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Neuro 1 Midterm > Pathology > Flashcards

Pathology Flashcards

1
Q

Inflammation of the brain parenchyma:

A

Encephalitis

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2
Q
  • Clinical term used to describe global brain dysfunction
  • May or may not be infectious in origin
  • Symptoms vary
A

Encephalopathy

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3
Q

Infection of the subarachnoid space and leptomeninges (pia mater and arachnoid)

A

Meningitis

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4
Q
  • Bacterial infection of the cerebrum

- Most often leads to a brain abscess

A

Cerebritis

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5
Q
  • Combination of meningitis and encephalitis
  • when of infectious origin, most often due to a viral infection
  • Cellular infiltrate composed of lymphocytes
A

Meningoencephalitis

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6
Q

Lumbar puncture is of greatest value in the diagnosis of:

A

CNS infections

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7
Q

TORCH:

A 
Toxoplasmosis
Other (includes syphilis, enterovirus, varicella-zoster, parvo B19, and "others")
Rubella
Cytomegalovirus
Herpes simplex I & II
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8
Q

Toxoplasma gondii is a protozoan responsible for cases of severe brain damage before birth. Along with CMV, it is likely to produce:

A

Calcifications in the fetal brain

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9
Q
  • Microcephaly
  • Heart disease
  • Petechiae and purpura
  • Eye anomalies
A

Rubella

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10
Q
  • LM: Eosinophilic owl-eye appearance of the nucleus
  • loss of brain substance and calcium deposits
  • usually transmitted by kissing
A

CMV (Human Herpesvirus-5)

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11
Q
  • Headache and neck stiffness, often assoc with fever, confusion or altered consciousness, vomiting, and inability to tolerate light (photophobia) or loud noises (phonophobia).
  • Children often exhibit irritability and drowsiness.
A

Meningitis

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12
Q

Meningitis caused by meningococcal bacteria (Neisseria meningitidis) may be accompanied by: (2)

A
  • Petechiae and purpura

- Adrenal collapse (“Waterhouse-Friderichsen”)

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13
Q
  • Vomiting
  • Severe generalized headache
  • Motor/sensory deficits
  • Nuchal rigidity
  • Seizures
A

Intracranial bleed

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14
Q
  • Kernig’s sign
  • Brudzinski’s sign
  • Nuchal rigidity
  • Headache pain intensified by movements of the head
A

Meningeal irritation

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15
Q
  • Thick layer of suppurative cream-to-yellow colored exudate which surrounds the brain
  • Neutrophils fill the subarachnoid space and surround vessels in the Virchow-Robin space
A

Bacterial infection

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16
Q

Type of infection that causes opacity and thickening of the leptomeninges

A

Fungal infection

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17
Q
  • Often self-limited
  • May see thickening of the meninges with slight opacification
  • Lymphocytes in a perivascular arrangement
  • Necrosis and microglials (typhi) nodules also commonly seen
A

Viral infection

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18
Q
  • Fever
  • Cephalalgia
  • Nausea
  • Vomiting
  • Lethargy, esp with acute onset and nuchal rigidity
  • Kernig’s/Brudzinski’s signs
A

CNS infection

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19
Q

Bacterial meningitis in neonates: (4)

A
  • Streptococcus agalactiae (group B)
  • E. coli
  • Proteus mirabilis
  • Listeria monocytogenes
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20
Q

Bacterial meningitis in older children: Community acquired. (3)

A
  • Neisseria meningitidis
  • Haemophilus influenzae
  • Streptococcus pneumoniae
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21
Q

Bacterial meningitis in teens and young adults: (1)

A

Neisseria meningitidis

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22
Q

Bacterial meningitis in older adults and alcoholics: (1)

A

Streptococcus pneumoniae

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23
Q

Bacterial meningitis in the immunocompromised and hospitalized pts:

A

Any bacterium.

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24
Q
  • “Perivascular cuffs” (lymphocytes around blood vessels)

- Seen in autoimmunity and in leukemia/lymphoma

A

Viral encephalitis

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25
Q

Microglial (“typhus”) nodule (group of activated macrophages) is distinctive of:

A

Viral or rickettsial encephalitis

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26
Q
  • Causes a necrotizing encephalitis
  • Cowdry type “A” nuclear inclusion
  • PCR = method of choice for detection in CSF samples
A

Herpes simplex I

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27
Q

Generally the temporal lobes are damaged the most severely in:

A

Herpes simplex encephalitis

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28
Q
  • Cause of shingles, recurrent chickenpox, and pain along a dermatome
  • Few lymphocytes in the involved sensory ganglion, but not impressive
A

Varicella-Zoster Virus (“Herpes Zoster”)

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29
Q
  • Seen in severely immunocompromised pts (AIDS, IVDA, etc.)

