Pathology

Question 1

What disease has proximal muscle weakness particularly of the limbs and is improved by Edrophonium

Answer 1

Lambert-Eaton myasthenic syndrome (LEMS)

Question 2

What other pathology is Lambert-Eaton myasthenic syndrome (LEMS) a/w?

Answer 2

Small cell lung cancer (paraneoplastic syndrome)

Question 3

what is the etiology of Lambert-Eaton myasthenic syndrome?

Answer 3

Autoantibodies are generated against presynaptic voltage-gated calcium channels

Question 4

Identify the disease:
African American
elevated ACE, CRP
Hypercalcemia
bilateral hilar lymphadenopathy
cough, dyspnea, chest pain

Answer 4

Sarcoidosis - noncaseating granulomas

Question 5

How does HCV and HBV differ in their pathogenesis of HCC?

Answer 5

HBV - DNA virus that integrates into genome

HCV - RNA virus, lacks reverse transcriptase and doesnt integrate into the genome

Question 6

What is the etiology of SLE?

Answer 6

loss of self tolerance = increased autoantibodies
increased immunce complex deposition in tissue
increased complement activation
= decreased complement factors

Question 7

Alpha fetoprotein is a serum tumor marker for which two tumors?

Answer 7

Hepatocellular Carcinoma

Germ cell tumors

Question 8

What is a common comobidity a/w Giant Cell Arteritis?

Answer 8

Polymyalgia Rheumatica - stiffness or pain in large proximal muscles

Question 9

Cytokeratin is a immunohistochemical marker for tumors derived what what time type of cell lineage?

Answer 9

Epithelial (ie breast cancer)

Question 10

What enzyme facilitates basement membrane penetration for invasive tumors

Answer 10

metalloproteinases - zine containing enzyme that degrade components of extracellular membrane

Question 11

Bitemporal Hemianopsia is most commonly caused by what in:

1. children
2. adults

Answer 11

1. Craniopharyngioma

2. Pituitary adenoma

Question 12

Small bluish lesion under fingernail
lesion is tender to touch
if lesion is a tumor what is the cell of origin?

Answer 12

Could be a Glomus tumor or Melanoma

• -melanoma - melanocyte
• -glomus tumor - glomus body (modified smooth muscle cells for thermoregulation (direct blood away from surface)

Question 13

5 year old female brought to ED for lethargy
over past couple days: more lethargic, vomiting
Hx: barking cough, fever, started on meds
Labs: ALT:200 U/L, elevated ammonia

what med is the cause?
what would liver biopsy reveal?

Answer 13

Aspirin

Reye syndrome - happens when aspirin is given to child with an active viral infection
–encephalopathy and signs of acute liver failure

bx: REVERSIBLE fatty changes

Question 14

What pathology is Myasthenia gravis associated with?

Answer 14

Thymoma - anterior mediastinal mass

Question 15

45 year old female presents with chest pain (2 days, intermittent, left side)
Jaundice, fever, pallor, tachycardia, hepatosplenomegaly
Coombs test positive
anemia, increase serum LDH, decreased haptoglobin

what is this disease and what is the most common other dz it commonly develops secondary to?

Answer 15

Autoimmune hemolytic anemia(AHA)

–can develop secondary to CLL, SLE, CVID

Question 16

autopsy of 78 year old male reveals a small heart without significant coronary artery atherosclerosis. Myocardial cells show prominent intracytoplasmic granules that are tinged yellowish-brown

what is the cause?

Answer 16

Lipofuscin = sign of “wear and tear” and aging

–insoluble pigment consisting of lipid polymers, and protein-complexed phospholipids (lipid peroxidation)

Question 17

In what circumstances is alkaline phosphatase increased?

Answer 17

increased in Cholestasis (eg biliary obstruction)
infiltrative disorders
bone disease

Question 18

Is prothrombin increased or decreased in advanced liver disease?

Answer 18

increased (decreased production of clotting factors)

Question 19

What is the most
1. common
2. lethal
cancer in men?

Answer 19

1. Prostate

2. Lung

Question 20

19 year old male presents with numbness and tingling in his lower extremities and loss of balance. Fam hx: Grandmother with T2 DM, Grandfather who died suddenly of an arrhythmia when playing bbal at 21.

Identify dz, and physical exam findings?

Answer 20

Friedreich ataxia - marked ventricular septal hypertrophy (HOCM)

• DM
• autosomal dominant

Question 21

What is the most appropriate initial step in the management of a patient with Guillain-Barre Syndome?

Answer 21

Respiratory support

Question 22

What are CSF findings of Multiple Sclerosis (autoimmune disease that causes demyelination of the CNS)?

Answer 22

Oligoclonal bands, IgG

Question 23

What is the most appropriate intervention for Guillain-Barre syndrome?

Answer 23

Plasmapheresis

–BS is an autoimmune dz