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1
Q

Term: when a tumor results in a meningitis-like picture

A

carcinomatous meningitis

2
Q

What is the gold standard for dx of carcinomatous meningitis

A

detection of tumor cells in CSF

3
Q

Carcinomatous meningitis occurs in ___% of patients with solid cancers.

A

1-5%

4
Q

What are the MC non-hematologic cancers that metastasize to the CNS?

A

lung, breast, melanoma

5
Q

What is the MC organism found in brain abscesses?

A

streptococcus

6
Q

What leads to paretic syphilis?

A

widespread parenchymal invasion by spirochetes

7
Q

What leads to tabes dorsalis?

A

damage to sensory nerves in dorsal roots -> ataxia, loss of pain sensation and proprioception

8
Q

Meningovascular syphilis frequently involves what area of the brain?

A

base of the brain -> CN palsies

9
Q

What is the MC presentation of meningovascular meningitis ?

A

stroke syndrome in a younger adult involving middle cerebral artery or branches of the basilar artery

10
Q

Paretic syphilis occurs ___ after initial exposure to T. pallidum.

A

20-30 years

11
Q

What is the MC symptoms seen in paretic syphilis?

A

personality change

12
Q

Which type of neurosyphilis is characterized by tissue invasion with spirochetes, chronic perivascular and meningeal inflammatory changes and meningeal fibrosis?

A

paretic syphilis

13
Q

Tabes dorsalis involves what areas and what occurs in these areas?

A

posterior columns (demyelination)posterior roots (inflammatory change w/ fibrosis)

14
Q

What is a common pathologic finding in neurosyphilis?

A

gumma

15
Q

Gumma

A

Meningeal granulomassoft, non-cancerous growth from 3˚ stage of syphilis

16
Q

Where can gummas be found?

A

liver MCalso heart, skin, bone, testis

17
Q

What is the name of the febrile reaction that can occur several hours after treatment of early stage syphilis?

A

Jarisch-Herxheimer reaction

18
Q

Progressive multifocal leukoencephalopathy (PML)

A

rare progressive demyelinating disease that results in the loss of oligodendrocytes

19
Q

Gross: PML

A

irregular areas of granularity in the white matter

20
Q

What is a rare complication of measles (rubeola) that can develop 1-20 years after initial measles infection?

A

subacute sclerosing panencephalitis (SSPE)

21
Q

Histology: subacute sclerosing panencephalitis (SSPE)

A

perivascular cuffing patchy demyelinizationgliosiseosinophilic inclusion bodies

22
Q

What is the only change in CSF profile in SSPE?

A

elevation of Rubeola IgG antibody

23
Q

Gross: SSPE

A

white matter hemorrhage and gliosis (both hemispheres and brainstem)

24
Q

Poliomyelitis

A

RNA virus transmitted via oral-fecal route

25
Q

Pathophysiology: poliomyelitis

A

viremia -> virus becomes neurotropic, destroying motor neurons in anterior horn and brainstem -> flaccid paralysis

26
Q

Post-polio syndrome

A

recurrent bouts of muscle weakness that can appear 20-50 years after infection

27
Q

Reye’s syndrome

A

often fatal encephalopathy characterized by fatty infiltration of liver and swelling of kidneys and brain

28
Q

Magnesium ammonium phosphate stones

A

Assoc. w/ UTIs dt urea-splitting bacteria (proteus)Assoc. with increased urine pH (less acidic)Assoc. w/ larger size (staghorn calculi)

29
Q

What is the MC type of renal stone?

A

calcium oxalate 75%triple phosphate 15%uric acid 5-6%cystine 1%

30
Q

What is the MC cz of hypothyroidism in the world?

A

iodine deficinecy

31
Q

MC sites for METS to the pituitary

A

Breast CALung CAProstate CA

32
Q

Histology: craniopharyngiomas

A

oil-filled cysts, which mb seen grosslylamellations of “wet” keratin

33
Q

Labs: seminoma tumor

A

Placental alklaline phosphatase (PLAP) in 50%elev. Human chorionic gonadotropin (hCG)Normal serum alpha fetoprotein

34
Q

Histology: gonococcal urethritis

A

gram- diplococciintracellular and extracellular bacteria, PMNs

35
Q

If bladder CA is related to schistosomiasis, it is more likely what type of CA?