- Involves the large areas of white matter

A

CMV encephalitis

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30
Q

Brown stain is an immunostain for:

A

West Nile Virus

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31
Q

An acute viral infectious disease caused by a virus that infects cells through their CD155 receptors:

A

Poliomyelitis

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32
Q

LM: Negri bodies (pink-staining round-to-oval cytoplasmic inclusions)

A

Rabies

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33
Q

Multinucleated giant cells form from the fusion of microglia/macrophages in:

A

HIV encephalitis

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34
Q
  • Immunocompromised pts
  • Infectious agent = JC papovavirus
  • Causes patchy loss of oligodendroglia (and thus of myelin) mostly under cortex
  • Viral inclusions in the nuclei of oligodendroglia at the edges
  • Giant astrocyte nuclei
  • Pts often have intractable seizures
A

TQ: Progressive multifocal leukoencephalopathy (PML)

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35
Q
  • Slow version of measles
  • Produces widespread destruction of the entire brain
  • Intra-nuclear measles-type inclusion bodies
A

Subacute sclerosing panencephalitis

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36
Q

Location of TB meningitis:

A

Base of the brain (where it thrives on the high oxygen levels provided by the circle of Willis)

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37
Q
  • Most clinically relevant fungi to cause meningoencephalitis
  • Immunocompromised pts
  • Little inflammation (the fungi follow vessels into the brain - hematogenous spread)
  • Narrow-based buds on India ink
A

Cryptococcus

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38
Q

Cryptococcus is often acquired from exposure to:

A

Pigeons

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39
Q
  • Loss of neurons
  • Activated microglia appearing as “rod cells”
  • Dementia
A

General paresis … due to syphilis infection (Treponema pallidum)

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40
Q
  • Loss of myelin on posterior columns
  • Pain syndrome
  • Loss of proprioception
A

Tabes dorsalis … due to syphilis infection (Treponema pallidum)

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41
Q
  • Plasma cell vasculitis
  • Primarily involves meninges
  • Sever chronic headache
A

Meningovascular syphilis … due to syphilis infection (Treponema pallidum)

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42
Q
  • Intracerebral masses
  • Necrosis
  • Abundant plasma cells
A

Gummas … due to syphilis infection (Treponema pallidum)

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43
Q
  • “The contact lens amoeba”

- Can produce a chronic granulomatous meningoencephalitis

A

Acanthamoeba

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44
Q

Eating raw burgers and handling three-day-old soiled kitty litter places a susceptible person at risk for acquiring:

A

Toxoplasmosis

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45
Q
  • Produces “cerebral malaria”

- Caused by vascular occlusion by altered “sticky” RBCs

A

Plasmodium falciparum

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46
Q

Location of pus around the base of a child’s brain suggests:

A

Haemophilus influenzae

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47
Q

“Spongiform change” typical of:

A

Prion disease

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48
Q

4 tubes for CSF collection:

A
  1. Chemistry and immunology, syphilis test
  2. Microbiology
  3. Hematology
  4. Optional
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49
Q

Which trisomy is often present in a “cyclops” baby, with one eye located in the center?

A

Trisomy 13

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50
Q

Proptosis:

A

The eye protrudes

  • e.g., Graves’ disease: the contents of the orbit are enlarged due to the same Abs that cause thyroid disease (likely bilateral)
  • muscles swell and push the eye forward
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51
Q

Other causes of proptosis:

A
  • Sarcoidosis
  • Tumors (likely unilateral - differentiation from Graves’)
  • Fibrosis assoc with IgG4 disease
  • Wegener’s
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52
Q

Hordoleum/”sty”:

A

Bacterial infection of an eyelash and its sebaceous glands

  • Presents on outer surface of the eyelid as a lump that may resemble a boil or pimple
  • Usually red and painful
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53
Q

Chalazion results from:

A

Blockage of the meibomian (sebaceous) glands in the eyelid and the subsequent inflammation

  • Subacute
  • Usually painless
  • Granulomas on histo
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54
Q
  • Ulcerated lesions on the face or extremity, usually in hair-bearing skin
  • Rarely metastasize
  • Appear on the lower eyelids and at the medial canthus
  • Histo: Basaloid cells, increased mitoses and apoptotic figures
A

