcinoma
Q: What bronchogenic carcinoma is associated with ectopic PTH-related peptide production?
A: Squamous cell carcinoma
Q: What bronchogenic carcinoma is most common?
A: Adenocarcinoma
Q: What bronchogenic carcinoma is thought not to be related to smoking?
A: Bronchioalveolar carcinoma
Q: What bronchogenic carcinomas are clearly linked to SSmoking?
A: SSquamous cell carcinoma and SSmall cell carcinoma
Q: What bronchogenic carcinomas usually express tumors that arise centrally? (2)
A: - Squamous cell carcinoma
A: - Small cell carcinoma
Q: What bronchogenic carcinomas usually express tumors that arise peripherally? (3)
A: - Adenocarcinoma
A: - Bronchioalveolar carcinoma
A: - Large cell carcinoma--undifferentiated
Q: What carcinoma occurs in the apex of the lung and may affect the cervical sympathetic, causing Horner's syndrome?
A: Pancoast's tumor
Q: What causes bronchiectasis?
A: Chronic necrotizing infection of bronchi
Q: What causes neonatal respiratory distress syndrome (NRDS)?
A: Surfactant deficiency
Q: What cells make surfactant and when is it made most abundantly in fetuses?
A: Type II pneumocytes most abundantly after 35th week of gestation
Q: What COPD has a productive cough for greater than three months in two years and hypertrophy of mucus-secreting glands in the bronchioles (Reid index greater than 50%)?
A: Chronic bronchitis
Q: What COPD is characterized by dilated airways, purulent sputum, recurrent infections, and hemoptysis?
A: Bronchiectasis
Q: What COPD is due to an enlargement of air spaces and decreased recoil resulting from destruction of alveolar walls?
A: Emphysema
Q: What COPD is due to bronchial hyperresponsiveness which causes reversible bronchoconstriction?
A: Asthma
Q: What does inhaled asbestos do to the lungs?
A: It causes diffuse pulmonary interstitial fibrosis
Q: What is the composition of surfactant:
A: Dipalmitoyl phosphatidylcholine
Q: What is the difference in FEV1/FVC ratios between obstructive and restrictive lungs diseases?
A: FEV1 and FVC are reduced in both, but in obstructive the FEV1 is more dramatically reduced, resulting in a decreased FEV1/FVC ratio
Q: What is the leading cause of cancer death?
A: Lung cancer
Q: What is the SPHERE (acronym) of complications associated with lung cancer?
A: Superior vena caval syndrome
A: Pancoast's tumor
A: Horner's syndrome
A: Endocrine (paraneoplastic)
A: Recurrent laryngeal symptoms (hoarseness)
A: Effusions (pleural or pericardial)
Q: What kind of pulmonary diseases are caused by a inhibition of air flow resulting in air trapping in the lungs?
A: Obstructive lung diseases (COPD)
Q: What organisms are is the most frequent cause of lobar pnuemonia?
A: Pneumococcus
Q: What organisms are the most frequent cause of bronchopnuemonia? (4)
A: - S. aureus
A: - H. flu
A: - Klebsiella
A: - S. pyogenes
Q: What organisms are the most frequent cause of interstitial (atypical) pnuemonia? (3)
A: - Viruses (RSV, adenoviruses)
A: - Mycoplasma
A: - Legionella
Q: What specific type of emphysema is caused by alpha-1-antitrypsin deficiency?
A: Panacinar emphysema (and liver cirrhosis)
Q: What specific type of emphysema is caused by smoking?
A: Centriacinar emphysema
Q: What test is used to measure in utero lung maturity?
A: The lecithin-to-sphingomyelin ratio in the amniotic fluid, usually less than 1.5 in neonatal respiratory distress syndrome
Q: What type of lung cancer can cause carcinoid syndrome?
A: Carcinoid tumor
Q: What type of pneumonia is characterized by acute inflammatory infiltrates from bronchioles into adjacent alveoli with a patchy distribution affecting more than one lobe?
A: Bronchopneumonia
Q: What type of pneumonia is characterized by diffuse patchy inflammation localized to interstial areas at alveolar walls and involves more than one lobe?
