Gen Path Exam 4

Front 1

What is the most common cause of hyperpituitarism?

Back 1

adenoma in anterior lobe

Front 2

What is the second most common functional adenoma?

Back 2

growth hormone producing adenoma

Front 3

Endocrine pathology associated with the pituitary gland

Back 3

hyperpituitarism

Front 4

_______________ as a result of a growth-hormone producing adenoma can lead to what two clinical manifestations?

Back 4

hyperpituitarism; gigantism or acromegaly

Front 5

Gigantism occurs as a result of a GH producing adenoma (hyperpituitarism) when it occurs ________ closure of the epipheseal plates and is characterized by growth in _____ bones.

Back 5

before; growth in long bones

Front 6

________ occurs as a result of a GH producing adenoma (hyperpituitarism) when it occurs after the closure of the epypheseal plates.

Back 6

acromegaly

Front 7

List the clinical features of acromegaly

Back 7

-no long bone growth

-large hands/feet

-mandibular prognathism

-gaps in between teeth

Front 8

List the conditions associated with acromegaly

Back 8

Diabetes mellitus

muscle weakness

Hypertension

Osteoporosis

Arthritis

Congestive heart failure

Front 9

Hyperthyroidism is also called ____________

Back 9

thyrotoxicosis

Front 10

What are the laboratory findings associated with primary hyperthyroidism?

Back 10

increased T3/T4

decreased TSH

Front 11

________ hyperthyroidism arrises due to hyperfunction of the thyroid while ______ hyperthyroidism arrises due to pituitary disease (adenoma)

Back 11

primary; secondary

Front 12

What are the lab findings associated with secondary hyperthyroidism?

Back 12

increased T3/T4

normal or increased TSH

Front 13

List the clinical features of hyperthyroidism

Back 13

-warm, flushed skin

-heat intolerance

-tachycardia

-heart palpitations

-weight loss

Front 14

What are the two clinical manifestations of hypothyroidism?

Back 14

1) cretinism

2) myxedema

Front 15

What are the lab findings associated with primary hypothyroidism?

Back 15

decreased T3/T4

increased TSH

Front 16

What are the lab findings associated with secondary hypothyroidism?

Back 16

decreased T3/T4

decreased TSH

Front 17

What is cretinism?

Back 17

The clinical manifestation of hypothryoidism in infancy and early childhood

Front 18

What is myxedema?

Back 18

The clinical manifestation of hypothyroidism observed in older children and adults

Front 19

List the characteristics of cretinism

Back 19

-mental retardation

-impaired CNS and skeletal system development

-umbilical hernia

-short stature

Front 20

List the characteristics of myxedema

Back 20

-apathy

-cold intolerance

-obese

-mucopolysaccharide-rich fluid accumulates in skin

-macroglossia

-enlarged heart

Front 21

TSH levels are ____ in a patient with primary hypothyroidism.

Back 21

elevated

Front 22

TSH levels are _____ in a patient with secondary hypothyroidism.

Back 22

decreased

Front 23

What is the most common cause of hypothyroidism?

Back 23

Hashimoto thyroiditis (Chronic Lymphocytic Thyroiditis)

Front 24

_________ __________ _____________ is characterized by autoimmnune destruction of the thyroid.

Back 24

Chronic lymphocytic thyroiditis

Front 25

List the morphological features of Chronic Lymphocytic Thyroiditis:

Back 25

-diffusely enlarged thyroid

-mononuclear inflammatory infiltrate

-atrophic thyroid follicles

-follicles lined with Hurthle cells

Front 26

Hurthle cells are characteristic of ___________, and are characterized by what characteristics?

Back 26

Chronic lymphocytic thyroiditis;

-eosinophilic

-granular cytoplasm

-numerous mitochondria

Front 27

List the clinical features of CLT (Hashimoto thyroiditis):

Back 27

-hypothyroidism

-painless goiter

-transient hyperthyroidism (from autoimmune mediated rupture of follicles)

-increased risk of B-cell non-Hodgkin lymphoma

Front 28

What are the laboratory findings associated with CLT?

Back 28

-hypothyroidism (decreased T3/T4, increased TSH)

-transient hyperthyroidism (increased T3/T4, increased TSH)

Front 29

_________ _________ is an autoimmune disease resulting in antibodies to TSH receptors causing (1) hyperthyroidism and (2) proliferation of thyroid follicular epithelium.

Back 29

Grave's disease

Front 30

List the morphological features of Grave's disease:

Back 30

-diffusely enlarged thyroid

-hypertrophy and hyperplasia of follicular cells: tall columnar form papillae in lumen

-lymphoid infiltrate with germinal centers

-opthalmopathology (inflam. edema in extraoccular muscles, lymphocyte infiltration of retroorbital space, glycosaminoglycan deposits)

-dermopathy (thickening of dermis)

Front 31

List the clinical features of Grave's disease:

Back 31

-goiter (hyperfunctional)

-opthalmopathy

-dermopathy

Front 32

What are the laboratory findings associated with Grave's disease?

Back 32

increased T3/T4

decreased TSH

Front 33

What is the most common thyroid cancer, associated with exposure to ionizing radiation?

Back 33

papillary carcinoma

Front 34

What is second most common thyroid cancer associated with iodine deficiency?

