Pathology Flashcards: Cellular Stress & Inflammation

TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISITIAN JERELL COSME For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. IMPORTANT LEGAL INFORMATION The handouts, videos and other review materials, provided by Topnotch Medical Board Preparation Incorporated are duly protected by RA 8293 otherwise known as the Intellectual Property Code of the Philippines, and shall only be for the sole use of the person: a) whose name appear on the handout or review material, b) person subscribed to Topnotch Medical Board Preparation Incorporated Program or c) is the recipient of this electronic communication. 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Topnotch review materials are updated every six (6) months based on the current trends and feedback. Please buy all recommended review books and other materials listed below. THIS HANDOUT IS NOT FOR SALE! This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. PATHOLOGY FLASHCARDS By Christian Jerell S. Cosme, MD PATHOLOGY FLASHCARDS QUIZLET 2024 https://qrs.ly/8bfkepi Your Mother Goose will announce the password CELLULAR RESPONSES TO STRESS QUESTIONS The two (2) consistent features of reversible cell injury Increase in cell NUMBER due to increased workload or compensatory response Increase in cell SIZE due to hormonal stimulation or compensatory response Decrease in cell size and/or number due to loss of innervation, loss of blood supply, etc. Differentiated cell type replaced by another Most common type of metaplasia Type of metaplasia in Barrett’s esophagus Degradation of this molecule causes increased cytoplasmic eosinophilia in necrotic cells Decreased basophilia of chromatin Nuclear shrinkage with increased basophilia Fragmentation of pyknotic nucleus Pattern of necrosis in the setting of ischemia in most organs; (+) “ghost cells” preserved cell architecture, loss of nucleus All organs undergo coagulative necrosis following ischemia, except: Pattern of necrosis occurring in bacterial infections and ischemic necrosis of the brain; due to neutrophilic enzymes; (+) pus ANSWERS Cellular swelling, Fatty change QUESTIONS Pattern of necrosis due to loss of blood supply in a limb; can be dry or wet (superimposed with bacterial infection) Pattern of necrosis characterized by cheese-like friable foci of necrosis and structureless collection of lysed cells and amorphous debris; seen in tuberculous infections Pattern of necrosis seen in acute pancreatitis; (+) chalky-white areas of saponification, (+) basophilic calcium deposits Pattern of necrosis characterized by pink, amorphous material in the walls of arteries; due to immune complex deposition Most characteristics feature of apoptosis Pathologic calcification that occurs in necrotic tissue in the setting of normal serum calcium levels Sand-like lamellated dystrophic calcifications seen in papillary cancers Pathologic calcification that occurs in viable tissue in the setting of hypercalcemia Pyknosis Karyorrhexis Vasodilating eicosanoids Hyperplasia Atrophy Metaplasia Squamous metaplasia Intestinal metaplasia Nucleic acids Karyolysis Coagulative necrosis Brain Liquefactive necrosis Gangrenous necrosis Caseous necrosis Fat necrosis Fibrinoid necrosis Chromatin condensation Dystrophic calcification Psammoma bodies Metastatic calcification INFLAMMATION AND REPAIR QUESTIONS The two (2) consistent features of reversible cell injury Transmigration of leukocytes across the endothelium i.e. postcapillary venules Movement of leukocytes towards a chemotactic signal Most common exogenous chemotactic product Endogenous chemotactic signals Vasoactive amine that causes vasodilation and increased vascular permeability; produced by mast cells, platelets, and basophils Vasoactive amine that causes vasoconstriction; produced by platelets and neuroendocrine cells Parent molecule of eicosanoids Hypertrophy ANSWERS Vasoconstricting eicosanoids Cytokine that has a significant role in fever Complement system pathway activated by antibodies Complement system pathway activated by antibodies Deficient complement proteins associated with increased risk to Neisseria infections Complement proteins acting as anaphylatoxins ANSWERS Cellular swelling, Fatty change Diapedesis Chemotaxis N-formylmethionine IL-8, C5a, leukotriene B4 Histamine Serotonin Arachidonic Acid PGI2 (Prostacyclin, PGE1, PGE2, PGD2 TXA2, LTC4, D4, E4 IL-1, TNF Classical pathway Alternative pathway Late components or Membrane attack complex (C5b, C6-C9) TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISTIAN JERELL S. COSME For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. C3a, C5a Page 1 of 27 TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISITIAN JERELL COSME For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. QUESTIONS Most common complement deficiency An autosomal dominant disease caused by deficiency in C1 inhibitor Hallmark of acute inflammation Cells involved in chronic inflammation Pattern of inflammation in TB or foreign body deposition Hallmark of granuloma Acute phase protein that causes red blood cells to form stacks (rouleaux) Reduces availability of iron to erythroid precursors in marrow; Causes anemia of chronic inflammation Most important source of growth factors during repair Examples of stable tissues quiescent but with limited capacity to proliferate in response to tissue injury and loss Examples of permanent tissue - terminally differentiated and nonproliferative Hallmark of repair Scar tissue that does not grow beyond the boundaries of the original wound Scar tissue grows beyond the boundaries of the original wound; more common in African American ANSWERS C2 Hereditary angioedema Dilation of small blood vessels and accumulation of leukocytes and fluid in the extravascular tissue Macrophage, lymphocytes Chronic granulomatous Epithelioid cells Fibrinogen Hepcidin Macrophage Liver, Kidney, Pancreas, Endothelium, Fibroblasts, Smooth muscle Neurons, Cardiac and skeletal myocytes Granulation tissue Hypertrophic scar Keloid HEMODYNAMIC DISORDERS QUESTIONS Mechanism of edema or effusion in heart failure Mechanism of edema or effusion in nephrotic syndrome or liver cirrhosis Mechanism of edema or effusion in burns or infections Mechanism of edema or effusion in tumors, filariasis, post-radiation fibrosis, postlymphadenectomy in breast cancer Type of effusion characterized by increased protein content, specific gravity, fibrin, and inflammatory cells Increased in blood volume in tissues due to arteriolar dilation; an active process Increased in blood volume in tissues due to reduced outflow; a passive process Engorged alveolar capillaries, septal edema, and focal intraalveolar hemorrhage (+) Hemosiderin-laden macrophages (heart failure cells); fibrotic septa ANSWERS ↑ Hydrostatic pressure ↓ Oncotic pressure ↑ Vascular permeability Lymphatic obstruction Exudate Hyperemia Congestion Acute pulmonary congestion Chronic pulmonary congestion QUESTIONS Distended central vein and