A: Interstitial (atypical) pneumonia
Q: Where does bronchogenic carcinoma commonly metastasize and how does it present? (3)
A: - Brain (epilepsy)
A: - Bone (pathologic fracture)
A: - Liver (jaundice, hepatomegaly)
Q: Why does alpha-1-antitrypsin deficiency cause emphysema?
A: Increased elastase activity
PATH_RHEUMATIC DISEASEA
Q: Define Ankylosing spondylitis?
A: Chronic inflammatory disease of spine & large joints, sacroilitis, uveitis, & aortic regurgitation
Q: Define Ankylosing spondylitis?
A: Chronic inflammatory disease of spine & large joints, sacroilitis, uveitis, & aortic regurgitation
Q: Define Celiac sprue
A: Autoimmune-mediated intolerance of gliadin (wheat) leading to steatorrhea.
Q: Define Celiac sprue
A: Autoimmune-mediated intolerance of gliadin (wheat) leading to steatorrhea.
Q: Define Gout.
A: Precipitation of monosodium urate crystals into joints due to hyperuricemia.
Q: Define Gout.
A: Precipitation of monosodium urate crystals into joints due to hyperuricemia.
Q: Define Scleroderma
A: Excessive fibrosis & collagen deposition throughout the body; commonly sclerosis of the skin, but also of CV & GI systems & kidney
Q: Define Scleroderma
A: Excessive fibrosis & collagen deposition throughout the body; commonly sclerosis of the skin, but also of CV & GI systems & kidney
Q: Define Sicca syndrome.
A: dry eyes, dry mouth, nasal & vaginal dryness, chronic bronchitis, reflux esophagitis
Q: Define Sicca syndrome.
A: dry eyes, dry mouth, nasal & vaginal dryness, chronic bronchitis, reflux esophagitis
Q: In what population is ankylosing sponsylitis more commonly found?
A: males (10-30 year old)
Q: In what population is ankylosing sponsylitis more commonly found?
A: males (10-30 year old)
Q: In what population is Celiac sprue more commonly found?
A: Assoc. w/ people of northern European descent
Q: In what population is Celiac sprue more commonly found?
A: Assoc. w/ people of northern European descent
Q: In what population is Goodpasture's syndrome more commonly found?
A: Men 20-40 y/o
Q: In what population is Goodpasture's syndrome more commonly found?
A: Men 20-40 y/o
Q: In what population is gout more commonly found?
A: Men
Q: In what population is gout more commonly found?
A: Men
Q: In what population is Osteoarthritis more commonly found?
A: Common in older patients
Q: In what population is Osteoarthritis more commonly found?
A: Common in older patients
Q: In what population is pseudogout more commonly found?
A: > 50 y/o, both sexes equally
Q: In what population is pseudogout more commonly found?
A: > 50 y/o, both sexes equally
Q: In what population is Reiter's syndrome more commonly found?
A: Strong predilection for males
Q: In what population is Reiter's syndrome more commonly found?
A: Strong predilection for males
Q: In what population is Rheumatoid arthritis more commonly found & what the common autoimmune factor present?
A: - Common in females
A: - 80% of RA pt's have positive rheumatoid factor (anti-IgG Ab)
Q: In what population is Rheumatoid arthritis more commonly found & what the common autoimmune factor present?
A: - Common in females
A: - 80% of RA pt's have positive rheumatoid factor (anti-IgG Ab)
Q: In what population is sarcoidosis more commonly found?
A: black females
Q: In what population is sarcoidosis more commonly found?
A: black females
Q: In what population is scleroderma more commonly found?
A: 75% female
Q: In what population is scleroderma more commonly found?
A: 75% female
Q: In what population is Sjogren's syndrome more commonly found?
A: females between the ages of 40 & 60
Q: In what population is Sjogren's syndrome more commonly found?
A: females between the ages of 40 & 60
Q: In what population is SLE more commonly found?
A: 90% are female & between ages 14 & 45. More common & severe in black females
Q: In what population is SLE more commonly found?
A: 90% are female & between ages 14 & 45. More common & severe in black females
Q: What are the 2 major categories of scleroderma & what findings are they assoc w/?
