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Pathology - SGU Systemic 2 Exam
Pathology - SGU Systemic 2 Exam
73
Pathology
Professional
06/13/2013

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Question 1
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Cerebral amyloid angiopathy in a patient with Alzheimer's dementia with no history of hypertension is a potential cause of lobar hemorrhage in the cerebral cortex.
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Long-standing hypertension is the most important risk factor for intra-parenchymal bleeding #brunchfact
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Cushing's reflex is a triad of elevated systolic blood pressure with a wide pulse pressure, bradycardia and irregular respiration. It is a sign of impending brain herniation secondary to increasing intracranial pressure. #tidythursdayfunfact
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Normal pressure hydrocephalus has a triad of dementia, ataxia and urinary incontinence. #sunnysideupbreakfastfact
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Did you know that Giant cell tumours of the bone (Osteoclastoma) arise from the epiphyses and they look histologically benign (non-neoplastic osteoclast-like multi-nucleated giant cells with neoplastic mononuclear cells) but have a malignant behaviour (local invasion, recurrence following surgical removal and occasional metastasis to the lungs)?
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Osteoscarcoma is a malignant tumor of osteoblast and it gives codman triangle (periosteal elevation) and sunburst appearance (periosteal reaction) on X-Ray with a lace-like appearing osteoid on histology. #summerintheairfunfact
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Osteoarthritis on the other hand affects the hip and knee asymmetrically and involves DIP. It has morning stiffness lasting 15-30 minutes and gets worse as the day progresses. CAN YOU SPOT THE DIFFERENCES BETWEEN THE TWO?!?! #brainteaser
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Ollier's disease gives multiple enchondromas while Maffucci syndrome gives multiple enchondromas, ovarian carcinoma and brain gliomas. Both diseases are associated with increased risk of chondrosarcoma. #wishfulwednesday #funfact
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The commonest cause of death in Osteopetrosis (marble bone disease) is recurrent infections from pancytopenia. #thatthreeo'clockintheafternoonfeelingfact
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The most accurate investigation for osteoporosis is DEXA scan. #funfacttuesday #tickleyourbrain
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Calcium, Phosphate, PTH and alkaline phosphatase levels are normal in osteoporosis. #lunchfact #enjoywahteveryou'rehaving
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The commonest cause of death in patients with post menopausal osteoporosis is pulmonary embolism from deep vein thrombosis as a result of immobility following pathological fractures. #brunchfact
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Achondroplasia gives short stature with normal reproductive ability, normal intelligence and normal life span. #temptationtuesday #funfact
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FGFR3 mutation is common to both urothelial bladder carcinoma and achondroplasia. #funfact
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Lithium toxicity, hypokalemia and hypercalcemia are some of the many causes of nephrogenic diabetic insipidus. #finallymondayisalmostover #funfact
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Bilateral ovarian metastasis with signet-ring cells on histology can be from diffuse gastric adenocarcinoma, invasive lobular breast carcinoma and colon adenocarcinoma, to name a few. #graymondayfact
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A hard, modular, irregular prostate on DRE is suggestive of prostate cancer while a smooth, firm prostate is usually consistent with BPH. #brunchfact
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The histology of testicular seminoma shows fried egg appearance and is identical to ovarian dysgerminoma and medullary carcinoma of the breast. All three cancers are radiosensitive and have excellent prognosis as a result. #smoothsunday #fact
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Membranoproliferative glomerulonephritis gives a tram-track or double contour appearance on light microscopy and on EM sub-endothelial and intramembranous deposits are consistent with Type 1 and Type 2 respectively. #fantasticfriday #funfact
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Autosomal recessive polycystic kidney disease is associated with Potter's sequence (flat faces, low set ears, amnion nodosum, pulmonary hypoplasia, malpositioning of the hands and feet, breech presentation) and leads to end stage renal disease and hepatic fibrosis. #funfact #imonfire .
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The greatest risk factor for urothelial carcinoma of the bladder is smoking. #breakfastfact
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Horseshoe kidney is usually an incidental finding on imaging and it is associated with Turner's and Edward's syndromes. Did you know that the famous Mel Gibson has a horseshoe kidney?! #funfact #terrificthursday
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Renal Cell Carcinoma is associated with Hypertension, obesity, smoking, cadmium exposure and acquired Polycystic kidney Disease? #Breakfastfact
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The combination of hearing loss, visual disturbance and hematuria, proteinuria and RBC casts in a male patient is highly suggestive of Alport's syndrome.
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The commonest cause of nephrotic syndrome in children is MCD while the commonest cause of nephrotic syndrome in adults is diabetic nephropathy
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Minimal change disease in adults is associated with Hodgkin's lymphoma and has a poor prognosis compared to MCD in children.
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The first functional change in diabetic nephropathy is hyperfiltration while the first biochemical change is microalbuminuria (30-300mg/24hrs)
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Patients with granulosa theca ovarian tumours should be scanned for breast cancer as well as endometrial hyperplasia/carcinoma because of the effect of excess estrogen?
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A complete Hydatidiform mole can become an invasive mole or a gestational choriocarcinoma!
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Molar pregnancies have a snowstorm appearance on ultrasound?
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Pagets Disease of the breast means that there's an underlying DCIS.
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commonest presentation of solitary cortical adenoma is asymptomatic which is why they are called Incidentalomasas?!