sinusoids, centrilobular ischemic necrosis, periportal fatty change Nutmeg liver, (+) hemosiderin-laden macrophages, hepatocyte dropout and necrosis Initial step in hemostasis that occurs due to reflex neurogenic mechanisms and endothelin Vitamin K-dependent proteins that act together as anticoagulants Main factor of fibrin degradation Vrichow triad of thrombosis Most common inherited thrombophilia; FV becomes resistant to Protein C inactivation Type of thrombosis that occurs due to turbulence/endothelial injury; retrograde propagation Common sites involved in arterial thrombosis Type of thrombosis that occurs due to stasis; anterograde propagation Most common site involved in venous thrombosis Detached intravascular mass that is carried by the blood from its point of origin to a distant site Most common form of thromboembolic disease Most common source of pulmonary embolism Type of pulmonary embolism that causes sudden death; located at the pulmonary artery bifurcation Most common source of systemic thromboembolism that results in end-organ ischemia Type of embolism associated with long bone fractures and soft tissue trauma 5th most common cause of maternal mortality worldwide, occurs in immediate postpartum Specific form of air embolism seen in divers who did rapid ascent; (+) bends and chokes Area of ischemic necrosis caused by vascular occlusion Type of infarct in solid organs with end-arterial circulation Type of infarct occurring due to venous occlusion in spongy tissues or organs with dual blood supply State in which diminished cardiac output or reduced effective circulating blood volume impairs tissue perfusion and leads to cellular hypoxia ANSWERS Acute hepatic congestion Chronic hepatic congestion Arteriolar vasoconstriction Protein C, Protein S Plasmin Endothelial injury, Abnormal blood flow, Hypercoagulability Factor V Leiden Arterial thrombosis Coronary > Cerebral > Femoral Venous thrombosis Lower extremity veins (90%) Embolus Pulmonary embolism Deep venous thrombosis Saddle embolus Mural thrombi Fat embolism Amniotic fluid embolism Decompression sickness TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISTIAN JERELL S. COSME For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Infarct White infarct Red infarct Shock Page 2 of 27 TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISITIAN JERELL COSME For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. QUESTIONS Type of shock seen in MI, arrhythmia, cardiac tamponade, tension pneumothorax Type of shock seen in hemorrhage, diarrhea Stage of shock where worsening circulatory and metabolic derangement (lactic acidosis) is observed Stage of shock refractory to corrective measures ANSWERS Cardiogenic shock Hypovolemic shock Progressive Irreversible GENETIC DISORDERS QUESTIONS One dominant allele is enough to produce phenotype (heterozygous) AD disorder characterized by a defect in fibrillin-1 gene (chromosome 15) Most striking feature in Marfan syndrome Most life-threatening feature in Marfan syndrome Two recessive alleles produce phenotype AR disorder with a defect in hexosaminidase A causing accumulation of GM2 ganglioside in neurons and retina AR disorder with sphingomyelinase deficiency Most common lysosomal storage disorder; (+) crumpled tissue paper on PAS Usually males express phenotype; Females may express the phenotype (due to inactivation of one X chromosome) X-linked recessive blood disorders Example of X-linked dominant disorders Most common chromosomal disorder; leading cause of mental retardation Edward syndrome Patau syndrome Most common chromosomal abnormality in Klinefelter syndrome Most consistent finding in Klinefelter syndrome Heart abnormality associated with Klinefelter syndrome Single most important cause of primary amenorrhea Most common chromosomal defect in Turner Syndrome ANSWERS QUESTIONS Defect in Fragile X syndrome Most distinctive feature in Fragile X syndrome CAG expansion; dementia + movement disorders Deletion in paternallyderived chromosome 15; (+) obesity, hyperphagia, short stature Deletion in maternallyderived chromosome 15; inappropriate laughter “happy puppet” Examples of mitochondrial disorders (maternal inheritance) Autosomal dominant (AD) Marfan syndrome Skeletal abnormalities e.g. pectus excavatum / carinatum, dolichocephalic, kyphosis/scoliosis Cardiovascular abnormalities e.g. MVP, aortic dissection, aortic insufficiency Autosomal recessive (AR) Tay-Sachs disease Niemann-Pick disease Gaucher disease X-linked recessive (XR) Hemophilia A and B, G6PD deficiency, CGD Alport syndrome and Vitamin D-resistant rickets Trisomy 21 Trisomy 18 Trisomy 13 47XXY (90%) Hypogonadism Mitral valve prolapse (50%) Turner syndrome 45XO Most important cause of increased mortality in children with Turner syndrome Cardiovascular abnormalities (preductal CoA, bicuspid aortic valve, aortic root dilation, aortic dissection) 2nd most common cause of mental retardation after Trisomy 21 Fragile X syndrome ANSWERS CGG expansion Macroorchidism Huntington disease Prader-Willi syndrome Angelman Syndrome Mitochondrial myopathy, Encephalopathy, Lactic Acidosis and Stroke (MELAS), Leber Hereditary Optic Neuropathy (LHON) DISEASES OF THE IMMUNE SYSTEM QUESTIONS Only cell in the body that can produce antibodies Most important antigenpresenting cell for initiating T-cell responses against protein antigens Type of antibody that can cross the placenta IgE-mediated type of hypersensitivity Examples of Type I hypersensitivity Antibody-mediated type of hypersensitivity Examples of type II hypersensitivity Immune complex-mediated type of hypersensitivity Most common sites of immune complex deposition Examples of type III hypersensitivity T cell-mediated or delayed type of hypersensitivity Examples of type IV hypersensitivity HLA type associated in seronegative spondyloarthropathies Most sensitive and best screening test for SLE Specific test for SLE that correlates with disease activity Autoantibody associated with drug-induced lupus Autoantibody associated with neonatal lupus and congenital heart block ANSWERS B Lymphocytes i.e. Plasma cells Dendritic cells IgG Type I or Immediate hypersensitivity Asthma, anaphylaxis, allergies Type II Immune hemolytic anemia, Rheumatic fever, Myasthenia gravis, Goodpasture syndrome, Graves disease Type III Kidneys, joints SLE, PSGN, Polyarteritis nodosa, Reactive arthritis Type IV RA, T1DM, TST, IBD, Psoriasis, Multiple sclerosis, contact sensitivity HLA-B27 AAnti-nuclear antibody (ANA) Anti-dsDNA Anti-histone Anti-Ro (SS-A)/ Anti-La (SSB) Antiphospholipid antibodies Anticardiolipin and β2glycoprotein I Autoimmune disease directed against lacrimal and salivary glands; (+) xerostomia (dry mouth) & keratoconjunctivitis sicca (dry eyes) Sjogren syndrome (SS) TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISTIAN JERELL S. COSME For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Page 3 of 27 TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISITIAN JERELL COSME