Back 34

follicular carcinoma

Front 35

Which thyroid cancers are derived from follicular epithelium?

Back 35

papillary and follicular carcinomas

Front 36

Which thyroid cancers are derived from parafollicular cells?

Back 36

medullary carcinoma

Front 37

___________ carcinoma is a neuroendocrine tumor that secretes _________.

Back 37

medullary; calcitonin

Front 38

Diagnosis for _____________ carcinoma is made based on what nuclear features?

Back 38

papillary thyroid carcinoma

-finely dispersed chromatin: " orphan Annie eye"

-psuedonuclear inclusions: invaginations of the cytoplasm

Front 39

List the morphological features of papillary carcinoma:

Back 39

-Nuclear features: finely dispersed chromatin (orphan Annie eye) and pseudonuclear inclusions

-Psammoma bodies: concentrically calcified structures

-papillary architecture

Front 40

What are the clinical features of papillary carcinoma?

Back 40

-nonfunctional tumor

-painless mass in neck or metastasis to cervical lymph node

-rare hematogenous metastasis: lung

Front 41

What are the morphological features of follicular carcinoma?

Back 41

-uniform cells make small follicles similar to normal thyroid

-hard to distinguish from thyroid adenoma

-must ID based on capsular and/or vascular invasion

Front 42

List the clinical features of follicular carcinoma:

Back 42

-nonfunctional tumor

-metastasis via bloodstream (lungs, bone, liver)

-regional node involvement is UNCOMMON

Front 43

What are the morphological features of medullary carcinoma?

Back 43

-solitary (sporadic form) or multiple (familial form)

-polygonal or spindle-shaped cells form nests, trabeculae or follicles

-acellular amyloid deposits (derived from altered calcitonin molecules)

Front 44

Amyloid deposits are associated with which type of thyroid cancer?

Back 44

medullary carcinoma

Front 45

Calcitonin is secreted by which type of thyroid cancer?

Back 45

medullary carcinoma

Front 46

What are the clinical features of medullary carcinoma?

Back 46

-mass in neck

-NO hypocalcemia!

-MEN 2A and 2B (prophylactic removal of thyroid is indicated)

Front 47

Primary hyperparathyroidism is associated with an increase in ____ and elevated blood _______ levels.

Back 47

increase in PTH; calcium

Front 48

Primary hyperparathyroidism arises due to ...?

Back 48

1) parathyroid adenoma

2) hyperplasia (ex: MEN type 1)

3) carcinoma

Front 49

Secondary hyperparathyroidism is uniquely associated with _____________ ____________ ___________.

Back 49

chronic renal insufficiency!

Front 50

List the morphological ft of hyperparathyroidism:

Back 50

- parathyroid adenoma and carcinoma involve a single gland while

-parathyroid hyperplasia is multiglandular

-skeletal lesions due to increased osteoclast activity *BROWN TUMORS*OSTEITIS FIBROSA CYSTICA*

Front 51

What are brown tumors?

Back 51

masses of giant cells and hemorrage within the bones of a person with hyperparathyroidism

Front 52

Osteitis fibrosa cystica is associated with _________

Back 52

hyperparathyroidism

Front 53

What are the clinical features of primary hyperparathyroidism?

Back 53

"renal stones, painful bones, psychic moans and abdominal groans"

-elevated serum calcium and PTH

-GI disturbances

-CNS disturbances

-neuromuscular weakness

-polyuria/polydipsia

Front 54

List the clinical features for secondary hyperparathyroidism:

Back 54

-renal failure

-hyperphosphatemia

-serum calcium normalizes due to compensatory increase in PTH

Front 55

Peripheral resistance to insulin

Back 55

type 2 DM

Front 56

Autoimmue-mediated insulin deficiency

Back 56

type 1 DM

Front 57

What is the pancreatic morphology associated with diabetes mellitus?

Back 57

-decrease in size and number of islets

-luekocyte infiltration of islets

-amyloid replacement of islets

Front 58

What are two broad categories of morphology associated with diabetes?

Back 58

1) macrovascular disease (hyaline arteriolosclerosis)

2) microangiopathy

Front 59

Microangiopathy results in ....

Back 59

1) thickening of the BM

2) leaky capillaries

Front 60

The leaky capillaries due to diabetic microangiopathy are responsible for ....

Back 60

1) nephropathy

2) retinopathy

3) neuropathy

Front 61

Hyaline arteriolosclerosis is also seen in what disease?

Back 61

benign hypertension

Front 62

What are Kimmelstiel-wilson lesions?

Back 62

ball-like matrix deposits found in the kidney of diabetic patients

Front 63

Hypercortisolism is also referred to as _________

Back 63

Cushing syndrome

Front 64

Adrenal insufficiency is divided into two categories:

Back 64

- Chronic: Addison disease

-Acute: adrenal crisis

Front 65

What are the 4 causes of Cushing syndrome?

Back 65

1) exogenous intake (Prednizone)

2) pituitary adenoma (Cushing Disease)

3) primary adenocortical hyperplasia/neoplasia

4) nonendocrine neoplasm

Front 66

Exogenous intake of cortisol leads to _______ adrenal atrophy.