A

squamous cell carcinoma (70%)

36
Q

Risks: bladder CA

A

cigarette smoking (esp. in men)analgesics (long-term)radiation to areaexposure to benzenesschistosomiasis

37
Q

Cystitis as a result of chemotherapy or radiation therapy can result in ___

A

hemorrhagic cystitis

38
Q

Histology: malakoplakia

A

foamy histiocytes w/ round basophilic inclusions (Michaelis-Gutmann bodies)

39
Q

Malakoplakia

A

slightly raised mucosal plaques of the bladder lining

40
Q

Histology: chronic cystitis

A

chronic inflammatory cells (esp. lymphocytes) in lamnia propria of the bladderlymphocytes may form germinal centers

41
Q

Men with prostatic enlargement are at an increased risk for ___

A

acquired bladder diverticuli

42
Q

Patients with congenital exstropy of the bladder have an increased risk for ____.

A

bladder adenocarcinoma

43
Q

What is the MC type of ureteral malignancies?

A

transitional cell carcinomas

44
Q

Morphology: Ureteritis follicularis

A

fine granular appearance

45
Q

Ureteritis follicularis

A

increased lymphocytes in subepithelial region dt chronic localized inflammation

46
Q

Most islet cell antibodies in DM1 are directed against ___

A

glutamic acid decarboxylase (GAD) within beta cells

47
Q

Histology: DM type 1

A

lymphocytic infiltration in islets of Langerhans

48
Q

Histology: DM type 2

A

hyalnization, amyloid deposits in islet cells

49
Q

What histological feature of DM2 is also seen in normal aging?

A

amyloid deposits

50
Q

Male patients with diabetic neuropathy are at an increased risk for ___

A

impotence

51
Q

What are the first histological changes that are noted in patients with diabetic nephropathy?

A

thickened capillary walls within glomerulus

52
Q

MC location for tumors (MEN1)

A

parathyroid gland (90%)pancreas (gastrinoma - 50%, insulinoma - 20%)pituitary gland (66%)

53
Q

MC location for tumors (MEN2A)

A

medullary thyroid carcinoma (100%)pheochromocytoma (50%)parathyroid gland (50%)

54
Q

MC location for tumors (MEN2B)

A

medullary thyroid carcinoma (85%)pheochromocytoma (60%)mucosal neuroma (100%)marfanoid body habitus (80%)

55
Q

What is the MC and often initial manifestation and of MEN1?

A

1˚ hyperparathyroidism

56
Q

What are the MC ant. pituitary tumors seen in MEN1 patients?

A

prolactinomas

57
Q

Histology: medullary thyroid cancer

A

multiple areas of amyloid deposition+ staining for calcitonin

58
Q

Both MEN2A and MEN2B have an increased risk of ___

A

intestinal aganglionosis and Hirschsprung dz

59
Q

PTH1 receptors are found in the highest concentration where?

A

bone, kidney

60
Q

PTHrP is MC secreted in which types of cancers?

A

breast, lung CA

61
Q

What is often the first sign of malignancy in paraneoplastic syndromes?

A

PTHrP-related hypercalcemia

62
Q

What is the 2nd MC form of 1˚ hyperparathyroidism?

A

parathyroid hyperplasia

63
Q

What is the least common form of 1˚ hyperparathyroidism?

A

parathyroid carcinoma

64
Q

What is the MC cz of 2˚ hyperparathyroidism?

A

renal failure

65
Q

Cells of the adrenal medulla produce ___

A

EPI (80%)NE (20%)Dopamine (small amt)

66
Q

What area of the adrenal produces aldosterone?

A

zona glomerulosa (outermost layer)

67
Q

What area of the adrenal produces cortisol?

A

zona fasiculata (middle layer)

68
Q

What area of the adrenal produces sex steroids?

A

zona reticularis (innermost layer)

69
Q

Etiology: Primary hyperaldosteronism (Conn’s syndrome)

A

MC functional adrenal adenoma

70
Q

MC Etiology: Cushing’s syndrome

A

long-term glucocorticoids

71
Q

What is the MC tumor associated w/ paraneoplastic production of ACTH?

A

carcinoma of the lungs

72
Q

1˚ Addison’s dz is often associated with what AI conditions?

A

DM1Hashimoto’s thyroiditisVitiligo

73
Q

Addison’s disease is a result of insufficient ___ production.

A

cortisol

74
Q

Waterson-Frederickson syndrome

A

Type of 2˚ Addison’s disease Adrenal gland failure dt hemorrhage into adrenals (hemorrhagic necrosis)MC dt severe bacterial infx (meningococcal infx)

75
Q

SSx: 21-hydroxylase deficiency

A

Females: virilization, abn menses, infertility Males: precocious sexual development

76
Q

What is the MC solid, extra-cranial malignancy in infants and children?

A

neuroblastoma

77
Q

Histology: neuroblastoma

A

rosettes, pale-staining neurofibrils

78
Q

What is the MC type of thyroid CA?