Basal cell carcinoma

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55
Q

Keratin pearls. You think…

A

Squamous cell carcinoma

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56
Q
  • Inflammation of the conjunctiva
  • Red to pink discoloration
  • Watering of the eyes
  • Caused by any irritation disease process
A

Conjunctivitis

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57
Q

Adding chlorine or bromine to swimming pools is most helpful in preventing:

A

Gonococcal and chlamydial eye infections

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58
Q
  • Produces pus

- Now prevented by administering eye drops to newborns

A

Bacterial (Gonococcal and chlamydial) conjunctivitis

59
Q

-Can produce large lymphoid follices

A

Viral and chlamydial conjunctivitis

60
Q
  • In the spring due to pollen

- Abundant eosinophils

A

Allergic conjunctivitis

61
Q
  • Etiologic agent = Chlamydia trachomatis

- Swollen eyelids, often with discharge and lymphadenopathy most prominent in front of ears

A

Trachoma

62
Q

What has proved very helpful in managing trachoma in the developing world?

A
  • Antibiotic eye ointment for everybody once/year or so
  • Building latrines
  • Fly control
  • Vitamin A supplementation
63
Q
  • Ex. 1: Hyperplasia of lymphoid follices
  • Ex. 2: Entropion produced by scar contracting on the inner eyelid surfaces
  • Ex. 3: Scar covering cornea causing blindness
A

Trachoma manifestations

64
Q
  • Yellow-white (lipid) deposition of the conjunctiva adjacent to the limbus
  • Causative agents: UV, wind, sun, sand
  • Due to degeneration of collagen
A

Pinguecula

65
Q
  • Wedge-shaped area of fibrosis that appears to grow into the cornea
  • Causative agents: UV, wind, sun, sand
  • Due to degeneration of collagen
A

Pterygium

66
Q

May occur from calcification of the cornea in pts with hypercalcemia:

A

Band keratopathy

67
Q

What do GNAQ and GNA11 encode?

A

G protein-coupled receptors that cause a gain-in-function mutation (BOARDS)

68
Q
  • Night-blindness
  • Xerophthalmia (dry eyes)
  • Keratomalacia
  • Bitot’s spots
A

Vitamin A deficiency

69
Q
  • Hematogenous spread
  • Elevated lesion
  • Aggressive cancer
A

Conjunctival melanoma

70
Q
  • Viral infection of the eye caused by herpes simplex virus
  • Tzanck smear (stain with Giemsa) shows:
  • Gold standard for dx viral infections:
A
  • Herpes keratitis
  • Tzanck smear (stain with Giemsa) shows multinucleated epithelial cells
  • Gold standard = Viral cultures
71
Q

MC cause of blindness due to corneal disease in developed nations:

A

Herpes keratitis

72
Q

Fluorescein reveals the _______ _____ in herpes keratitis.

A

dendiritic ulcer

73
Q
  • A rare cause of corneal dz characterized by pain, redness, excess tearing, sensitivity to light
  • Assoc with prolonged contact lens use or improper cleaning of contact lenses
  • Free-living organism found in soil, water, and esp in hot tubs
A

Acanthamoeba keratitis

74
Q
  • River blindness
  • Caused by a nematode that infects the eyes
  • Carried by flies and affects entire communities in Africa
A

Onchocerciasis

75
Q

The eye worm…

A

Loa Loa

76
Q
  • Abnormally-shaped cornea
  • May be asymptomatic or serious problem is eyelids don’t close
  • Histo: Separation of corneal epithelium from underlying membrane
A

Keratoconus

77
Q
  • Causes a very mild opacification of the cornea
  • Thickening of Descemet’s membrane
  • “Droplet” formation on its inner aspect
A

Fuchs’ dystrophy

78
Q

Ectopia lentis in:

A

Marfan’s

79
Q
  • Develop as a result of progressive clouding of the lens
  • Usually age-related change, but may be due to medications/drugs (famously glucocorticoids), radiation, injury, disease/galactosemia (sugars) or other dz process
A

Cataracts

80
Q
  • Multifactorial dz process
  • Increased intraocular pressure over time due to nerve damage, optic neuropathy
  • 2 main categories: open-angle and closed-angle
A

Glaucoma

81
Q

Pus in the anterior chamber of the eye

A

Hypopyon

82
Q

Blood in the anterior chamber of the eye

A

Hyphemia

83
Q
  • Congenital dz - inheritance of recessive gene alleles
  • Often absent or defective tyrosinase
  • Lack of pigment in the choroid seriously interferes with vision
A