For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. QUESTIONS Most important and most common associated autoantibodies associated with SS Earliest histologic finding in SS Most common associated disease with SS Patients with SS have increased risk to develop what type of malignancy EXcessive fibrosis throughout the body Type of scleroderma that has widespread skin involvement, rapid progression, early visceral involvement Autoantibody associated with diffuse scleroderma Type of scleroderma with limited skin and visceral involvement Clinical features of CREST syndrome Autoantibody associated with limited scleroderma Disease with clinical features that overlap with those of SLE, systemic sclerosis, and polymyositis Autoantibody associated with mixed connective tissue disease AR disease associated with selectin/integrin abnormalities; (+) delayed separation of the umbilical cord, omphalitis XR disease characterized by NADPH oxidase deficiency; (+) susceptibility to catalasepositive organism XR disease characterized by failure of B cell maturation; respiratory and GIT infections at 6 months of age Defect in DiGeorge syndrome Clinical features of DiGeorge syndrome Triad of Wiskott-Aldrich Syndrome Most serious secondary immunodeficiency Most abundant HIV antigen; detected in screening tests for HIV infection First stage of infection with HIV; Symptoms include flulike illness, rash, cervical adenopathy, diarrhea, vomiting ANSWERS Anti-Ro (SS-A) Anti-La (SSB) Periductal and perivascular lymphocytic infiltration Rheumatoid arthritis Lymphoma Systemic Sclerosis (Scleroderma) Diffuse scleroderma Anti DNA topoisomerase I (anti-Scl 70) Limited scleroderma or formerly known as CREST syndrome Calcinosis, Raynaud phenomenon, Esophageal dysmotility, Sclerodactyly, Telangiectasia Anti-centromere Mixed Connective Tissue Disease Anti-U1-RNP Leukocyte Adhesion Deficiency Chronic Granulomatous Disease Bruton agammaglobulinemia Chromosome 22q11 deletion→Failure of development of pharyngeal pouches (thymus and parathyroid glands) CATCH22 – Cardiac abnormalities, abnormal facies, thymic aplasia, cleft palate, hypocalcemia/ hypoparathyroidism Thrombocytopenia (with small platelets), Recurrent infections, Eczema Acquired immunodeficiency syndrome (AIDS) p24 Acute Retroviral Syndrome or Acute HIV Syndrome QUESTIONS Examples of AIDS-defining illnesses Most common fungal infection associated with AIDS Most common neoplasm associated with AIDS; causes by HHV-8 Most common type of lymphoma in AIDS Hemodialysis-associated amyloid protein Amyloid protein in Alzheimer disease Most common and potentially most serious form of organ involvement ANSWERS Opportunistic infections, secondary neoplasms, CNS disease Candidiasis Kaposi Sarcoma B-cell Lymphoma Aβ2m: β2- microglobulin Aβ: Amyloid precursor protein Renal involvement NEOPLASIA QUESTIONS Formation of abundant collagenous stroma in response to parenchymal cells Tumor containing recognizable mature or immature tissues belonging to more than one germ cell layer Disorganized mass composed of cells indigenous to the involved tissue Term applied to heterotopic (misplaced) but organized rest of cells (aka heterotopia, ectopia) Lack of differentiation; Hallmark of malignancy Architectural disarray, loss of orderly maturation, and cytologic atypia confined within the epithelium; “disordered growth” Unequivocal marker of malignancy Route of dissemination typically seen in carcinomas Route of dissemination typically seen in sarcomas Most favored sites of hematogenous spread Most common cancer in males Most common cancer in females Most common cause of cancer death in both males and females Normal gene whose products promote cellular proliferation Most common type of abnormality involving protooncogenes in human tumors Tumor suppressor gene that regulates G1-S checkpoint; governor of proliferation Most frequently mutated gene in human cancers Cancer associated with cholangitis or Opsithorchis viverrini infection Cancer associated with Hashimoto thyroiditis and Sjogren syndrome Asbestosis-related cancers ANSWERS Desmoplasia Teratoma Hamartoma Choristoma Anaplasia Dysplasia Metastasis Lymphatic spread Hematogenous spread Lungs, liver Prostate cancer Breast cancer Lung cancer Proto-oncogene RAS RB TP53 Extrahepatic cholangiocarcinoma Marginal zone lymphoma Mesothelioma, lung carcinoma TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISTIAN JERELL S. COSME For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Page 4 of 27 TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISITIAN JERELL COSME For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. QUESTIONS Cancer associated with Schistosoma haematobium infection HPV-associated cancers HTLV-1-associated cancer Vinyl chloride-associated cancer Cadmium-associated cancer Benzene-associated cancer Signs and symptoms not referable to the anatomic distribution of the tumor; due to hormones or substances elaborated by the tumor Most common endocrinopathy Most common paraneoplastic syndrome Serum abnormalities observed in tumor lysis syndrome Tumor marker for medullary thyroid carcinoma Tumor marker for hepatocellular carcinoma, nonseminomatous germ cell tumors of testis ANSWERS Bladder squamous cell carcinoma Oropharyngeal, Cervical, Vulvar, Penile carcinomas Adult T cell leukemia/lymphoma Hepatic angiosarcoma Prostate cancer Acute myeloid leukemia Paraneoplastic syndrome Cushing syndrome Hypercalcemia Hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia Calcitonin α-fetoprotein (AFP) INFECTIOUS DISEASES QUESTIONS Multinucleated giant cells with eosinophilic nuclear and cytoplasmic inclusion bodies seen in measles infection Ulcerated mucosal lesions in oral cavity near opening of Stensen duct in measles Most common extra salivary gland complication in mumps Causative agent of cold sores, herpetic whitlow Causative agent of genital herpes α-herpesviruses β-herpesvirus γ-herpesvirus Large cell and nucleus with intranuclear basophilic inclusions with surrounding clear halo (Owl’s eye) EBV-associated malignancies Causative agent of infectious mononucleosis Clinical form of leprosy characterized by intact cellmediated immunity, (+) Lepromin skin test, and asymmetric nerve involvement with granulomatous inflammation Clinical form of leprosy characterized by depressed cell-mediated immunity, symmetric nerve involvement, (-) Lepromin skin test, and (+) Lepra cells Most common extrapulmonary manifestation of TB ANSWERS Warthin-Finkeldey cells Koplik spots Aseptic meningitis HSV-1 HSV-2 HSV-1, HSV-2, VZV CMV, HHV-6, HHV-7 EBV, HHV-8 QUESTIONS Most commonly involved segment of the intestine in gastrointestinal TB Components of Ghon complex Ileum Ghon focus +pulmonary hilar node involvement Anogenital painless lesion in primary syphilis Broad-based plaques on skin in secondary syphilis Histologic findings of gummas Causative agent of Lyme disease Expanding area of redness with pale center on tick bite site in Lyme disease Most common zoonotic infection in the world