A

Papillary carcinoma

79
Q

What is the 2nd MC type of thyroid CA?

A

follicular carcinoma

80
Q

What is the 3rd MC type of thyroid CA?

A

medullary carcinoma

81
Q

XR: Paget’s dz of bone

A

cotton ball appearance

82
Q

Patients with Paget’s dz of bone have an inc. risk for ___

A

development of malignant neoplasms, esp. osteosarcoma

83
Q

Histology: Paget’s dz of bone

A

mosaic pattern of lamellar bone (jigsaw puzzle)

84
Q

Legg-Calve-Perthes syndrome

A

idiopathic avascular osteonecrosis of the epiphysis of the femoral head

85
Q

Osteogenesis imperfecta (brittle bone dz)

A

congenital bone d/odeficiency of type-1 collagen -> defective CT

86
Q

Xray: solitary bone cyst vs aneurysmal bone cyst

A

solitary - continuous area of bone loss aneurysmal - honeycomb appearance

87
Q

Osteoid osteomas are usually (single/multiple).

A

single, but when multiple may be dt Gardner’s syndrome

88
Q

Osteoporosis cannot be reliably detected on XR until ___ of bone mass has been lost.

A

30-40%

89
Q

What is the MC cz of osteomyelitis in infants?

A

GABHS

90
Q

Drug users with osteomyelitis are more likely to have ___ infx.

A

gram- bacteria

91
Q

Pott’s disease

A

Tubercular osteomyelitis

92
Q

XR: osteoid osteoma

A

small, well-circumscribed round/oval lesion surrounded by densely sclerotic bone

93
Q

Gross pathology: osteoid osteoma

A

gritty, cherry red, dense sclerotic bone

94
Q

Loaction: osteoid osteoma

A

MC cortical area, sometimes in the medullary area

95
Q

What are the three MC malignancies in adolescents?

A

LeukemiaLymphomaOsteosarcoma

96
Q

Progression: osteosarcoma

A

aggressive, rapid growthhigh risk for METSMETS as “skip” lesions w/ involvement of soft tissue

97
Q

What type of METS is common with osteosarcoma?

A

early pulmonary METS

98
Q

Histology: fibrosarcoma

A

sheets of spindle-shaped cells

99
Q

Histology: Ewing sarcoma

A

small, rounded cells, uniform in size and densely packedindistinct cellular border, resembling lymphocytes

100
Q

XR: Ewing sarcoma

A

mottled “moth-eaten” lesion found in the medullary cavity and cortex, oft extending into surrounding soft tissue

101
Q

In children, bone METS MC originates from ___

A

neuroblastoma, Wilm’s tumor, or bone tumor

102
Q

Heberden’s nodes

A

nodes seen at surface of DIP joints in DJD

103
Q

Bouchard’s nodes

A

nodes seen at surface of PIP joints in DJD

104
Q

Genetics: RA

A

HLA-DR4

105
Q

Felty’s syndrome

A

name given to clinical triad of RA, splenomegaly, and manifestations of hypersplenism

106
Q

JRA vs RA

A

less joint pain in JRA compared to RAless cases of JRA are RF positivesubQ nodules are infrequent in JRA

107
Q

Immunology: Ankylosing spondylitis

A

HLA-B27 positive

108
Q

80% of Reiter’s syndrome (Reactive arthritis) cases are ___

A

HLA-B27 +

109
Q

What is the MC associated GU infection for Reiter’s syndrome (Reactive arthritis)?

A

Chlamydia

110
Q

What infectious arthritis-causing organism is mc seen in females?

A

gonococcal arthritis

111
Q

What is the MC organism found in older children and adults with bacterial arthritis?

A

Staph. aureus

112
Q

What is the MC cz of bacterial arthritis in children < 2?

A

Haemophilus influenza

113
Q

Sickle cell patients are at a greater risk for ___ infection of their joints.

A

salmonella

114
Q

When bacterial arthritis has a non-gonoccocal cause, it is MC that ___

A

only a single joint is involved

115
Q

Baker’s cyst

A

synovial cyst in the popliteal fossa

116
Q

Baker’s cysts are a well recognized complication of ___.

A

RA

117
Q

Thymomas are notable for their association with ___

A

myasthenia gravis

118
Q

~60% of Lambert-Eaton syndrome cases are associated with ___

A

small cell lung CA

119
Q

What is the MC soft tissue tumor in children?

A

Rhabdomyosarcoma

120
Q

Up to 50% of dermatomyositis cases mb dt ___

A

paraneoplastic syndrome

121
Q

Histology (2 classic findings): dermatomyositis

A

mixed B/T-cell perivascular inflammatory infiltrateperifascicular muscle fiber atrophy

122
Q

What is a characteristic symptom of dermatomyositis?