Albinism

84
Q
  • WT1 deletion

- Risk of Wilms’ tumor

A

Aniridia

85
Q
  • Inflammation of the uvea
  • Can be produced by JVA, Crohn’s/UC, sarcoidosis, reactive arthritis, and Behcet’s
  • Close examination reveals abnormal iris
A

Uveitis

86
Q
  • An autoimmune, delayed hypersensitivity inflammatory response durected toward ocular Ags (specifically to melanin-containing structures)
  • Result of traumatic injury
A

Sympathetic ophthalmia

87
Q

Keyhole-like midline defect in the pupil:

A

Coloboma

88
Q
  • Iris hamartomas

- Think neurofibromatosis

A

Lisch nodules

89
Q

-Cause of anisochromia

A

Wartenburg’s

90
Q
  • Neoplastic condition arising from malignant melanocytes
  • Dark pigment on back of retina
  • Famously metastasizes to liver
  • Often fatal
  • Histo: Brown pigment in cytoplasm, big nuclei, invading blood vessels
A

Uveal melanoma

91
Q

Excess firmness and thickening of the walls of little arteries producing narrowings, crossing defects/AV nicks, copper wires asilver wires visible on the retina suggest what underlying illness?

A

High blood pressure

92
Q

In a hypertensive “flame hemorrhage,” where is the blood?

A

Nerve layer of the retina

93
Q
  • Due to HTN

- Affects arterioles and small arteries by inducing hypertrophy/hyalinization of the tunica media

A

Hypertensive arteriopathy

94
Q

The “cherry red spot” seen on the macula suggests:

A

Storage disease

95
Q
  • Deficiency of hexosaminidase A, resulting in fatty molecules called ganglioside accumulating around the nerves
  • “Cherry red spot”
A

Tay-Sachs

96
Q

Which is the MC cause of blindness in the developed world?

A

Macular degeneration

97
Q

-New vessels between the retinal pigment epithelium and Bruch’s membrane (retina and choroid), resulting in separation of the choroid from the retina and blindness

A

“Wet” macular degeneration

98
Q
  • Most important cause of serious vision loss in the developed world
  • Caused by Drusen
A

“Dry” macular degeneration

99
Q
  • Degenerative eye dz that affects the photoreceptors and retinal pigment epithelium of the eye
  • Most often affect peripheral vision and night vision
A

Retinitis pigmentosa

100
Q

Which tumor suppressor gene is defective in the germline in retinoblastoma families?

A

Rb

101
Q
  • White to cream-colored tumor with chalky flecks and focal areas of yellow discoloration
  • Histo: Composed of small round blue cells with moderate amounts of cytoplasm, characteristically form Flexner-Wintersteiner rosettes and tumor cells align around blood vessels
A

Retinoblastoma

102
Q

Optic nerve glioma - think:

A

Neurofibromatosis type I

103
Q

-Ear deformity that is much-prized by fighters and rugby players

A

Perichondral hematoma

causes Cauliflower ear

104
Q
  • Round raised nodule on the external ear, with central crater filled with necrotic material
  • Inflammatory lesion result of squamous epith hyperplasia, necrobiotic collagen (fibroblasts are dead), and alterations/degeneration of underlying cartilaginous plate
A

Chondrodermatitis

differentiated from squamous cell CA and actinic keratosis

105
Q
  • Caused by T-cell attacks on cartilage
  • Migratory/transient dz
  • Sparing of the ear lobe
A

Relapsing polychondritis

106
Q

Black cartilage:

A

Ochronosis/alkaptonuria

107
Q

The pinna may calcify:

A

Addison’s

108
Q

Tophi (uric acid granulomas) are common in the pinna b/c uric acid crystallizes in the cold

A

Gout

109
Q
  • Due to long-term sun exposure

- Locally aggressive and rarely metastasizes

A

Basal cell CA

110
Q
  • Due to long-term sun exposure

- Precursor = actinic keratosis

A

Squamous cell CA of the ear

111
Q

Painful manipulation of the external ear suggests:

When Pseudomonas is causative agent, it’s termed:

A
  • Otitis externa

- Malignant otitis externa

112
Q

Infected hairs (due to _____) can be very painful

A

Staph

113
Q
  • Infected wet keratin

- Often caused by Pseudomonas or less often staph or strep, sometimes candida

A

Swimmer’s ear

114
Q

Pain in the ear canal often caused by zoster (Ramsey-Hunt) is assoc with:

A

Bell’s palsy

115
Q
  • MC lesion of the ear

- Failure of eustachian tube to drain

A

Otitis media

116
Q

Pain in the ear from pressure changes:

A

Aerotitis media

117
Q

Fluid in ear without infection:

A

Acute catarrhal otitis media

118
Q

Scar without infection after previous bacterial otitis media:

A

Chronic catarrhal otitis media

119
Q
  • A poorly understood syndrome of blisters on the external surface of the tympanic membrane
  • Painful
A

Bullous myringitis

120
Q
  • Seen with upper respiratory infections

- Moderately painful

A

Viral otitis media

121
Q
  • Most important causes of earache

- Red, bulging tympanic membrane

A

Acute bacterial otitis media

122
Q
  • Inherited dz
  • MC form of hearing loss in young adults
  • Abnormal dense bone in the middle ear, esp where stapes meets cochlea
A

Otosclerosis

123
Q
  • A form of hearing loss that is progressive with age
  • Results in equal loss in both ears - higher pitches lost first
  • Primarily due to inner ear damage
A

Presbycusis

124
Q
  • Most distinctive ear tumor
  • Very vascular
  • Pt can often hear their rumble before detected clinically
A

Glomus jugulare tumor

paraganglioma

125
Q
  • A subtype of dizziness that is central or peripheral in cause
  • Sx: imbalance, N/V, hearing loss, tinnitus, pain or plugged feelings in ears
A

Vertigo

126
Q
  • Dz characterized by aural fullness and ear pressure
  • Add’l sx: imbalance, tinnitus, hearing loss, N/V
  • Onset may be sudden
A

Meniere’s dz

127
Q
  • Common cause of severe vertigo
  • Assoc with N/V and lack of balance
  • Follows nonspecific viral infection and can do permanent damage
A 
Vestibular neuronitis
('labyrinthitis")
128
Q
  • Episodic disorder of sudden rapid head movement
  • Causes intense vertigo with visible positional nystagmus lasting < 1 min
  • Sx decrease with repeated motion
A

Barany’s benign positional vertigo

129
Q

Delta-aminolevulinic acid and porphobilinogen are:

A

Neurotoxins

130
Q

The heme ring intermediaries are:

A

Photosensitizers

131
Q

Porphobilinogen deaminase deficiency

-Screen urinary porphobilinogen

A

Acute intermittent porphyria

132
Q

Uroporphyrinogen III decarboxylase deficiency

-Screen urinary uroporphyrin

A

Porphyria cutanea tarda
(skin porphyria)
-Measure total plasma porphyrins

133
Q

Protoporphyrinogen III oxidase deficiency

-Screen urinary porphobilinogen

A

Variegate porphyria

134
Q

Ferrochelatase deficiency

-Screen erythrocyte protoporphyrin

A

Erythropoietic protoporphyria

135
Q

Acute attacks:
-Mysterious abdominal pain
-N/V, constipation
-“Mental illness”
-Maybe low serum sodium (“inappropriate ADH”)
-Maybe pain and weakness between attacks (peripheral neuropathy)
Caused by toxicity from porphobilinogen (Dx by finding in urine)

A

Acute intermittent porphyria
r/o Variegate porphyria
r/o Hereditary coproporphyria

136
Q 
Erosive photosensitivity:
-Blisters
-Fragile skin
-Extra hair
Caused by "soret band" UV photons
A

Porphyria cutanea tarda
r/o Variegate porphyria
r/o Hereditary coproporphyria

137
Q

Acute painful photosensitivity:
-“My skin feels like it’s on fire after I have been out in the sunlight for just a few minutes”
Caused by sunlight reacting with protoporphyrin IX in the skin

A

Erythropoietic protoporphyria

138
Q

Child can have jaundice and/or hemolysis and/or skin blisters and/or severe neuro signs

A

Neonatal porphyria

139
Q

On exposure to light, porphobilinogen turns:

A

Purple

140
Q

Subepidermal blister formation with preservation of the shape of the dermal papillae:

A

Variegate / Cutanea Tarda

141
Q

Intensely PAS(+) material deposited thickly around the blood vessels:

A

Erythropoietic protoporphyria

142
Q

Birefringent crystals deposit in the liver in:

A

Erythropoietic protoporphyria

143
Q

-You MIGHT spot uroporphyrin needles in the liver

A

Porphyria cutanea tarda

144
Q

May present with:

  • Erythrodontia
  • Photo mutilation
A

Congenital erythropoietic porphyria

Neuro 1 Midterm (5 decks)

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