Back 66

bilateral

Front 67

When Cushing syndrome is a result of a pituitary adenoma it is called ______

Back 67

Cushing disease

Front 68

What are the clinical features of Cushing syndrome?

Back 68

1. hypertension and weight gain

2. hyperglycemia, polydipsia

3. redistribution of fat

4. decrease muscle mass

5. hirsutism

6. osteoporosis

Front 69

What are the potential causes of Addison disease?

Back 69

1. autoimmune adrenalitis

2. infection (TB)

3. AIDS

4. cancer

Front 70

What are the causes of adrenal crisis (acute adrenal insufficiency)?

Back 70

1. Waterhouse-Friderichsen syndrome (sepsis due to Neisseria meningitidis)

2. sudden withdrawl of corticosteroid

3. stress in pt. with underlying chronic adrenal insuficency

Front 71

What are the clinical features of adrenal insufficency?

Back 71

-90% destruction of adrenal cortex

-weakness, fatigue

-vomitting, weight loss

-hyperpigmentation of skin and mucous membranes

-increase ACTH

-hyperkalemia

-low blood pressure

-low blood sugar

Front 72

hyperpigmentation of the oral mucosa and hyperkalemia may indicate?

Back 72

adrenal insufficiency (Addison)

Front 73

Neoplasm of the adrenal medulla composed of chromaffin cells derived from ________ ________

Back 73

Pheochromocytoma

derived from neural crest

Front 74

Pheochromocytomas release ________ resulting in sustained ________ .

Back 74

catecholamines (epi and norepi) ; hypertension

Front 75

What is the rule of 10's ?

Back 75

applies to pheochromocytomas

- 10% arrise in an extra-adrenal site

- 10% are bilateral

- 10% are malignant

25% arie in association with a familial syndrome (MEN2A, MEN 2B)

Front 76

Clincial features of pheochromacytoma:

Back 76

1. sustained hypertension

2. tachycardia, palpitations, headache

3. sweating, tremor

Front 77

What are the laboratory features of pheochromacytoma?

Back 77

increase urinary catecholamines:

-vanillylmandelic acid

-epinephrine

-norepinephrine

Front 78

Characterized by hyperplasias, adenomas, and carcinomas of multiple endocrine organs

Back 78

multiple endocrine neoplasia syndromes (MEN)

Front 79

MEN type 1

Back 79

Parathyroid: primary hyperparathyroidism from hyperplasia

Pancreas: functional tumors

Pituitary: prolactin-secreting adenoma

Front 80

MEN type 2

Back 80

Parathyroid: primary hyperparathyroidism from hyperplasia

Thyroid: medullary carcinoma

Adrenal medulla: pheochromocytoma

Front 81

MEN type 3

Back 81

same as type 2 but no parathyroid problem and type 3 has oral manifestations! **benign nerve tumor on mucosa

Front 82

Clincial features of testicular neoplasm:

Back 82

-painless mass

-metastasis before palpable

-lymph or heme metastasis

Front 83

Tumor markers for testicular neoplasm:

Back 83

1) HCG: human chorionic gonagotropin (100% of choriocarcomas)

2) AFP: alpha feta protein ( 90% of yolk sac tumors)

Front 84

____________-dependent proliferation of stromal and epithelial cells in the inner transitional zone of the prostate gland causing obstruction of urine flow

Back 84

ANDROGEN-dependent;

BPH: benign prostatic hyperplasia

Front 85

Clinical ft of benign prostatic hyperplasia?

Back 85

- UTI

-obstruction of urinary flow

-(increase in PSA)

Front 86

The most common cancer in men:

Back 86

Carcinoma of the prostate

Front 87

Where is prostate cancer usually found?

Back 87

in peripheral prostate (posterior lobe near rectum)

-LESS LIKELY TO OBSTRUCT URINE FLOW

Front 88

Most prostate cancer is in the form of _____

Back 88

adenocarcinoma

Front 89

What are the clinical features of carcinoma of the prostate?

Back 89

- elevated PSA

- BONE METASTASIS --> axial skeleton

-regional infiltration of lesion

Front 90

Syphilis is caused by:

Back 90

Teponema Pallidum

Front 91

There are 4 forms of syphilis; the ____ form is noninfectious

Back 91

tertiary

Front 92

primary syphilis is characterized by:

Back 92

-Chancre

-Enlarged lymph nodes

Front 93

secondary syphilis is characterized by:

Back 93

-mucocutaneous lesions/rash (maculopapular)

-condylomata lata

-lymph node enlargement

Front 94

tertiary syphilis affects the ___ and ____ systems, and is characterized by ...

Back 94

cardiovascular and nervous;

granulomas and gummas!

Front 95

Congential syphilis is characterized by

Back 95

"The Hutchinson Triad"

-Hutchinson's incisors

-8th nerve deafness

-interstitial keratitis

Front 96

Gonorrhea is caused by

Back 96

Neisseria gonorrhoeae

Front 97

clinical ft of gonorrhea in men:

Back 97

- mucopurulent uretral discharge

-dysuria

-urinary frequency

Front 98

clinical ft. of gonorrhea in women:

Back 98

-asymptomatic!