A

periorbital heliotrope macular rash

123
Q

Gottron’s sign

A

purple-red papular rash over dorsal MCPs, DIPs, and PIPsseen in dermatomyositis

124
Q

V sign

A

eruption similar to Gottron’s sign occurring at the ant. neck and upper chest

125
Q

SSx: dermatomyositis vs polymyositis

A

no skin involvement in polymyositis

126
Q

Histology: polymyositis

A

lymphocytic infiltration, usu T8 lymphocytespale/enlarged muscle fibers w/ macrophage infiltration

127
Q

Histology: inclusion body myositis

A

focal areas of WBCs and inflammatory cells within muscle fibersdeposits of amyloid-related proteins and inclusions within muscle cells

128
Q

Pathophysiology: myasthenia gravis

A

circulating antibodies that block ACh receptors at post-synaptic neuromuscular junction -> inhibits ACh

129
Q

Physiology: Lambert-Eaton syndrome

A

antibodies directed against presynaptic calcium channels, preventing ACh release

130
Q

What is the MC CN neuropathy?

A

Bell’s palsy (acute idiopathic facial nerve neuropathy)

131
Q

Which blood vessel is MC responsible for CN V root compression in trigeminal neuralgia?

A

superior cerebellar artery

132
Q

Location (sensory sxs): Meralgia paresthetica

A

distribution of the lateral cutaneous nerve of the thigh (anterolateral thigh)

133
Q

What is the MC cz of acute generalized paralysis in the US?

A

Guillain-Barre syndrome (GBS)

134
Q

Pathogenesis: CIDP

A

demyelination of axons by macrophages

135
Q

Familial amyloidosis is a result of mutated forms of ___

A

transthyretin

136
Q

What is the MC viral pathogen that affects the PNS?

A

VZV

137
Q

Vestibular schwannomas are seen in what syndrome?

A

neurofibromatosis

138
Q

Comparison (schwannomas): neurofibromatosis type 1 vs type 2

A

Type 1: bilateral rareusu present in adult lifecafe au lait spotsdt mutation of neurofibrominType 2: bilateral< 21dt mutation of protein merlin (neurofibromin 2)

139
Q

Neurofibroma

A

common, benign, spindle cell tumors of peripheral nerves

140
Q

Spina bifida occulta

A

condition dt missing portion of a posterior vertebral body

141
Q

Meningocele

A

herniation of the meninges but not cord

142
Q

Menigomyelocele

A

herniation of the meninges and spinal cord

143
Q

What lab result is associated with neural tube defects (spina bifida, anencephaly) and abd. wall defects?

A

elevated AFP

144
Q

Below normal AFP levels are associated with ___.

A

Down’s syndrome and Trisomy 18

145
Q

Mothers with which genetic variant are more likely to have elevated AFP?

A

methylenetetrahydrofolate reductase

146
Q

Cerebral palsy MC occurs when?

A

during pregnancy (75%)birth (10%)after birth (15%)

147
Q

Cerebral palsy is mc in ___.

A

premature infants

148
Q

What is the MC autopsy finding in newborns and infants with cerebral palsy?

A

periventricular leukomalacia

149
Q

PVL

A

white matter necrosis developing around the lateral ventricles with calcification, cysts, and glial scarring

150
Q

Histology: meningococcal meningitis

A

gram- diplococci within a neutrophil

151
Q

Dx: cryptococcal meningitis

A

CSF stains w/ India ink may show circular yeast bodies

152
Q

What is the MC cz of viral meningitis in children and adults?

A

enteroviruses (Coxsackie A and B, echovirus, poliovirus)

153
Q

What is the MC cz of sporadic encephalitis in developed countries?

A

HSV

154
Q

Labs: Paget’s dz of bone

A

elev. serum alk phos

155
Q

Paget’s dz of bone (osteitis deformans)

A

d/o characterized by high bone turnover w/ accelerated osteoclast and osteoblast activityleads to inc. calcification of bone -> inc. bone deposition in skull, pelvis, tibia, femur

156
Q

Sxs: GBS vs botulism

A

GBS - ascending paralysisbotulism - descending paralysis

157
Q

Mechanisms for diabetic neuropathy

A

microvascular dz -> ischemia/hypoxiahyperglycemia -> inc. sorbitol, dec. inositol -> dec. Na/K ATPase -> change axon structure and conduction

158
Q

% of prolactinomas with excess hormone production?

A

35%

159
Q

% of somatotrophic adenomas with excess hormone production?

A

16%

160
Q

% of corticotrophic adenomas with excess hormone production?