Triad of Weil disease or icteric phase of leptospirosis Most consistent pathologic finding in leptospirosis Most prevalent fungal pathogen of humans; produces a germ tube at 37°C Important cause of CNS infection in immunocompromised patients; (+) capsule Important cause of pneumonia in AIDS patients; stains with Gomori Methenamine Silver Fungi with septate hyphae branching at acute angles Cancer caused by Aspergillus flavus aflatoxin Fungi with non-septate hyphae branching at right angles Most virulent malarial parasite; Most common malarial parasite in the Philippines Benign tertian malaria Quartan malaria Most common cause of death in hepatic schistosomiasis Leading cause of bacterial vaginosis Cytomegalovirus (CMV) Amsel criteria in the diagnosis of bacterial vaginosis (3 out of 4) Nasopharyngeal carcinoma, Burkitt lymphoma, some Hodgkin lymphoma type Painful genital ulcers Causative agent of chancroid EBV Painless genital ulcer Causative agent of LGV Tuberculoid (paucibacillary) ANSWERS Purulent discharge, Gram (-) intracellular diplococci Greenish vaginal discharge with fishy odor, (+) strawberry cervix Chancre Condyloma lata Granuloma with central coagulative necrosis and surrounding plasma cells Borrelia sp. Erythema migrans Leptospirosis Jaundice, renal failure, hemorrhage Capillary vasculitis Candida Cryptococcus neoformans Pneumocystis jirovecii Aspergillosis Liver cancer Mucor Plasmodium falciparum Plasmodium vivax and ovale Plasmodium malariae Cirrhosis Gardnerella vaginalis Thin, white homogenous discharge; clue cells; vaginal fluid pH >4.5; (+) Whiff test - fishy odor upon addition of 10% KOH Chancroid, Granuloma inguinale, Genital herpes Haemophilus ducreyi Chancre, lymphogranuloma venereum (LGV) Chlamydia trachomatis, L1-L3 strain Gonococcal urethritis Trichomoniasis Lepromatous (multibacillary) Lymphadenitis (scrofula) TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISTIAN JERELL S. COSME For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Page 5 of 27 TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISITIAN JERELL COSME For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. ENVIRONMENTAL AND NUTRITIONAL PATHOLOGY QUESTIONS Most common organ system affected by air pollution Systemic, colorless and odorless gas asphyxiant; (+) cherry red discoloration of the skin and mucous membranes Percent saturation of CO that causes death Hemoglobin synthesis enzymes inhibited by lead Hematologic findings observed in lead poisoning Form of gout caused by lead poisoning Disease caused by in utero exposure to methylmercury through ingestion of contaminated fish Known as the king of poisons; Chronic exposure causes keratosis that may progress to squamous cell carcinoma Most prevalent preventable cause of death in man A metabolite of nicotine used as a measure of passive smoking exposure Tobacco smoke compounds that promote carcinogenesis Most commonly abused substance Amount of alcohol that is reported to be protective against coronary artery disease Ethanol metabolite that causes cellular injury by lipid peroxidation and adduct formation Blood alcohol level that causes coma and respiratory arrest Most common thermal injury Most common causes of thermal burns Most common microorganism causing sepsis in burn patients Mechanism of heat cramps Most common hyperthermia syndrome Hyperthermia, hyperkalemia, tachycardia, arrhythmia, and rhabdomyolysis following exposure to anesthetic agents Mutated gene in malignant hyperthermia Most common form of current at home that causes electrical injuries ANSWERS Respiratory system i.e. lungs Carbon Monoxide (CO) 60-70% ALA dehydratase and Ferrochelatase Basophilic stippling, ring sideroblast (iron-laden mitochondria), microcytic hypochromic anemia Saturnine gout Minamata disease Arsenic Smoking Cotinine Tar, Polycyclic aromatic hydrocarbons, Benzopyrene, Nitrosamine Ethanol 20-30 g/day Acetaldehyde ≥ 400 mg/dL Thermal burns Fire, Scalding (in children) Pseudomonas aeruginosa Electrolyte loss through sweating Heat exhaustion Malignant hyperthermia Ryanodine receptor 1 (RYR1) gene Alternating current (AC) QUESTIONS Weight for height ratio that is 3 standard deviations below the normal range Type of SAM occurring due to caloric deficiency; (+) growth retardation, wasting, minimally depleted serum albumin Type of SAM with profound hypoalbuminemia (protein > caloric deficiency, “flaky paint” skin appearance, “flag sign” or alternating bands of pale and darker hair Highest death rate of any psychiatric disorder; selfinduced starvation to promote weight loss Binge eating followed by purging such as vomiting and laxatives or non-purging techniques like obsessive exercising and diet pills Vitamin deficiency associated with squamous metaplasia in ocular, respiratory and skin tissues; (+) night blindness, xerophthalmia Dementia, dermatitis, diarrhea Vitamin deficiency that presents as dry or wet beriberi; causes Wernicke and Korsakoff syndrome with excessive alcohol intake Megaloblastic anemia with neurologic symptoms due to degeneration of the spinal cord Megaloblastic anemia without neurologic symptoms Cancers associated with the increased synthesis of estrogen in obese individuals ANSWERS Severe acute malnutrition (SAM) Marasmus Kwashiorkor Anorexia nervosa Bulimia nervosa Vitamin A Pellagra (Niacin/Vitamin B3 deficiency) Vitamin B1 (thiamine Vitamin B12 Vitamin B9 Breast and endometrial cancers CONGENITAL ANOMALIES QUESTIONS Primary errors of morphogenesis (Intrinsically abnormal developmental process) Secondary destruction of a normally developed organ e.g. amniotic bands compressing fetal parts Extrinsic disturbance of development; most common cause is uterine constraint Cascade of anomalies triggered by one initiating aberration Congenital anomaly associated with thalidomide use Second most common cause of neonatal morbidity, second to congenital anomalies Most common cause of respiratory distress in newborns ANSWERS Malformation Disruption Deformation Sequence Phocomelia Prematurity Neonatal respiratory distress syndrome / X-rays, gamma rays, highMain sources of ionizing Hyaline membrane disease energy neutrons, alpha radiation Pulmonary immaturity and particles , beta particles Surfactant deficiency Effects of whole-body Lymphocytes→bone Fundamental defect in RDS (DPPC: ionizing radiation (in marrow→small dipalmitoylphosphatidylch increasing dose) bowel→brain oline) TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISTIAN JERELL S. COSME Page 6 of 27 For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISITIAN JERELL COSME For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. QUESTIONS ANSWERS Hyaline membranes along alveolar walls: Fibrin + Necrotic Type 2 pneumocytes Ground-glass appearance of the lungs Retinopathy of prematurity, bronchopulmonary dysplasia QUESTIONS Wilms tumor, Organomegaly, macroglossia, hemihypertrophy, omphalocele, adrenal cytomegaly Tumor with a classic triphasic pattern that includes blastemal, epithelial, and