A: Diffuse scleroderma: widespread skin involvement, rapid progression, early visceral involvement. Assoc. w/ anti-Scl-70 Ab
Q: CREST syndrome:
A: Calcinosis, Raynaud's phenomenon, Esophageal dysmotility, Sclerodactyly & Telangiectasia; limited skin involvement, often confined to fingers & face. More benign clinical course - assoc w/ anticentromere Ab
Q: What are the 2 major categories of scleroderma & what findings are they assoc w/?
A: Diffuse scleroderma: widespread skin involvement, rapid progression, early visceral involvement. Assoc. w/ anti-Scl-70 Ab
Q: CREST syndrome:
A: Calcinosis, Raynaud's phenomenon, Esophageal dysmotility, Sclerodactyly & Telangiectasia; limited skin involvement, often confined to fingers & face. More benign clinical course - assoc w/ anticentromere Ab
Q: What are the associated sx's & risks for Sjogren's syndrome?
A: - Parotid enlargement
A: - incr risk of B-cell lymphoma
A: - Assoc. w/ RA
Q: What are the associated sx's & risks for Sjogren's syndrome?
A: - Parotid enlargement
A: - incr risk of B-cell lymphoma
A: - Assoc. w/ RA
Q: What are the characteristic findings in Celiac sprue?
A: Blunting of villi, lymphocytes in the lamina propria, & abnormal D-xylose test
Q: What are the characteristic findings in Celiac sprue?
A: Blunting of villi, lymphocytes in the lamina propria, & abnormal D-xylose test
Q: What are the common characteristics of Sarcoidosis?
A: immune-mediated, widespread noncaseating granulomas & elevated serum ACE levels
Q: What are the common characteristics of Sarcoidosis?
A: immune-mediated, widespread noncaseating granulomas & elevated serum ACE levels
Q: What are the common gross findings in Goodpasture's syndrome?
A: pulmonary hemorrhages, renal lesions, hemoptysis, hematuria, crescentic glomerulonephritis
Q: What are the common gross findings in Goodpasture's syndrome?
A: pulmonary hemorrhages, renal lesions, hemoptysis, hematuria, crescentic glomerulonephritis
Q: What can cause gout?
A: Lesch-Nyan disease, PRPP excess, decreased excretion of uric acid, or G6PD deficiency. Also assoc. w/ the use of thiazide diuretics which competitively ingibit the secretion of uric acid.
Q: What can cause gout?
A: Lesch-Nyan disease, PRPP excess, decreased excretion of uric acid, or G6PD deficiency. Also assoc. w/ the use of thiazide diuretics which competitively ingibit the secretion of uric acid.
Q: What causes pseudogout?
A: deposition of calcium pyrophosphate crystals w/in the joint space
Q: What causes pseudogout?
A: deposition of calcium pyrophosphate crystals w/in the joint space
Q: What CV disease state can be caused by SLE?
A: SLE causes LSE (Libman-Sacks Endocarditis): vavular vegetations found on both sides of valve (mitral valve stenosis) & do not embolize
Q: What CV disease state can be caused by SLE?
A: SLE causes LSE (Libman-Sacks Endocarditis): vavular vegetations found on both sides of valve (mitral valve stenosis) & do not embolize
Q: What drugs can induce a commonly reversible SLE-like syndrome?
A: - procainamide
A: - INH
A: - phenytoin
A: - hydralazine
Q: What drugs can induce a commonly reversible SLE-like syndrome?
A: - procainamide
A: - INH
A: - phenytoin
A: - hydralazine
Q: What immune marker aids in dx?
A: 90% of cases are assoc w/ B27 (gene which codes for HLA MHC-I)
Q: What immune marker aids in dx?
A: 90% of cases are assoc w/ B27 (gene which codes for HLA MHC-I)
Q: What is characteristic about gout crystals?
A: needle-shaped & negatively berefringent.
Q: What is characteristic about gout crystals?
A: needle-shaped & negatively berefringent.
Q: What is characteristic about pseudogout crystals?
A: basophilic, rhomboid crystals
Q: What is characteristic about pseudogout crystals?
