Review Questions 3

Question 1

What are the most common tumors that metastasize to the brain?

Answer 1

• Disseminated Melanoma (50% of metastasis)
• Breast and lung (35%)
• Kidney and colon (5%)

**Prostate, liver and sarcomas rarely spread

Question 2

• A chronic demyelinating disease of the CNS in which there are numerous patches of demyelination throughout gray or white matter?
• Which disease?

Answer 2

• White matter
• Multiple Sclerosis (MS)

Question 3

• Disease which affects both sensory and motor functions
• Characterized by exacerbations/remissions over period of several years

Answer 3

MS

Question 4

• MS is commonly found in which climates? Which climate is it rare in?
• MS is acquired at which age? Rare in which ages?

Answer 4

• Common: temperate climates
• Rare: Tropics
• Acquired: age 30
• Rare before 14 yrs, rare after 60 yrs

Question 5

Which sex is most affected by MS?

Answer 5

Women, twice as often!

Question 6

Etiology of MS

Answer 6

Idiopathic. But, experimental/clinical studies point to:

• genetic
• immune
• infectious

Question 7

Plaques are the hallmark of this diease

Answer 7

MS

Question 8

• Describe plaques of MS.
• Where are they most commonly located?

Answer 8

• Variable size w/ smooth rounded contour
• Usually in white matter, but occasionally breech the gray-white junction

Question 9

With MS, where do the plaques prefer to be?

Answer 9

Optic nerves and chiasm, uniformly localized to periventricular white matter

Question 10

What are plaques in MS?

Answer 10

Areas of demylenation

Question 11

Clinically, when does MS onset?

Answer 11

3rd or 4th decades

Question 12

When a patient with MS has an “exacerbation,” what does this mean?

Answer 12

There is a formation of new plaques of demylenation

Question 13

What are the initial sxs of MS?

Answer 13

• Sxs related to lesions of optic nerves, brainstem, or spinal cord.
• Blurred vision or loss of vision in one eye is common

Question 14

With MS, if the initial lesion is in the brainstem, what are the 2 most troubling early sxs?

Answer 14

• Double vision
• Vertigo

Question 15

W/ MS, plaques within the spinal cord show which sxs?

Answer 15

• Weakness of one or both legs
• Sensory sxs (numbness in LE)

Question 16

Are sxs of MS reversible?

Answer 16

Yes, many sxs are “partially reversible” within a few months, but in most patients the course of the disease is chronic relapse/remitting

Question 17

• MS patients range from minor disability to severe incapacity (paralysis, dysarthria (slurred/slow speech), severe visual defects, incontinence, dementia.
• Patients w/ MS usually die of which 2 things?

Answer 17

• Respiratory paralysis
• UTIs (as most are women)

*When they are in a terminal coma*

Question 18

An Intracranial Schwannoma (acoustic neuroma) is restricted to which cranial nerve, located where?

Answer 18

8th CN in the cerebellar pontine angle (CPA)

Question 19

Causes tinnitus, deafness, and if large enough can compress cranial nerves.

Answer 19

Intracranial Schwannoma (acoustic neuroma)

Question 20

Are acoustic neuromas (Intracranial Schwannoma) malignant?

Answer 20

Rarely, although they can recur with incomplete excision

Question 21

What is an example of pseudomembranous infammation?

Answer 21

C. difficile causing pseudomembranous colitis caused by a bacterial overgrowth secondary to intake of broad spectrum abx.

Question 22

A complication of wound healing from lack of sufficient tensile strength resulting in separation of wound margins.

Answer 22

Dehiscence

Question 23

• Deficient scar formation occurs in DM patients due to ischemia and metabolic disturbances. These patients have higher levels of experiencing wound dehiscence due to what?
• What substance is not produced as much in patients tx w/ corticosteroid hormones which lead to dehiscence?

Answer 23

• DM: Sluggish formation of granulation tissue
• Cortico: Collagen

Question 24

Excess scar formation w/ defective remodeling of scar tissue/results in immature scar

• What is an example of this?
• What are they composed of?

Answer 24

• Keloid
• Type 3 Collagen

Question 25

Etiology of keloids?

Answer 25

Genetic

Question 26

Vascularized connective tissue that is rich in macrophages + (myofibroblasts, angioblasts, fibroblasts). What is this called?