stromal components A premature infant presents with hematochezia, abdominal distension, and hypotension following aggressive bottle feeding. Necrotizing Enterocolitis Radiographic findings seen in NEC Pneumatosis intestinalis (gas within the intestinal wall), pneumoperitoneum (severe cases) QUESTIONS Severe blood pressure elevations (> 200/120 mmHg) with renal failure and other end-organ damage Thickened arterial wall with homogenous pink, hyaline material; seen in hypertension, diabetes mellitus Concentric, laminated thickening of the arterial wall composed of smooth muscle cells with thickened, reduplicated basement membrane or “onion-skin lesion”; seen in severe HTN Microscoping finding expected in RDS (not seen in stillborn infants) Typical imaging finding in RDS Diseases associated with hyperoxic injury Excessive accumulation of fluid in 2 or more feta; cavities Primary mechanism of immune hydrops in hemolytic disease of the fetus and newborn (HDFN) Most serious complication of immune hydrops Most common cause of HFDN A newborn presents with jaundice immediately postdelivery. The G2P2 mother is B - while the baby is B +. What is the most likely diagnosis? Recurrent respiratory infections, malabsorption, and increased sweat chloride levels Etiology of cystic fibrosis Most common cause of death in cystic fibrosis Most common cause of death between 1 month to 1 year old in the US Most common tumors of infancy Most common teratoma of childhood Most common malignant pediatric tumor Most common extracranial solid tumor of childhood; Most commonly diagnosed malignancy of infancy Childhood tumor presenting as an abdominal mass that crosses the midline; (+) blueberry muffin skin discoloration; increased blood VMA levels Most common site of neuroblastoma Tumor cells around a central space filled with neuropil; seen in neuroblastoma and medulloblastoma Most common primary renal tumor of childhood Wilms tumor, Aniridia, Genitourinary anomalies, Mental retardation ANSWERS Beckwidth-Wiedemann syndrome (WT2) Wilms Tumor BLOOD VESSELS Fetal Hydrops High-output heart failure to hemolytic anemia → Edema Kernicterus ABO incompatibility Rh incompatibility [Setup: Mother: Rh (-), Fetus: Rh (+), subsequent pregnancy] Non-modifiable risk factors of atherosclerosis Most common sites involved in atherosclerosis Cystic fibrosis CFTR gene (Chromosome 7) mutation Cardiorespiratory complications (persistent lung infections, obstructive pulmonary disease, cor pulmonale) Sudden infant death syndrome (SIDS) Hemangioma Sacrococcygeal teratomas Leukemia Neuroblastoma Neuroblastoma Adrenal medulla Homer-Wright pseudorosettes Nephroblastoma (Wilms tumor) WAGR syndrome (WT1 gene mutation) Level of critical stenosis or at which ischemia starts Localized, abnormal dilatation of the blood vessel or the heart Cytokine involved in the development of aneurysm in Marfan syndrome A 55-year-old male smoker presents with a pulsating abdominal mass Most common site of abdominal aortic aneurysm Blood tunnels through the layers of the vessel wall through an intimal tear→ blood-filled channel within the aortic wall Most common site of aortic dissection A 55-year-old woman complains of headache particularly on the temporal area and blurring of vision. She is also diagnosed with polymyalgia rheumatica. What is the most likely diagnosis? ANSWERS Malignant hypertension Hyaline arteriosclerosis Hyperplastic arteriosclerosis Genetic abnormalities, family history, increasing age, male gender Lower abdominal aorta and iliac arteries > Coronary arteries > Popliteal arteries > Internal carotid arteries > Circle of Willis 70–75% occlusion Aneurysm TGF-β Abdominal aortic aneurysm Between renal arteries and bifurcation of aorta Aortic dissection Ascending aorta within 10 cm of aortic valve Giant cell arteritis or temporal arteritis Histologic finding observed in temporal arteritis Medial granulomatous inflammation with T cells and multinucleated giant cells Immune vasculitis that occurs in individuals <50 years old characterized by weakening of pulses in upper limbs and ocular disturbances. Takayasu arteritis or pulseless disease TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISTIAN JERELL S. COSME For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Page 7 of 27 TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISITIAN JERELL COSME For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. QUESTIONS Medium-vessel immune vasculitis associated with Hepatitis B infection A 3-year-old male presents with a 5-day history of fever, bilateral conjunctivitis, (+) strawberry tongue, erythema of the palms and soles, polymorphous rash and cervical lymphadenopathy. Most commonly involved blood vessels in Kawasaki disease Microscopic finding in microscopic polyangiitis Persistent asthma, allergic rhinosinusitis, joint pains, renal disease, eosinophilia, (+) MPO-ANCA/p-ANCA Most common form of renal disease in Churg-Strauss syndrome Persistent pneumonitis, chronic sinusitis with saddle nose deformity, nasopharyngeal ulcers, glomerulonephritis, (+) PR3ANCA/c-ANCA Large-vessel vasculitides Medium-vessel vasculitides Small-vessel vasculitides Most likely diagnosis in a 60year-old heavy smoker who presents with claudication, Raynaud phenomenon, and gangrenous lower extremity Exaggerated vasoconstriction of the fingers and toes in response to cold or emotion; secondary type is associated with SLE, Scleroderma, Buerger disease Most common etiology of lymphangitis Most common vascular ectasia Most common type of hemangioma Age at which most cases of juvenile hemangioma regresses Type of lymphangioma associated with Turner syndrome Benign tumor from modified smooth muscle cells of arteriovenous structures involved in thermoregulation; subungual in location Clinical form of Kaposi sarcoma that is common in Mediterranean, Middle Eastern, or Eastern European descent (especially Ashkenazi Jews) and has no HIV association Most sensitive and specific endothelial marker for angiosarcoma ANSWERS Polyarteritis nodosa Kawasaki disease Coronary arteries Leukocytoclasia or fragmented neutrophils in post-capillary venules Churg-Strauss syndrome or Eosinophilic granulomatosis with polyangiitis Focal segmental glomerulosclerosis Wegener granulomatosis or granulomatosis with polyangiitis Takayasu arteritis, temporal arteritis Kawasaki disease, polyarteritis nodosa Churg-Strauss syndrome, Wegener granulomatosis, Microscopic polyangiitis Buerger disease or thromboangiitis obliterans Raynaud phenomenon Group A Beta-Hemolytic Streptococci (GABHS) Nevus flammeus (Birthmark) Capillary hemangioma 7 years old Cavernous lymphangioma (Cystic hygroma) Glomus tumor Classic Kaposi sarcoma ERG HEART QUESTIONS Main effect of left-sided heart failure Hemosiderin-laden macrophages in the lungs seen in long standing leftsided heart failure Most common cause of rightsided heart failure Right-sided heart failure as a consequence of increased pulmonary vascular resistance in the setting of primary pulmonary