-may cause ectopic pregnancy meningitis

-scarring = infertility

Front 99

Herpes in primary form is characterized by:

Back 99

-painful erythematous vesicles

-dysuria

-fever, aches

Front 100

Morphology of herpes:

Back 100

- intraepithelial vesicles

- multiple, molded nuclei

Front 101

Venereal wart caused by HPV 6 & 11

Back 101

Condyloma acuminatum

Front 102

fetal transmission of condyloma acuminatum can lead to

Back 102

URT papillomas

Front 103

Morphology of condyloma acuminatum:

Back 103

-papillary proliferation of stratified squamous epithelium

-koilocytes - squamous epithelial cell infection with HPV, central nucleus, perinuclear clearing

Front 104

Distinct episode of neurological deficits separated in time, attributable to white matter lesions separated in space.

Back 104

Multiple Sclerosis

Front 105

MS is a disease of the _____, not the ______

Back 105

myelin; nerve

Front 106

Clincal ft of MS:

Back 106

- f > m

-insidious onset

-visual disturbances

-speech disturbances

-gait abnormalities

-cognitive impairment ABSENT!

-involvement of brainstem

-plaques

Front 107

Where are MS plaques located?

Back 107

1) white matter beside lateral ventricles

2) optic nerves

3) chiasm

Front 108

Dx of MS:

Back 108

- plaque on MRI

- moderate pleocytosis in CSF

Front 109

-Most common cause of dementia

-Progressive impairment of memory and cognitive function

-Disorientation, loss of language

Back 109

Alzheimer's Disease

Front 110

Hydrocephalus exvacule

Back 110

excess fluid in the brain of Alzheimer patients due to shrinkage of brain matter

Front 111

Microscopic features of Alzheimer's disease:

Back 111

-neurofibrillary tangles (tau protein)

-neuritic plaques

-amyloid vasculopathy

Front 112

Pathogenesis of Alzheimer's

Back 112

- deposition of amyloid beta protein (ABP)

- protein tau

Front 113

Non-inherited degenerative disorder involving dopamine-secreting neurons in the substantia nigra and locus ceruleus

Back 113

idiopathic parkinson disease

Front 114

clinical feature of parkinson's

Back 114

-disturbance in motor functions

* tremor

* stooped posture

* expressionless face

* gait disturbance

-dementia only in minority of cases

Front 115

Gross pathology of Parkinson's

Back 115

-pallor of substantia nigra and locus cerulus

Front 116

Microscopic pathology of Parkinson's

Back 116

-loss of pigmented catecholaminergic neurons

-gliosis

-Lewy bodies

Front 117

Severe dementia and progressive movement disorder characterized by an increase in trinucleotide repeats

Back 117

Huntington disease

Front 118

Clinical features of Huntington disease:

Back 118

- initially: involuntary writhing movements

-seizures and rigidity

-neuropsychiatric disturbances

Front 119

Gross pathology of Huntington's Disease:

Back 119

-atrophy of caudate and putamen regions of brain

-dilation of ventricles

Front 120

Microscopic pathology of Huntington's Disease:

Back 120

-severe loss of neurons in caudate and putamen with

-gliosis

Front 121

List 3 agents that might cause Erythema multiforme

Back 121

- Herpes Simplex

- Mycoplasma infections

- Penicillin

Front 122

Erythema multiforme is a __________ reaction.

Back 122

hypersensitivity

Front 123

Macules, papules, vesicles, and bullae and "Target lesions" with eroded centers are characteristics of ____

Back 123

Erythema multiforme

Front 124

What is a characteristic oral manifestation of erythema multiforme ?

Back 124

hemorrhagic crusting of the lips

Front 125

What is the extensive form of EM usually triggered by a drug?

Back 125

Stevens-Johnson syndrome

Front 126

Penicillin allergy

Back 126

Stevens-Johnson EM

Front 127

Most severe type of EM

Back 127

Toxic epidermal necrolysis (TEN)

Front 128

Huge bullae resembling extensive burns

Back 128

Toxic epidermal necrolysis

Front 129

What are the 3 main triggers for toxic epidermal necrolysis?

Back 129

1. herpes

2. mycoplasma

3. penicillin

Front 130

List 3 diseases of acute dermatosis:

Back 130

1. erythema multiforme

2. stevens-johnson syndrome

3. toxic epidermal necrolysis

Front 131

Morphology of erythema multiforme (steven-johnson/ toxic epidermal necrolysis)

Back 131

-margination of lymphocytes along the dermoepidermal junction

-dermal edema*

-superficial perivascular lymphocytic infiltrate

-degenerating and necrotic keratinocytes

-epidermal necrosis --> blister formation

Front 132

Chronic inflammatory dermatosis

Back 132

Lichen planus

Front 133

Results from a CD8+ T cell mediated cytotoxic immune response against antigens in the ______ cell layer

Back 133

basal; Lichen Planus

Front 134

-Pruritic, purple, polygonal papules and plaques

-papules are highlighted by white dots or lines called _______ _______

Back 134

Lichen Planus; Wickham striae

Front 135

______________ is a clinical and histological feature of Lichen Planus which results due to melanin deposition in the dermis as a result of degeneration of basal cells.

Back 135

Hyperpigmentation

Front 136

In Lichen Planus, _________ are near the basal layer and both are destroyed.

