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Pathology 2nd Sem Prelim > CNS Part 2 > Flashcards

CNS Part 2 Flashcards

1
Q

Rupture of a blood vessel can produce a bleeding type of a stroke. This is when an aneurysm, or an out-pouching, of a blood vessel in the brain ruptures

A

Cerebral hemorrhage

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2
Q

denotes an inflammatory process that is localized to the interfacing surfaces of the pia and arachnoid –CSF – excellent culture medium for most microorganisms

A

Leptomeningitis

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3
Q

Inflammation of the dura, a consequence of contiguous infection: Chronic sinusitis / Mastoiditis –Dura – substantial barrier to infection & inflammation is usually restricted to the outer surface

A

Panchymeningitis

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4
Q

Bacterial menigitis

Purulent meningitis (suppurative meningitis) is a type of meningitis characterized by a purulent exudate within the subarachnoid space •Most definitive index of meningitis - PMNs

A

SUPPURATIVE MENINGITIS

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5
Q

Suppurative menigitis

prime cause in NBs –Cross-placental transfer: requires IgM

A

E. Coli

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6
Q

Suppurative menigitis

Maximal in 3mos - 3 yrs

A

H. Influenza

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7
Q

Suppurative menigitis

Pts with basilar skull fracture
2nd most frequent cause of purulent menigitis

A

Strep pneumoniae

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8
Q

Suppurative menigitis

Frequents the nasopharynx

A

Neisseria meningitides

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9
Q

Severe infection, almost always caused by bacterial infection •Highest peak in Children ; 2nd peak in elderly

A

Acute suppurative meningitis

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10
Q

Neonate and children

A

Group B Strep, E. coli, Listeria

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11
Q

Older infant, children, young adults

A

Strep. Pneumonia,

N. meningitidis

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12
Q

Older adults

A

S. pneumoniae, gm – rods

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13
Q

> 2 months

A

H. Influenzae

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14
Q
A

Group B strep
E. Coli
L. Monocytogenes

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15
Q

Suppurative meningitis

Pathogenesis

Hematogenous dissemination (most common)

A

From bacteremia

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16
Q

Suppurative meningitis

Pathogenesis

Near organ infected

A

Sinusitis
Otitis media
Mastoiditis
Brain trauma

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17
Q

Suppurative meningitis

Pathogenesis

From congenital developmental malformation

A

Spinal Menigocele,
Paranasal sinuses leak
Sinus tract

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18
Q

Suppurative meningitis

Pathogenesis

Cerebral surgery and lumbar puncture

A

Latrogenic

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19
Q

Usually self limiting caused by viral infection

A

Lymphocytic meningitis

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20
Q

Lymphocytic meningitis

Viral

Clear CSF

A

Normal glucose
Moderately increased protein
Increase in lymphocytes

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21
Q

Progressive multifocal leukoencephalopathy

A

Oligodendrogilia

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22
Q

Cytomegalovirus

A

Neuron or

Astrocytes

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23
Q

Rabies

Panenecephalitis

A

Neuron

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24
Q

Inhalation of contaminated particulates
•Birds excreta – inhaled- pneumonitis – bloodstream – intracranial compartment
•Gelatinous cysts – brain parenchyma

A

Cryptococcal meningitis

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25
Q

Naegleria & Acanthamoeba – olfactory nerves to cribriform plate – intracranial compartment after swimming

A

Amoebic meningoencephalitis

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26
Q

Treponema pallidum - enters the bloodstream from the primary chancre

A

Syphilitic meningitis

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27
Q

CSF profile

Bacteria

A

PURULENT
PMNs
LOW GLUCOSE
INCREASED CHON

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28
Q

CSF profile

TB, fungal,

A

LYMPHOCYTIC

LOW GLUCOSE

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29
Q

CSF profile

Viral

A

LYMPHOCYTIC
NORMAL GLUCOSE
MOD. INCREASED CHON

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30
Q

Predominantly involve the cerebrum – Adults

A

Oligodendrogliomas

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31
Q

Highest incidence in the 4th ventricle
–Intramedullary lesion derived from the lining of the spinal canal & filum terminale
–Lowest incidence
– Lateral ventricle