disease Main effect of right-sided heart failure Hallmark of RSHF Most common genetic cause of congenital heart disease (CHD) Acyanotic heart disease Cyanotic heart disease The phenomenon at which L→R shunt becomes R→L (shunt reversal) due to pulmonary vascular remodelling Most common CHD in adults Most common type of ASD Most common CHD (overall) Most common type of VSD Most common cyanotic CHD Four components of Tetralogy of Fallot Main determinant of outcome or prognosis of TOF ANSWERS Pulmonary congestion Heart failure cells Left-sided heart failure Cor pulmonale Systemic/portal venous congestion Dependent edema Trisomy 21 Left-to-right shunts Right-to-left shunts Eisenmenger phenomenon Atrial septal defect Secundum Ventricular septal defect Membranous Tetralogy of Fallot (TOF) Large VSD, Right ventricular outflow tract obstruction, Aorta overriding the VSD, Right ventricular hypertrophy Degree of RVOT obstruction or pulmonic stenosis A known Turner syndrome patient presents with lower extremity cyanosis; CXR: rib notching Coarctation of the Aorta Most common cause of ischemic heart disease Atherosclerosis of epicardial coronary arteries (Coronary artery disease) Type of angina that occurs during vasospasm of a coronary artery Prolonged chest pain, unrelieved by rest, normal cardiac biomarkers Expected light microscopy findings 30 minutes to 4 hours post-MI Time where early coagulative necrosis is observed in the myocardium Most common cause of death within 3-7 days post-MI Most common cause of death within the first 24 hours post-MI Granulation tissue formation is expected at this time postMI Unexpected death from cardiac causes either without symptoms, or within 1 to 24 hours of symptom onset Most common cause of sudden cardiac death Prinzmetal angina Unstable angina None or myocardial waviness 12-24 hours Myocardial rupture Arrhythmia 7-10 days Sudden cardiac death Coronary artery disease TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISTIAN JERELL S. COSME For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Page 8 of 27 TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISITIAN JERELL COSME For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. QUESTIONS Most common mechanism of sudden cardiac death Etiology of left-sided hypertensive heart disease Minimum Pathologic criteria of left-sided HHD Etiology of right-sided hypertensive heart disease Most common cause of rightsided HHD A 65-year-old hypertensive patient presents with dyspnea. PE revealed (+) early diastolic murmur on 2nd ICS, right parasternal border, wide pulse pressure, and (+) De Musset sign, headbobbing synchronous with arterial pulse ANSWERS Arrhythmia (asystole or ventricular fibrillation) Systemic Hypertension Concentric LVH with no other cardiovascular pathology AND History/pathologic evidence of hypertension in other organs Pulmonary hypertension Left-sided heart failure Aortic Regurgitation Most common cause of aortic stenosis Age-related calcification of normal or congenital bicuspid aortic valves Most common cause of mitral regurgitation Mitral valve prolapse Microscoping finding seen in mitral valve prolapse Myxomatous degeneration of spongiosa layer + Attenuation of collagenous fibrosa Non-suppurative cardiac sequelae of Group A Streptococcal pharyngitis Streptococcal antigen that cross-reacts with cardiac selfantigens Granulomatous cardiac lesions composed of T cells, plasma cells, and activated macrophages in ARF Activated plump macrophages seen in Aschoff bodies; also known as “caterpillar cells” because of the wavy, slender chromatin Cardinal morphologic changes in rheumatic heart disease (RHD) Most common cause of mitral stenosis Most common valve affected in rheumatic heart disease Hallmark lesion of infective endocarditis Microorganism associated with acute infective endocarditis in IV drug users Most commonly isolated microorganisms in subacute infective endocarditis Etiology of carcinoid heart disease Affected structures in carcinoid heart disease Type of endocarditis associated with SLE Acute rheumatic fever (ARF) M protein Aschoff bodies Anitschkow cells Leaflet thickening, commissural fusion and shortening, and thickening and fusion of the tendinous cords Rheumatic heart disease Mitral valve Vegetations Staphylococcus aureus Viridans Streptococci, HACEK organisms (HACEK: Haemophilus spp, Aggregatibacter spp., Cardiobacterium spp., Eikenella corrodens, Kingella spp.) Bioactive substances (e.g., serotonin) produced by carcinoid tumors in the setting of massive liver metastatic burden Right heart valves (Tricuspid), Endocardium Libman-Sacks endocarditis QUESTIONS Pathogenesis of Marantic endocarditis Type of cardiomyopathy with reduced ejection fraction Types of cardiomyopathy with preserved ejection fraction Most common type of cardiomyopathy Most common cause of dilated cardiomyopathy Type of cardiomyopathy associated with alcohol and iron excess, childbirth, chronic anemia, and hyperthyroidism Left ventricular contractile dysfunction after extreme psychological stress A young athlete died suddenly with an unexplained cause of death. Post-mortem examination of the heart showed disproportionate thickening of the interventricular septum relative to the free wall. Etiology of restrictive cardiomyopathy Most common helminthic cause of myocarditis Most common cause of myocarditis in the US A McCune-Albright syndrome patient presents with fever, left-sided weakness, dyspnea, and pulmonary edema. 2Decho showed a pedunculated mass in the left atrium. What is the most likely diagnosis? Most common primary tumor of the adult heart Most common primary tumor of the adult heart Beck triad of cardiac tamponade Intense pericarditis weeks post-MI probably due to antibodies against injured pericardium Most common type of acute pericarditis Most common cause of hemorrhagic pericarditis ANSWERS Hypercoagulable state →Thrombosis Dilated cardiomyopathy Restrictive cardiomyopathy, Hypertrophic cardiomyopathy Dilated cardiomyopathy Genetic Dilated cardiomyopathy Takotsubo cardiomyopathy (Broken heart syndrome) Hypertrophic cardiomyopathy Idiopathic, Amyloidosis, Sarcoidosis, Radiationinduced fibrosis, Metastatic tumors, Storage disease Trichinella spiralis Viruses (Coxsackie A/B, enteroviruses) Myxoma Myxoma Rhabdomyoma ↑ jugular venous pressure, arterial hypotension, muffled heart sounds Dressler syndrome Fibrinous/Serofibrinous Malignant tumor WHITE BLOOD CELLS, LYMPH NODES, SPLEEN AND THYMUS QUESTIONS Most common cause of neutropenia Etiopathogenesis of neutropenia in SLE Type of leukopenia observed in advanced HIV Increased WBC count ( ≥ 50×109/L) in the absence of myeloproliferative neoplasm A cytochemical stain used to differentiate leukemoid reaction from CML ANSWERS Drug toxicity Immune destruction Lymphopenia Leukemoid reaction Leukocyte alkaline phosphatase (LAP) (Normal LAP score in leukemoid reaction; Low in CML) TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISTIAN JERELL S. COSME