Answer 26

Granulation tissue

Question 27

Precursors of blood vessels that proliferate like sprouts from the several small blood vessels at the margins of the wound. (Development of new blood vessels)

Answer 27

Angioblasts/Angiogenesis

Question 28

* Healing of sterile surgical wounds * Incision site initially contains coagulated blood forming a scab * PMNs invade scab (scavenge debris), then 2 - 4 days later replaced by macrophages

Answer 28

Healing by First Intention

Question 29

* Composition of the wound matrix changes from Fibronectin and Collagen 3 --\> Collagen 1 * Proliferation of epithelial cells from wound margins cover defect within 3 - 7 days

Answer 29

Healing by First Intention

Question 30

Granulation tissue filling a skin defect of a wound healing by primary intention will transform into a scar by when?

Answer 30

3 - 6 weeks

Question 31

Wound healing of large defects and all infected wounds

Answer 31

Secondary intention

Question 32

* Granulation tissue exposed to external surface * Myofibroblasts cannot accomplish wound contraction

Answer 32

Secondary intention

Question 33

Type 3 collagen Mature or Immature?

Answer 33

Immature

Question 34

Type 1 Collagen Mature or Immature

Answer 34

Mature, most common form of collagen in body

Question 35

an antibody or other substance which binds to foreign microorganisms or cells making them more susceptible to phagocytosis.

Answer 35

Opsonin

Question 36

2 examples of opsonins

Answer 36

* Immunoglobulins (Fc) * Complement (C3)

Question 37

•A special form of chronic inflammation that typically is not preceded by an acute, PMN-mediated inflammation.

Answer 37

Granulomatous Inflammation

Question 38

What causes Granulomatous Inflammation?

Answer 38

* antigens that evoke a cell-mediated hypersensitivity reaction * antigens that persist at the site of inflammation

Question 39

Oral cavity to esophagus is made of which type of tissue?

Answer 39

Stratified squamous

Question 40

Stomach to Anus, which type of tissue? | (pancreas, gallbladder, liver)

Answer 40

Glandular

Question 41

When the heart is damaged, this is loss of myocardial cells. How does the heart repair itself? What cells is it made of?

Answer 41

* Fibrous scarring * Non-dividing/Permanent cells (do not proliferate under any circumstances) * Damage to heart is irreversible

Question 42

Damage to brain results in loss of brain cells. How does the brain repair itself? What cells?

Answer 42

* Gliosis/Astrogliosis * Non-dividing/Permanent cells * Irreversible damage

Question 43

What are the 3 cell types that enter the cell cycle?

Answer 43

* Continuously dividing (labile) cells * Quiescent (stable) cells * Nondividing (permanent) cells

Question 44

* Stem cells (RBC) , which type of cell? * Bone marrow * Intestine

Answer 44

Continuously dividing (labile cells)

Question 45

Cells of parenchymal organs (solid) : liver and kidneys are made of which cell type?

Answer 45

Quiescent cells (stable cells)

Question 46

Neurons and Myocardial cells are which cell type?

Answer 46

Nondividing (permanent) cells

Question 47

* 20% of primary intracranial neoplasms * Poorly demarcated, infiltrates cortex, indistinct margin * Can be seen in pons and cerebellum of children * Can be seen in cervical spinal cord in young adults

Answer 47

Grade 1 Astrocytoma

Question 48

* Life expectancy is 5 years w/ therapy: surgery and radiation * Transformation to higher degree anaplasia (GBM) occurs in 10% of cases which shortens life expectancy

Answer 48

Grade 1 Astrocytoma

Question 49

* Greater cellularity * Cellular pleomorphism * Anaplasia * Rapid growth of tumor * Life expectancy of 3 years w/ therapy

Answer 49

Anaplastic Grade 2 Astrocytoma

Question 50

* 40% of primary intracranial neoplasms * Predominates in later decades of life * Life expectancy of 18 months w/ therapy * Infiltrates extensively into cortex, frequently crossing corpus callosum

Answer 50

Glioblastoma Multiforme (GBM)

Question 51

* Extends bilaterally into white matter of both hemispheres * Has both mottled red (recent hemorrhage) and yellow (remote hemorrhage) * Looks like butterfly

Answer 51

GBM

Question 52

How does HTN compromise the integrity of cerebral arterioles which leads to HTN associated aneurysms?

Answer 52

Through deposition of lipid and hyaline material in the walls (lipohyalinosis)

Question 53

Charcot-Bouchard aneurysms are small fusiform dilatations in the trunk of a vessel as opposed to bifurcation. They are predisposed to rupture and cause which type of hemorrhage?

Answer 53

Hypertensive cerebral hemorrhage

Question 54

What may cause death by transtentorial herniation?

Answer 54

Hypertensive Intracerebral hemorrhage

Question 55

Etiology of strokes

Answer 55

Atherosclerosis predisposes pt to vascular thrombosis and embolic events (ischemic strokes most common)