Back 136

melanocytes

Front 137

Skin lesions symmetrically distributed on the extremities: wrists and elbows and resolve in 1-2 years.

Back 137

Lichen Planus

Front 138

70% of pt with Lichen Planus have oral manifestations of the disease

Back 138

-white striations, ulcerations, erythema

-white plaques on dorsum of tongue

-bilaterally symmetrical!

-oral lesions persist longer than dermatological manifestations of disease

Front 139

Morphology of Lichen Planus (chronic inflammatory dermatosis)

Back 139

- infilatrate of lymphocytes along the dermoepidermal junction

-degeneration and necrosis of basal cells

-"sawtooth" rete pegs

anucleate, necrotic basal cells: civatte bodies or colloid bodies

-no dermal edema (Seen in EM)

Front 140

Whickham striae

Back 140

white lines on papules associated with LICHEN PLANUS

Front 141

Sawtooth rete pegs

Back 141

Lichen planus

Front 142

Is there dermal edema in lichen planus? erythema multiform?

Back 142

erythema multiform - yes

lichen planus - no

Front 143

Lichen planus is ___-cell mediated

Back 143

T

Front 144

Em is ________ rxn

Back 144

hypersensitivity

Front 145

Rare autoimmune blistering disorder affecting skin and mucous membranes

Back 145

Pemphigus

Front 146

In pemphigus, autoantibodies are directed against _______ _______ __________ that hold th epidermis (and mucosa) together.

Back 146

intercellular cement substance

Front 147

Pemphigus is a type __ hypersensitivity

Back 147

type II

Front 148

Pemphigus is characterized by blisters within the epithelium:

Back 148

superficial vesicles and bullae that rupture easily --> erosions

Front 149

Nikolsky sign

Back 149

oral manifestation of Pemphigus & Pemphigoid; can induce blister with airstream

Front 150

Morphology of pemphigus:

Back 150

-acantholysis* (separation of sqaumous epithelium)

-dermal infiltrate of lymphcytes, macrophages, and eosinophils

-circulating autoantibodies

-characteristic DIRECT immunofluorescence: chicken wire pattern

Front 151

Pemphigoid bullae are located _____ epithelium

Back 151

under (think 'd' for down)

Front 152

Clinically, how may pephigus and pemphigoid be distinguished?

Back 152

-checking for symblepharon: adhesions between bulbar and palpebral conunctiva

(occular lesions = pemphigoid)

Front 153

What is the causative difference between pemphigus and pemphigoid?

Back 153

pemphigus - autoab attack adhesion (intercellular cement)

pemphigoid - autoab attack BM

Front 154

Morphological features of bullous pemphigoid:

Back 154

-subepidermal, nonacantholytic blister

-superficial dermal edema (as seen in EM)

-direct immunofluoresence: IgG and complement band at BM

Front 155

Common, pigmented epidermal tumor; benign

Back 155

Seborrheic Keratosis

Front 156

Seborrheic keratosis morphology:

Back 156

-melanin pigment

-hyperkeratosis

-keratin filled cysts (horn cysts)

-psuedohorn cysts

Front 157

Circulating antibodies are likely to be seen in _____ but not _____.

Back 157

pemphigus; not pemphigoid

Front 158

Explosive onset of numerous seborrheic keratosis lesions may indicate

Back 158

internal malignancy - Lesser-Trelat

Front 159

Skin cancers:

Back 159

1. sqaumous cell carcinoma

2. basal cell carcinoma

(3. melanocytic nevus)

4. melanoma

Front 160

squamous cell morophology

Back 160

-highly atypical cells at the all levels of epidermis

-varying degrees of differentiation and keratinization

-less than 5% metastasize to regional nodes

Front 161

cancer that arrises due to sun exposure in light-skinned individuals

Back 161

basal cell carcinoma

Front 162

presents as pearly papule with prominent dilated subepidermal blood vessels; slow-growing tumor that rarely metastasizes

Back 162

basal cell carcinoma

Front 163

Morphology of basal cell carcinoma:

Back 163

- tumor cells resemble those in basal cell layer

-islands of basaloid cells infiltrate a fibrotic stroma (periphery of islands stand up like soilders)

-retraction artifact (pulling away at periphery

Front 164

Any congenital or acquired neoplasm of melanocytes

Back 164

Melanocytic nevus

Front 165

most common skin cancer

Back 165

basal cell carcinoma

Front 166

Nevus cells represent transformed melanocytes and demonstrate _______ ________ in the deeper connective tissue.

Back 166

cellular maturation

Front 167

melanocytic nevi are characteristically...

Back 167

-less than 5 mm

-symmetrical

-brown uniformally pigmented papules with

-well-defined borders

Front 168

What are the three histological patterns of melanocytic nevi?

Back 168

1. junctional

2. compound

3. dermal

Front 169

1. junctional: nests (theques) of nevus cells at ___________________

2. compound: nests (theques) of nevus cells at the _____________________________ and ________

3. dermal: nests (theques) of nevus cells in __________

Back 169

1. junctional: nests (theques) of nevus cells at dermoepidermal junction

2. compound: nests (theques) of nevus cells at the dermoepidermal junction and CT

3. dermal: nests (theques) of nevus cells only in CT

Front 170

What is the most important clinical sign of melanoma?