For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Page 9 of 27 TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISITIAN JERELL COSME For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. QUESTIONS Form of lymphadenitis in a patient with rheumatoid arthritis who present with chronic painless lymph node enlargement Expansion of interfollicular (T-cell) zones in lymph nodes during a viral infection A 7-year-old male presents with pallor, recurrent infections, and easy bruising. CBC showed leukocytosis with elevated bands, anemia, and thrombocytopenia. What is the most likely initial diagnosis? Most common cancer in children Immunostain used to identify immature lymphoid process A patient presented with the following results: PBS - (+) Auer rods, (+) Faggot cells. Immunostain - (+) MPO Hematologic emergency associated with acute promyelocytic leukemia Most common leukemia in adults in the Western world Fragile lymphocytes that are flattened in the process of smearing blood of CLL patients Transformation of CLL to Diffuse Large B-cell Lymphoma Etiology of Chronic Myeloid Leukemia (CML) A known CML patient refuses to undergo treatment. 5 years later, PBS showed ≥20% blasts. Which phase is the patient currently in? Dry tap on bone marrow is common in this type of leukemia due to marrow fibrosis or increased reticulin fiber deposition; Immunostain: (+) TRAP Cells with Large, multiple nuclei or single with multiple lobes; each with nucleolus (“Owl-eye nucleus”) Reed-Sternberg cells are seen in which type of lymphoma Most common Hodgkin Lymphoma subtype Least common Hodgkin Lymphoma subtype but has the worst prognosis; seen in HIV patients Staging system used in the prognosis of lymphoma Type of non-Hodgkin lymphoma (NHL) associated with lymphomatous polyposis of the GI tract Most common form of indolent NHL ANSWERS Follicular hyperplasia Paracortical hyperplasia QUESTIONS Type of NHL with bimodal distribution. Typical PBS show starry sky pattern or sheets of medium-sized atypical lymphocytes) with tingible body macrophages Type of lymphocytes elevated in Multiple Myeloma Myeloma-defining events Leukemia Acute lymphoblastic leukemia/lymphoma Tdt (terminal deoxynucleotidyl transferase) Acute myeloid leukemia Disseminated intravascular coagulation Chronic lymphocytic leukemia (CLL) Smudge cells Richter syndrome t(9;22)→BCR::ABL1 fusion (Tyrosine kinase) Blast phase Hairy cell leukemia Protein detected in urine of multiple myeloma patients Serum protein electrophoresis finding in multiple myeloma Hallmark of myelodysplastic syndromes or defective hematopoietic maturation Common mutation in myeloproliferative neoplasms Most likely diagnosis in a patient with facial plethora (redness). pruritus worsened by bathing, and elevated Hgb In primary myelofibrosis, RBCs assume this teardropshaped poikilocyte due to squeezing from fibrotic marrow Chronic venous congestion of the spleen occurs in the setting of Thymic disorder seen in DiGeorge Syndrome Most common thymic disorder associated with myasthenia gravis Most common thymic epithelial tumor Immune paraneoplastic syndrome associated with thymoma Most common histology of thymic carcinoma Lymphocyte-depleted (LDHL) Ann-Arbor stage Clinical features observed in intravascular hemolysis Hodgkin Lymphoma Nodular sclerosis (NSHL) Burkitt Lymphoma Plasma cells CRAB -HyperCalcemia, Renal failure, Anemia, Bone lesions Bence-Jones protein Monoclonal gammopathy (IgG) Dysplasia in one or more myeloid lineages JAK2 V617F mutation Polycythemia vera Dacryocyte Liver cirrhosis Thymic Aplasia Thymic follicular hyperplasia Thymoma Myasthenia gravis Squamous cell carcinoma RED BLOOD CELLS AND BLEEDING DISORDERS QUESTIONS >95% of adult hemoglobin is composed of this type Variability in red cell size Variability in red cell shape Type of hemolytic anemia that occurs due to inherent defects in red cells Type of hemolysis that occurs in the spleen Reed-Sternberg cells ANSWERS ANSWERS HbA1/HbA (Adult hemoglobin): α2β2 Anisocytosis Poikilocytosis Intrinsic hemolysis Extravascular hemolysis Hemoglobinemia, Hemoglobinuria, Hemosiderinuria Viral infection associated Parvovirus B19 infection with aplastic crisis Mantle cell lymphoma Most likely diagnosis in a patient presenting with jaundice and gallstones; Lab Hereditary Spherocytosis Follicular lymphoma findings include ↑ MCHC, ↑ RBC osmotic fragility Diffuse Large B-cell Most common NHL Most common trigger of red Lymphoma cell hemolysis in G6PD Infection Type of NHL associated with Marginal Zone Lymphoma deficiency chronic inflammatory of Mucosa-Associated Precipitated denatured disorders such as H. pylori Lymphoid Tissue hemoglobin seen in G6PD Heinz bodies gastritis, Hashimoto (MALToma) deficiency thyroiditis TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISTIAN JERELL S. COSME Page 10 of 27 For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISITIAN JERELL COSME For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. QUESTIONS Having G6PD deficiency and/or sickle cell trait is protective against which parasitic infection Pattern of inheritance of sickle cell anemia Etiology of sickle cell anemia Most common cause of morbidity and mortality in sickle cell anemia Autosplenectomy causes increased susceptibility to which type of organisms Beta-thalassemia syndrome with 2 mutated β globin genes in chromosome 11 Alpha-thalassemia syndrome with 3 deleted α-globin gene mutations Alpha-thalassemia syndrome with 4 deleted α-globin gene mutations Red cell surface proteins absent in patients with paroxysmal nocturnal hemoglobinuria which increases susceptibility to complement-mediated lysis Most common cause of disease-related death in PNH Most common form of immunohemolytic anemia; Associated with autoimmune diseases (SLE), Lymphoid neoplasms (CLL) Type of antibody in WAIHA Infections associated with cold agglutinin disease Type of antibody in CAD Disease-causing antibody in paroxysmal cold hemoglobinuria, which is common in children postviral infection Possible deficient vitamins in patients with megaloblastic anemia Gastrectomy and autoimmune atrophic gastritis causes vitamin B12 deficiency due to the absence of Parasite that competes with vitamin B12 absorption Features that differentiate Vitamin B12 deficiency from Vitamin B9 deficiency DMARD used in the management of RA that causes Vitamin B9 deficiency Most common nutritional disorder in the world Peptide hormone increased in anemia of chronic disease that prevents mobilization of stored iron BMA: Hypocellular marrow with fat cells and scattered lymphocytes and plasma cells; CBC:Pancytopenia with normocytic, normochromic anemia ANSWERS Malaria Autosomal recessive Point mutation in the βglobin gene (glu→val) Vaso-occlusive (Pain) crises encapsulated organisms (S. pneumoniae and H. influenzae) β- thalassemia major HbH disease Hydrops fetalis CD55, CD59 Venous thrombosis Warm Autoimmune Hemolytic Anemia (WAIHA) IgG active at 37°C Mycoplasma pneumoniae, EBV, CMV, HIV IgM active below 37°C