A: basophilic, rhomboid crystals
Q: What is Reiter's syndrome?
A: a seronegative spondyloarthropath w/ a HLA-B27 link
Q: What is Reiter's syndrome?
A: a seronegative spondyloarthropath w/ a HLA-B27 link
Q: What is the 'classic triad' for Reiter's syndrome?
A: 1. Urethritis (Can't pee)
A: 2. Conjunctivities & ant. uveitis (Can't see)
A: 3. Arthritis (Can't climb a tree)
Q: What is the 'classic triad' for Reiter's syndrome?
A: 1. Urethritis (Can't pee)
A: 2. Conjunctivities & ant. uveitis (Can't see)
A: 3. Arthritis (Can't climb a tree)
Q: What is the 'classic triad' for Sjogren's syndrome?
A: 1. dry eyes (conjunctivitis, xerophthalmia)
A: 2. dry mouth (dysphagia, xerostomia)
A: 3. arthritis
Q: What is the 'classic triad' for Sjogren's syndrome?
A: 1. dry eyes (conjunctivitis, xerophthalmia)
A: 2. dry mouth (dysphagia, xerostomia)
A: 3. arthritis
Q: What is the classic pathology for Osteoarthritis?
A: Mechanical: wear & tear of joints leads to destruction of articular cartilage, subchondral bone formation, sclerosis, osteophytes, eburnation, & Heberden's nodes (DIP)
Q: What is the classic pathology for Osteoarthritis?
A: Mechanical: wear & tear of joints leads to destruction of articular cartilage, subchondral bone formation, sclerosis, osteophytes, eburnation, & Heberden's nodes (DIP)
Q: What is the classic pathology for Rheumatoid arthritis?
A: Autoimmune: inflammatory d/o affecting synovial joints, w/ pannus formation in joints (MCP, PIP), subcutaneous rheumatoid nodules, ulnar deviation, subluxation.
Q: What is the classic pathology for Rheumatoid arthritis?
A: Autoimmune: inflammatory d/o affecting synovial joints, w/ pannus formation in joints (MCP, PIP), subcutaneous rheumatoid nodules, ulnar deviation, subluxation.
Q: What is the Classic presentation for Osteoarthritis?
A: pain in weight-bearing joints after use (e.g.- at the end of the day), improving w/ rest. No systemic sx's
Q: What is the Classic presentation for Osteoarthritis?
A: pain in weight-bearing joints after use (e.g.- at the end of the day), improving w/ rest. No systemic sx's
Q: What is the classic presentation for Rheumatoid arthritis?
A: morning stiffness improving w/ use, symmetric joint involvement & systemic symptoms: fever, fatigue, pleuritis, pericarditis
Q: What is the classic presentation for Rheumatoid arthritis?
A: morning stiffness improving w/ use, symmetric joint involvement & systemic symptoms: fever, fatigue, pleuritis, pericarditis
Q: What is the common immunologic finding for Goodpasture's syndrome?
A: Anti-glomerular basement membrane antibodies produce linear staining on immunofluorescence
Q: What is the common immunologic finding for Goodpasture's syndrome?
A: Anti-glomerular basement membrane antibodies produce linear staining on immunofluorescence
Q: What is the common tx for gout?
A: allopurinol, probenecid, colchicine, & NSAID's.
Q: What is the common tx for gout?
A: allopurinol, probenecid, colchicine, & NSAID's.
Q: What is the common tx for pseudogout?
A: no tx
Q: What is the common tx for pseudogout?
A: no tx
Q: What is the descriptive acrynym for Sarcoidosis?
A: GRAIN
A: Gammaglobulinemia
A: Rheumatoid arthritis
A: ACE incr.
A: Interstitial fibrosis
A: Noncaseating granulomas
Q: What is the descriptive acrynym for Sarcoidosis?
A: GRAIN
A: Gammaglobulinemia
A: Rheumatoid arthritis
A: ACE incr.
A: Interstitial fibrosis
A: Noncaseating granulomas
Q: What is the useful memory tool for Goodpasture's syndrome?
A: there are TWO Good Pastures for this disea
)