Back 170

change in size or color of a pigmented lesion

Front 171

Clinical warning signs of melanoma:

Back 171

1. rapid enlargement of preexisting mole

2. pruritis (itching or pain in lesion)

3. development of new pigmented lesions as an adult

4. irregular borders

Front 172

Radial growth phase

Back 172

-the initial tendency of a melanoma to grow horizontally within epidermis and superficial dermis

-can't metastasize (no deep tissue invasion)

Front 173

Vertical growth phase

Back 173

-melanoma grows downward into deeper dermis

-expansile mass

-metastatic potential

Front 174

Morphology of melanoma

Back 174

-melanoma cells larger than nevus cells

-large nuclei with irregular contours and prominent red nucleoli

-poorly formed nests in the epidermis and dermis

-no cellular maturation

Front 175

___________ growth phase of melanoma determines the biologic behavior of melanoma

Back 175

vertical

Front 176

Large nuclei, RED NUCLEOLI and no cellular maturation

Back 176

Melanoma

Front 177

Generalized metabolic bone disease characterized by reduced bone mass with susceptibility to fracture:

Back 177

Osteoporosis

Front 178

Is the bone matrix normal in osteoporosis?

Back 178

yes, but there is considerably less of it

Front 179

Metabolic bone disease such as _____________ usually effects the __________ __________.

Back 179

Osteoporosis; entire skeleton

Front 180

What is the main feature of osteoporosis?

Back 180

osteopenia -reduced bone mass (normal matrix)

Front 181

Osteonecrosis of the jaw, decreased estrogen, vitamin D, fracture, normal blood lab values:

Back 181

osteoporosis

Front 182

Regional disorder of osseous remodeling resulting in enlarged deformed bones

Back 182

Paget's disease

Front 183

Paget's disease is a disease of bone ________ that results in bones which are ______ than normal.

Back 183

remodeling; larger

Front 184

"matrix madness"

Back 184

Paget's disease

Front 185

Etiology:

-slow viral infectoin (paramyxovius)

-hereditary predisposition

-mutation SQSTM1 gene - NF - kappaB

Back 185

Paget's disease

Front 186

Paget's disease is usually _____, meaning more than one bone is invovled.

Back 186

polyostotic

Front 187

Oral, head and neck manifestations of Paget's disease:

Back 187

-enlarged calvarium

-leontiasis ossea (facial deformity)

-osteoporosis circumscripta ( cotton wool appearance)

-enlarged alveolar ridges

Front 188

Histological ft Paget's disease:

Back 188

-increased osteoclast activity

-increased osteoblast activity

-disorganized architecture

-vascular fibrous marrow

Front 189

Clinical lab findings of Paget's disease:

Back 189

elevated serum alkaline phosphatase

elevated urinary hydroxyproline, hydroxylysine (due to collagen turnover)

Front 190

Elevated serum alkaline phosphatase

Elevated urinary hydroxyproline, hydroxylysine

Back 190

Lab findings indicative of Paget's disease

Front 191

________ can lead to osteosarcoma (1%)

Back 191

Paget's disease

Front 192

Complications/ clinical ft. of Paget's disease:

Back 192

-orthopedic deformation

-verterbral fractures (back pain)

-osteoarthritis

-calvarial enlargement (headache)

Front 193

Paget's disease might result in difficult dental extractions due to ___________

Back 193

hypercementosis

Front 194

Benign bone-forming tumor with predilection for the craniofacial bones and associated with familial adenomatous polyposis syndrome

Back 194

Osteoma

Front 195

familial adenomatous polyposis syndrome is likely underlying _________ formation

Back 195

osteoma

Front 196

precancerous changes in the cervical epithelium associated with HPV __ and __

Back 196

cervical intraepithelial neoplasia (CIN); 16 and 18

Front 197

Morphology of cervical intraepithelial neoplasia

Back 197

CIN I: mild dysplasia

CIN II: moderate dysplasia

CIN III: severe dysplasia

koilocytosis -squamous epithelial cells infected with papilloma virus(also seen in condolyoma acumentata venereal warts from 6 and 11)

Front 198

Invasive carcinoma of the cervix is preceded by ___________, cause by __________, and is usually ___________ cell carcinoma.

Back 198

cervical intraepithelial neoplasia; HPV 16, 18; squamous

Front 199

abnormal vaginal bleeding

leukorrhea

painful intercourse

dysuria

Back 199

invasive carcinoma of the cervix

Front 200

the most common cancer of the female genital tract

Back 200

endometrial carcinoma

Front 201

endometrial carcinoma is due to ________ and ________ in perimenopausal women.