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Epidural hematoma has a biconvex lens-shaped appearance on non-contrast CT scan while subdural hematoma has a crescentic appearance. #itsalmostfridayfunfact
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Transtentorial (uncal) herniation gives a down and out eye with pupillary dilation (blown pupil) on the ipsilateral side.
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Brain abscess gives a ring-enhancing lesion on contrast CT scan?
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Complications of subarachnoid hemorrhage from ruptured berry aneurysm include ischemic stroke secondary to vasospasm and communicating hydrocephalus secondary to fibrosis of the arachnoid granulations. :D
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Multiple sclerosis gives periventricular gadolinium enhancing lesions on contrast MRI and oligoclonal IgG bands on CSF
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The commonest brain malignancy is metastasis to the brain from primaries like melanoma, breast and lung cancers to mention a few.
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Glioblastoma multiforme is a high grade astrocytoma with a butterfly appearance with hemorrhage and necrosis in the region of corpus callosum on gross and shows a central necrosis with pseudo-pallisading arrangement of tumour cells on histology.
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Patients with hypothyroidism can develop hyperprolactinemia from elevated thyrotropin releasing hormone (TRH) that results from lack of negative feedback.
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CSF findings in brain abscess are normal glucose, elevated protein and elevated WBC while for bacterial meningitis; low glucose, elevated protein and elevated WBC are seen.
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1. Graves' disease : high T3, T4 with low TSH. Also high TSI. Most common cause in the US.
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. Sub-acute granolomatous(de quervain's) thyroiditis: high T3, T4 with low TSH. Also gives a tender thyroid gland following a viral infection.
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TSH secreting anterior pituitary adenoma: can be a part of MEN 1 syndrome. Has high T3, T4 with high TSH. Only cause with high TSH.
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Toxic adenoma: hot thyroid nodule. High T3, T4 with low TSH.
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Struma ovarii: specialized teratoma but rarely functional. High T3, T4 with low TSH. Can lead to thyroid gland atrophy.
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. Exogenous use of thyroid hormone: high T3, T4 with low TSH. Can also lead to thyroid gland atrophy.
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Ovaries: streak leading to primary amenorrhea and infertility, dysgerminoma.
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Short stature, webbed neck, peripheral lymphedema, cubitus valgus, pigmented nevi, shield-shaped chest and wide-spaced nipples.
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CVS: coarctation of the aorta, congenital bicuspid aortic valve.
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Kidney: horse-shoe
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The progression from oliguria to anuria and from azotemia to uremia within 2-3 weeks in any of the following diseases nails the diagnosis of rapidly progressive (crescentic) glomerulonephritis:
1. Goodpasture- linear deposits on immunoflorescence(IF)
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2. IgA nephropathy/HSP- coarse granular(lumpy bumpy) on IF
2. Post strep. glomerulonephritis- lumpy bumpy on IF
2. SLE- lumpy bumpy on IF
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3. Wegener's granulomatosis- negative on IF
3. Churg Strauss- negative on IF
3. Microscopic polyangitis- negative on IF
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MEN 1: 3 Ps
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1. Parathyroid adenoma
2. anterior Pituitary adenoma
3. Pancreatic tumour
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MEN 2a:
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1. Parathyroid hyperplasia
2. Pheochromocytoma
3. Medullary carcinoma of the thyroid
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Definitive diagnosis of Alzheimer's dementia can only be made on autopsy and the commonest cause of death is aspiration pneumonia.
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Differential diagnosis of conditions with psammoma bodies:
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1. Papillary thyroid carcinoma
2. Meningioma
3. Serous cyst ovarian tumours
4. Serous endometrial carcinoma
5. Mesothelioma
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Childhood brain tumours are infratentorial while the adult brain tumours are supratentorial
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Multiple sclerosis gives periventricular gadolinium enhancing lesions on contrast MRI and oligoclonal IgG bands on CSF.
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The commonest brain malignancy is metastasis to the brain from primaries like melanoma, breast and lung cancers to mention a few. #fantasticfridayfunfact
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Glioblastoma multiforme is a high grade astrocytoma with a butterfly appearance with hemorrhage and necrosis in the region of corpus callosum on gross and shows a central necrosis with pseudo-pallisading arrangement of tumour cells on histology.
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There was a question and then it's gone.
Still here's the answer..... No epithelial hyperplasia for simple FCC. #Cheers
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The commonest predisposing condition for acute osteomyelitis in adults is diabetes. The commonest microorganism is Staph aureus. The commonest route of spread is contiguous from an ulcer/soft tissue infection.
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The commonest cause of hypercalcemia is primary hyperparathyroidism resulting from a parathyroid gland adenoma and the most common presentation is asymptomatic.
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Rickets and osteomalacia have low serum calcium, phosphate, Vit.D and high PTH and alkaline phosphatase.
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Fibromuscular dysplasia is a likely cause of renal artery stenosis, particularly in young females. Atherosclerosis is by far the commonest cause of this disease.
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The commonest cause of Addisson's disease in the US is autoimmune destruction. Other causes include: metastastic cancer, TB and DIC to name a few.
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Endometriosis can give bilateral chocolate ovarian cysts associated with infertility, Fallopian tube scarring leading to ectopic pregnancy, hematuria, hemoptysis, hematochezia (resulting from endometrial glands in the bladder, lungs and rectum respectively) and a triad of dysmenorrhea, dysperunia and dyschezia.
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