A

Ependymomas

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32
Q

Arise from widely distributed arachnoid villi but with preferred sites of origin

A

Meningiomas

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33
Q

Medial aspect of the hippocampus (uncus) herniates into the aperture of the tentorium
•Interferes with the circultory dynamics of the midbrain & causes a decline in the level of consciousness – result of the impaired function of the reticular formation

A

Transtentorial herniation

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34
Q

TRANSTENTORIAL HERNIATION

Compresses the 3rd nerve against the edge of the tentorium – 3rd nerve palsy

A

Fixed dilated pupil

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35
Q

Cerebellar tonsils herniate into the Foramen magnum due to increase pressure in the posterior fossa
•Compresses the cardiac & respiratory centers
•Death

A

Foramen magnum herniation

36
Q

The cingulate gyrus herniates beneath the falx – results in infarction of areas supplied by the pericallosal vessels&raquo_space; Weakness or sensory loss in the legs

A

Sufalcine herniation

37
Q

A glioma composed of well-differentiated astrocytes •20% of primary intracranial tumors

A

Astrocytomas

38
Q

Aastrocytoma frequent location

Adults

A

Cerebral hemisphere

39
Q

Aastrocytoma frequent location

1st 2 decades of life

A 
Optic nerve
Walls of 3rd ventricle
Midbrain
Pons 
Cerebellum
40
Q

Aastrocytoma frequent location

Young adults

A

Spinal cord

Thoracic and cervical region

41
Q

The pivotal event in the transformation of normal to neoplastic astrocytes is mutation of the tumor supressor gene p53 on 17p. •GFAP immunostain -The protein of these filaments, glial fibrillary acidic protein

A

Fibrillary astrocytoma

42
Q

is the most common histologic subtype of diffuse astrocytoma

A

Fibrillary astrocytoma

43
Q

is the other common subtype, and it has a higher and more rapid rate of progression to glioblastoma

A

Gemistocytic

44
Q

Abundant eosinophilic cytoplasm
•the tumor cells can be stellate, spindle-shaped with fiber like processes, or plump with a large eosinophilic cytoplasmic mass (gemistocytic astrocytomas). They spread in a diffuse fashion but may also form microcysts and other tissue patterns

A

Gemistocytic astrocytoma

45
Q

Occurs in children

•Characterized by abundant hair-like glial processes

A

Juvenile psilocytic astrocytoma

46
Q

Vascular endothelial proliferation •
Densely cellular arrays of tumor cells are often arranged in a perpendicular (pseudopalisading) fashion around serpiginous necrotic areas. It has been proposed that these tumor cells are migrating away from a central hypoxic area.
•is one of the most highly vascular solid tumors

A

Glioblastoma multiforme who grade 4

47
Q

WHO grading system

Pilocytic astrocytoma –Benign cytological features

A

Grade 1

48
Q

WHO grading system

Low-grade astrocytoma –Moderate cellularity-no anaplasia or mitotic activity

A

Grade 2

49
Q

WHO grading system

Anaplastic astrocytoma

A

Grade 3

50
Q

WHO grading system

Glioblastoma –Same as Grade III plus microvascular proliferation and necrosis

A

Grade 4

51
Q

Arise in the cerebral hemispheres of middle-aged adults.

•They are insidious, slow-growing tumors and have a mean survival of five years

A

Oligodendrioglioma

52
Q

are more circumscribed than astrocytomas.
•the tumor cells are uniform and have round central nuclei surrounded by a clear space or halo (unstained cytoplasm) which is an artifact of processing

A

Oligodendrioglioma

53
Q

Some oligodendrogliomas have an astrocytic component. Such mixed tumors are called

A

Oligoastrocytoma

54
Q

Oligodendrogliomas are among the most chemosensitive solid tumors. •They show losses of chromosomes 1p and 19q which correlate with increased sensitivity

A

PVC and temozolomide chemotherapy

55
Q

Predominantly tumors of children and adolescents.
•Arise most frequently in the 4th ventricle and cause hydrocephalus by blocking CSF flow.
•Occur anywhere in relation to the ventricular system or central canal

A

Ependymomas

56
Q

The most common primary intra-axial tumors in the spinal cord and filum terminale.
•Well demarcated from the surrounding brain and spinal cord •Grow in an exophytic fashion, protruding into and out of the fourth ventricle