Back 201

-estrogen excess

-endometrial hyperplasia

Front 202

leukorrhea

irregular bleeding in postmenopausal women

Back 202

endometrial carcinoma

Front 203

benign tumor derived from smooth muscle; "fibroid;" occur in as many as 50% of women; stimulated by estrogen and oral contraceptives

Back 203

leiomyoma

Front 204

Leiomyomas are whorled bundles of smooth muscle that are often asymptomatic but may manifest with symptoms of _____ or _____

Back 204

menorrhagia (heavy/prolonged menstruation)

metrorrhagia (bleeding unrelated to menstruation)

Front 205

The most common breast abnormality in reproductive women; arrises due to cyclic breast changes throughout menstrual cycle; NOT related to estrogen therapy or oral contraceptive use

Back 205

fibrocystic breast disease

Front 206

The fibrocystic breast change associated with increased risk of breast carcinoma:

Back 206

atypical ductal or atypical lobular hyperplasia

Front 207

most common benign neoplasm of the female breast due to an increase in estrogen (most common in 20's) NEVER BECOME MALIGNANT

Back 207

fibroadenoma

Front 208

What is the lifetime risk of breast carcinoma in the US?

Back 208

1 in 8

Front 209

most common in white women over 50; risk increases with prolonged hormone replacement tx (exogenous estrogen)

Back 209

carcinoma of breast

Front 210

List the genetic changes that predispose breast carcinoma:

Back 210

-overexpression of HER2/NEU protooncogene

-amplification of RAS and MYC genes

-mutations of RB and TP53 tumor supressor genes

-mutations in BRAC1 and BRAC2

Front 211

central lesions and those in the outer quadrants metastasize to ______ nodes

Back 211

axillary

Front 212

lesions in the medial inner quadrants metastasize to the _____ nodes

Back 212

internal mammary nodes

Front 213

carcinoma of the breast spreads via

Back 213

hematogenous and lymphatic routes

Front 214

the presence of _______ or ______ receptors confers a better prognosis regarding breast carcinoma.

Back 214

estrogen or progesterone

Front 215

tumors with estrogen or progesterone receptors respond to ______

Back 215

tamoxifen (antiestrogen therapy)

Front 216

overexpression of _______ is assocaited with a poor prognosis (breast carcinoma) and tumors with this overexpression should be treated with _______.

Back 216

HER2/NEU proto-oncogenes ; HERceptin (inhibits HER2/NEU function)

Front 217

familial adenomatous polyposis syndrome

Back 217

associated with osteomas and Gardner's syndrome

Front 218

Associated with familial adenotamous polyposis syndrome, APC gene, autosomal dominant inheritance, multiple osteomas, supernumerary and impacted teeth, increased risk of thyroid cancer, intestinal adentomatous polyps which usually progress to adenocarcinoma

Back 218

Gardner's syndrome

Front 219

benign bone-forming tumor involving the cortex of long bones characterized by severe pain

Back 219

osteoid osteoma

Front 220

benign bone-forming tumor involving the spine with similar mesenchymal odontogenic tumor

Back 220

osteoblastoma

Front 221

bone tumor in vertebral column

Back 221

osteoblastoma

Front 222

What are the two variants of osteoblastoma?

Back 222

1. aggressive osteoblastoma

2. benign cementoblastoma

Front 223

severe pain that is passivated by aspirin is observed in ____ _____

Back 223

osteoid osteomas

Front 224

low grade, chronic aching pain is associated with _______

Back 224

osteoblastomas

Front 225

What is the only histological difference between osteoblastoma and osteoid osteoma?

Back 225

osteoblastoma has less reactive bone sclerosis

Front 226

osteoblastoma is rare in the _____; most like a _____________ if found here

Back 226

jaw; chrondroblastoma

Front 227

malignant bone forming tumor involving metaphysis of long bones during adolescence

Back 227

osteosarcoma

Front 228

What is the classic presentation for osteosarcoma?

Back 228

teenage boy with painful mass around knee

Front 229

most common site of osteosarcoma:

Back 229

-metaphysis of long bones

-distal femur, proximal tibia, humerus

Front 230

Most common primary bone malignancy

Back 230

osteosarcoma

Front 231

Clinical laboratory findings associated with Paget's disease:

Back 231

elevated serum alkaline phophatase

elevated urinary hydroxyproline and hydroxylysine

Front 232

secondary osteosarcoma is associated with _______________

Back 232

Paget disease

Front 233

which is smaller: osteoid osteoma or osteoblastoma?

Back 233

osteoid osteoma

Front 234

Codman triangle is associated with _____

Back 234

osteosarcoma

Front 235

What is Codman's triangle?

Back 235

periosteal reaction observed radiographically in patients with osteosarcoma

reactive woven bone laid down around growing tumor

Front 236

Sunburst pattern -osteoid production (radial spicules)

widened PDL

Calcified matrix above alveolar crest after extraction

Spiking root resorption

Back 236

Osteosarcoma!

Front 237

sarcomas of the ____ and ____ are better differentiated and exhibit later metastasis

Back 237

head and neck

Front 238

Histological features of osteosarcoma:

Back 238

-pleomorphic malignant mesenchymal cells

-spindled/polygonal morphology

-osteoid production

-osteoblastic, chrondroblastic, fibroblastic

-atypical mitotic figures

-necrosis

Front 239

Malignant primitive neuroectodermal tumor of bone and soft tissue occurring in childhood (small, round, blue cell tumor or childhood)

Back 239

Ewing sarcoma

Front 240

Ewing sarcoma most often occurs in ...

Back 240

diaphysis of long bones

Front 241

Histological features of Ewing sarcoma

Back 241

-permeative sheets of hyperchromatic small round cells

-hemorrhage, necrosis

Front 242

What special tests are needed for the diagnosis of Ewing sarcoma?