A

7%

161
Q

% of gonadotropic adenomas with excess hormone production?

A

12%

162
Q

% of thyrotrophic adenomas with excess hormone production?

A

< 1%

163
Q

What % of all pituitary adenomas are non-secretive?

A

25-30%

164
Q

Lumbar Puncture (opening pressure): bacterial vs viral vs fungal vs tubercular

A

bac - elev (> 180)viral - usu normalfungal/TB - variable

165
Q

Lumbar Puncture (WBC): bacterial vs viral vs fungal vs tubercular

A

bac - > 1000viral - < 100fungal/TB - variable

166
Q

Lumbar Puncture (cell differential): bacterial vs viral vs fungal vs tubercular

A

bac - PMNs (neutrophils)viral/fungal/TB - lymphocytes

167
Q

Lumbar Puncture (protein): bacterial vs viral vs fungal vs tubercular

A

bac - mild/marked elev. (>4.5)viral - normal to elev.fungal/TB - elev.

168
Q

Lumbar Puncture (CSF-to-serum glucose ratio): bacterial vs viral vs fungal vs tubercular

A

bac - normal to marked dec. (<0.4)viral - usu normalfungal/TB - low

169
Q

Intracranial hypotension

A

< 60 mm H2O

170
Q

Intracranial hypertension

A

> 250 mm H2O

171
Q

Yellow, orange, or pink discoloration of the CSF

A

xanthochromia

172
Q

Xanthochromia is pressent in > 90% of patients with ___ within __ hrs.

A

SA hemorrhage12

173
Q

Latex agglutination is best used to diagnose __.

A

H. influenzae

174
Q

CSF: gram stain is positive __% of the time.

A

60%

175
Q

CSF: culture is positive __% of the time.

A

80%

176
Q

PCR is best for identifying __

A

viral meningitis

177
Q

What is pathognomonic for ATN?

A

muddy brown casts on UA

178
Q

Goodpasture’s leads to basement membrane changes where?

A

kidneyslungs

179
Q

Histology: chronic interstitial nephritis

A

glomeruli do not show pathologic changes

180
Q

Genetics: Wilm’s tumor

A

chromosome 11 defect

181
Q

Histology: non-gonoccocal urethritis

A

granulated cytoplasmic inclusions

182
Q

Histology: papillary carcinoma of the thyroid

A

psammoma bodies

183
Q

Bilateral or unilateral: medullary carcinoma

A

bilateral when familialunilateral when sporadic

184
Q

Lab: medullary carcinoma

A

elev. calcitonin

185
Q

Histology: parathyroid adenoma

A

little/no adipose tissue

186
Q

Histology: parathyroid cancer

A

fibrotic septae

187
Q

Histology: IgA nephropathy

A

PAS +

188
Q

Histology: Diabetic nephropathy

A

PAS + nodules

189
Q

Histology: insulinoma

A

increased cellular uptake

190
Q

What is often the only clinical sign of 1˚ hyperaldosteronism

A

HTN

191
Q

MC cz of 1˚ Addison’s

A

AI destruction of adrenal cortex

192
Q

MC organism: Waterhouse-Friderichsen syndrome

A

Neisseria meningitidis

193
Q

Histology: Waterhouse-Friderichsen syndrome

A

hemorrhagic necrosis

194
Q

What causes increased osteoclast activity in 2˚ osteoporosis?

A

increased cytokines

195
Q

Onset: osteopetrosis vs Paget’s

A

osteopetrosis - birthPaget’s - 4th decade

196
Q

XR: Paget’s

A

widened bone w/ coarse trabecular markins

197
Q

Location: solitary bone cyst vs aneurysmal bone cyst

A

solitary - epiphysisaneurysmal - metaphysis

198
Q

XR: osteosarcoma

A

joint space rarely involvedspicules of calcium

199
Q

XR: giant cell tumor

A

non-scleroticwell-defined borders

200
Q

Histology: OA

A

fibrous-lined cysts in subchondral bone

201
Q

Joint involvement: RA

A

bilateral, symmetrical, polyarticular

202
Q

MC organism in infants: osteomyelitis vs bacterial arthritis

A

osteomyelitis - group B strepbacterial - H. flu

203
Q

Histology: pigmented villonodular synovitis

A

PMNs, hemosiderin-laden macrophages

204
Q

XR: synovial sarcoma

A

focal calcification

205
Q

MC location: rhabdomyosarcoma

A

orbit

206
Q

Histology: rhabdomyosarcoma

A

interweaving bundles of spindle-shaped cells

207
Q

Histology: perineuroma

A

elongated cells in parallel bundles