A

Ependymomas

57
Q

An anaplastic version of ependymoma, called

A

Ependymoblastoma

58
Q

Most ependymomas are histologically and

A

Biologically low grade

59
Q

highly malignant primary brain tumor that originates in the cerebellum (infratentoria) or posterior fossa in the external granular layer of the neurons

A

Medulloblastoma

60
Q

most common PNET originating in the brain

A

Medulloblastoma

61
Q

Another term for medulloblastoma is

A

Infratentorial PNET

62
Q

Second most frequent BT in children after pilocytic astrocytoma

A

Medulloblastoma

63
Q

Most medulloblastomas occur in the

A

1st decade of life

64
Q

which has been applied to medulloblastoma and other “small blue cell tumors” of the brain, reflects the embryonal nature and undifferentiated appearance of these tumors and their potential for neuronal and glial diffferentiation

A

Primitive neuroectodermal tumor

65
Q

Medulloblastoma

are groups of tumor cells arranged in a circle around a fibrillary center

A

Rosettes

66
Q

for recurrent Medulloblastoma

A

Gamma knife radio surgery

67
Q

Intracranial tumor that arise from the arachnoid villi and produce symptoms by compressing adjacent brain tissue

Mesenchymal origin

A

Meningioma

68
Q

Meningioma pathogenesis

A

Arise in one of the 3 settings: 1.Sporadic cases (most common) 2.Iatrogenic cases caused by prior radiation therapy to the cranium 3.In association with a genetic disorder esp neurofibromatosis type 2

69
Q

Meningioma

ransitional meningiomas, tumor cells are arranged in whorls with hyalinized and calcified centers that are called

A

Psammoma bodies

70
Q

composed of fascicles of fiber-like cells with abundant interstitial collagen

A

Fibroblastic meningioma

71
Q

composed of diffuse masses of arachnoidal-like cells

A

Meningothelial hemangioma

72
Q

are relatively infrequent. They display overt histological anaplasia and increased mitoses and invade the brain

A

Malignant meningiomas

73
Q

grow more rapidly and are more prone to recur after surgical resection

A

Atypical meningioma

74
Q

Arise most often in cranial and spinal nerve roots and peripheral nerves but can occur anywhere, including in the brain and in the ventricles

A

Schwannoma

75
Q

Most Schwannomas are solitary. •Bilateral acoustic or multiple Schwannomas are the hallmark of

A

NF2

76
Q

Schwannoma

90% arise in the 8th nerve root

A

Acoustic

77
Q

Peripheral nerve tumors composed of a mixture of Schwann cells and fibroblasts.
•They cause a fusiform enlargement of the nerve in which they arise.
•Microscopically, their cells are loosely arranged in a wavy pattern

A

Neurofibroma

78
Q

composed of sheets of squamous epithelial cells and keratin, set in a loose connective tissue stroma.
•Islands of keratin often calcify.
•Water accumulating in the central portion of the epithelial islands causes them to loosen, creating an appearance that resembles adamantinoma

A

Craniopharnygioma

79
Q

are sporadic or familial.
•The latter are associated with the von Hippel Lindau disease. •Young & middle aged group
•Found in the cerebellum as a mural nodule within a cyst

A

Hemangioblastoma

80
Q

Primary cerebral lymphomas are thought to arise from indigenous brain histiocytes (microglia) or from rare lymphocytes that are normally present in the meninges and around vessels.
•affect immunosuppressed individuals such as patients with AIDS

A

Lymphoma

81
Q

very common, and some cerebral lymphomas arise in the subarachnoid space

A

Meningial spread

B cell

82
Q

The tumor with the highest rate of metastasis is

A

Melanoma

83
Q

seen in 4% to 8% of metastatic BT and is more common with carcinoma of the lung, carcinoma of the breast, and acute lymphoblastic leukemia

A

Meningeal carcinomatosis

84
Q

CSF profile carcinomatosis

A

high protein,
low glucose, and a
few lymphocytes

85
Q

Answer the questions

A

In last 5 pages

86
Q

The most common type of stroke occurs when a blood vessel becomes plugged, and it accounts for about 80% of all strokes

A

Cerebral ischemia

Pathology 2nd Sem Prelim (2 decks)

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