Back 242

electron microscopy

cytogenetics

immunohistochemistry

histochemistry

Front 243

Benign cartilage forming tumor involving the mature hyaline cartilage of small tubular bones of the hands (and feet).

Back 243

Chondroma (endochondroma)

Front 244

List two multiple chondroma syndromes

Back 244

1. Ollier's syndome

2. Maffucci's syndrome

Front 245

Maffucci's syndrome is characterized by:

Back 245

-multiple endochondromas

-soft tissue hemangiomas

-ovarian carcinomas

-brain gliomas

-risk of transformation into chondrosarcoma

Front 246

Malignant cartilage forming tumor involving the central axial skeleton in older adults

Back 246

Chondrosarcoma

Front 247

2nd most common primary malignant bone tumor

Back 247

chrondrosarcoma

Front 248

most common primary malignant bone tumor?

Back 248

osteosarcoma

Front 249

does chrondroma formation have a sex predilection? chondrosarcoma?

Back 249

chondroma -no

chondrosarcoma - male

Front 250

what is the most common location for a chrondrosarcoma to arise in the head and neck region?

Back 250

layrnx

Front 251

Histology of chondrosarcoma:

Back 251

-lobular growth

-infiltrative

-increased cellularity

-round/spindle cells

-binucleation

Front 252

most common site for chondrosarcoma

Back 252

central skeleton: pelvis, proximal femur, ribs, shoulder girdle

Front 253

non-neoplastic replacement of normal bone by fibrous tissue and disordered trabeculae of woven bone

Back 253

fibrous dysplasia

Front 254

McCune-Albright syndrome

Back 254

Fibrous dysplasia; young female women, cafe-au-lait macules --> Lichtenstein syndrome

Endocrine abnormalities: hyperthyroidism and Cushing's syndrome

Front 255

Craniofacial fibrous dysplasia occurs more often in the _______ than _________

Back 255

maxilla> mandible

Front 256

Oral and maxillofacial manifestations of craniofacial fibrous dysplasia:

Back 256

-painless swelling

-facial asymmetery

-diffuse

-not well circumscribed

-malocclusion

-radiographically: ground glass

Front 257

Histology of fibrous dysplasia:

Back 257

-woven bone

-fibrous stroma

-no osteoblastic lining

(fibrous proliferation replaces normal bone)

Front 258

radiation tx should be avoiding in patients with _______

Back 258

fibrous dysplasia; could progress to osteosarcoma

Front 259

What is the most common form of cancer occurring in bone?

Back 259

Metastatic disease: cancer spreading to bone

Front 260

What are the most common cancers that metastasize to bone?

Back 260

Breast

Lung

Thyroid

Kidney

Prostate

(BLT and a Kosher pickle) : D

Front 261

What is the histology of metastatic bone disease?

Back 261

infiltrating nests and cords of pleomorphic epithelial cells with fibrous stroma

Front 262

______ is caused b y degeneration of articular cartilage as a consequence of aging

Back 262

arthritis.

Front 263

what is the % incidence of arthritis in the above 65 age group?

Back 263

80-90%

Front 264

Where is arthritis most commonly observed?

Back 264

oligoarticular - weight bearing joints

hipes, knees, hands

Front 265

enburnation

Back 265

the polished, ivory appearance of exposed bone due to deterioration of articular cartilage in arthritis

Front 266

Arthritis caused by deposition of urate crystals in joints leading to inflammation and tissue injury

Back 266

Gouty arthritis

Front 267

The urate crystals in gouty arthritis are associated with defective _________ metabolism.

Back 267

purine

Front 268

Gouty arthritis is associated with genetic deficiency like ...

Back 268

Lesch- Nyhan syndrome

Front 269

tophi

Back 269

deposits of urate crystals in soft tissue, sometimes surrounding the joint in gouty arthritis

Front 270

most common sites for gouty arthritis:

Back 270

big toe, foot, wrist

Front 271

Podagra

Back 271

pain in the big toe caused by gout

Front 272

inhereted degenerative disease of muscle caused by abnormal structural protein

Back 272

muscular dystrophy

Front 273

in muscular dystrophy the structural protein ___________ is defective or missing. This is determined via ____ or _____.

Back 273

Dystrophin; western blot analysis or immunohistochemical staining

Front 274

Duchenne muscular dystrophy

Back 274

The most common type of muscular dystrophy in which the dystrophin molecule is missing altogether.

Front 275

-high serum creatine kinase levels

-relentless progression

-wheelchair bound in adolescence

-death in early adulthood

Back 275

Duchenne muscular dystrophy

Front 276

Becker muscular dystrophy

Back 276

less common that Duchenne, dystrophin molecule is defective not missing

Front 277

Is muscular dystrophy sex-linked?

Back 277

si, x-linked; Xp21 in males

Front 278

autoimmune disease causing blockade of neuromuscular transmission and weakness

Back 278

myasthenia gravis

Front 279

antibodies to acetylcholine receptor; blockage of neuromuscular transmission

Back 279

myasthenia gravis

Front 280

thymus hyperplasia and thymomas

Back 280

myasthenia gravis

Front 281

myofibril atrophy and lymphorrhages

Back 281

myasthenia gravis