IgG anti-P (DonathLandsteiner antibody) Vitamin B12, B9 Intrinsic factor Diphyllobothrium latum (+) neurologic symptoms due to subacute combined degeneration of spinal cord + ↑ methylmalonate (normal in Vit B9 deficiency) Methotrexate (a folate antagonist) Iron deficiency anemia Hepcidin Aplastic anemia QUESTIONS Most common cause of aplastic anemia (+) Parvovirus B19 infection/autoimmune disease; BMA: Absent erythroblasts with normal granulocytic and megakaryocytic lineages Space-occupying lesions displace bone marrow elements Most common cause of secondary myelophthisic anemia A 5-year-old patient presents with multiple petechiae. He had a URTI 3 days ago and has no significant medical history. CBC: Low platelets Etiology of immune thrombocytopenic purpura Form of ITP that is more common in adults and is associated with SLE, HIV, CLL Thrombotic disease that occurs due to decreased ADAMTS13 level or activity Action of ADAMTS12 Causative agent of typical hemolytic uremic syndrome Autosomal recessive inherited GPIb/IX deficiency; defective platelet adhesion Autosomal recessive inherited GPIIb/IIIa deficiency; defective platelet aggregation Most common inherited bleeding disorder ANSWERS Drugs Pure red cell aplasia Myelophthisic anemia Metastasis Immune thrombocytopenic purpura (ITP) Anti-GPIIb-IIIa and GPIb-IX (80%) IgG Chronic ITP Thrombotic thrombocytopenic purpura (TTP) Degrades von Willebrand factor (vWF) multimers E. coli O157:H7 Bernard-Soulier Syndrome / Giant Platelet Syndrome Glanzmann Thrombasthenia Von Willebrand Disease Clinical and laboratory features of VWD Mucocutaneous>Internal bleeding, ↑ BT, ↑ aPTT, Normal PT Most common hereditary disease associated with lifethreatening bleeding Hemophilia Christmas Disease Most common adverse transfusion reaction Most common reaction in platelet transfusions Transfusion-transmitted infections are more common in this blood product due to its storage at room temperature Hemophilia B (Factor IX deficiency) Febrile non-hemolytic anemia Allergic reactions Platelet concentrate LUNG AND PLEURA QUESTIONS Type of atelectasis due to airway obstruction Type of atelectasis associated with fluid, air, or mass inside the pleural cavity Type of atelectasis that occurs as a result of pulmonary/pleural fibrosis Abrupt onset of hypoxemia and bilateral pulmonary edema in the absence of heart failure Histologic hallmark for the acute phase of acute respiratory distress syndrome ANSWERS Resorption atelectasis Compression atelectasis Contraction atelectasis Acute lung injury Diffuse Alveolar Damage TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISTIAN JERELL S. COSME For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Page 11 of 27 TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISITIAN JERELL COSME For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. QUESTIONS Irreversible enlargement of airspaces distal to terminal bronchiole Type of emphysema associated with smoking Type of emphysema associated with α-1antitrypsin deficiency Type of emphysema associated with spontaneous pneumothorax in young adults Persistent cough with sputum production for at least 3 months in at least 2 consecutive years in the absence of any other cause Ratio of thickness of the mucus gland layer to the wall thickness Chronic inflammatory airway disease that produces episodic variable expiratory airflow obstruction Extruded mucus plugs seen in sputum examination of asthmatic patients Microscopic crystals made up of galectin-10 from eosinophils A known cystic fibrosis patient presents with severe, persistent cough with foulsmelling mucopurulent sputum. Episodes of hemoptysis were also noted. What is the most likely diagnosis? Bronchiectasis, Sinusitis, Situs inversus, Sperm dysmotility Clinicopathologic syndrome marked by progressive interstitial pulmonary fibrosis and respiratory failure; (+) Honeycomb fibrosis Most important environmental factor of IPF Black discoloration of the bronchi due to carbon deposits; accentuated in coal workers’ pneumoconiosis Most common pneumoconiosis and chronic occupational disease worldwide; (+) Eggshell calcifications in lymph nodes Hallmark of silicosis ANSWERS Emphysema Centriacinar Panacinar Distal acinar (Paraseptal) Chronic bronchitis Reid index Asthma Curschmann's spiral Charcot-Leyden crystals Bronchiectasis Kartagener syndrome Idiopathic pulmonary fibrosis (IPF) Cigarette smoking Anthracosis Silicosis Whorled collagen fibers surrounded by dust-laden macrophages QUESTIONS Most common cause of community- acquired acute pneumonia and lobar pneumonia Most common cause of Gramnegative bacterial pneumonia; (+) Currant jelly sputum Bacteria associated with hospital-acquired infections, cystic fibrosis and neutropenic patients Viral pneumonia linked to Parkinson's disease later in life Stage of lobar pneumonia where the lungs are heavy and boggy; Vascular engorgement, intra-alveolar fluid with few neutrophils, numerous bacteria Stage of lobar pneumonia where the lungs are red, firm, airless with a liver-like consistency. (+) intra alveolar PMNs, RBCs, fibrin Microscopic finding of the lungs in viral pneumonia Most common cause of lung abscess Most common site of lung abscess Most common primary lung tumor Most common symptom of lung cancer Type of lung carcinoma associated with paraneoplastic syndromes; strongest association with smoking Most common histologic type of lung cancer; most common type in never smokers; peripheral in location Most common mutation of lung adenocarcinoma in nonsmokers Type of lung cancer that is central in location; (+) keratinization, keratin pearls, intercellular bridges IHC stains positive in carcinoid tumor Cannon-ball lesions or multiple discrete lesions in the lung is typical of Most common cause of noninflammatory transudative effusions Mechanism of pleural effusion in CHF Type of effusion associated with radiation, autoimmune disease, uremia Type of effusion associated with thoracic duct trauma Pneumothorax sufficient to cause circulatory collapse due to compression of mediastinal structures Type of pneumothorax that occur due to rupture of subpleural blebs in young patients ANSWERS Streptococcus pneumoniae Klebsiella pneumonia Pseudomonas aeruginosa Influenza virus type A Congestion Red Hepatization Interstitial mononuclear inflammation Aspiration Right lower lobe Lung carcinoma Cough Small cell carcinoma Adenocarcinoma EGFR mutation Squamous cell carcinoma Synaptophysin, Chromogranin Metastatic neoplasm Congestive heart failure Most common manifestation Pleural plaques of asbestosis ↑Capillary hydrostatic Golden brown rods with pressure translucent core containing Asbestos bodies Serous, serofibrinous, asbestos coated with an ironfibrinous protein complex X-ray finding in sarcoidosis Bilateral hilar adenopathy Chylous Mean pulmonary artery Pulmonary hypertension pressure ≥ 25 mm Hg at rest WHO classification of Tension pneumothorax pulmonary HTN secondary to Group 2 heart failure WHO classification of pulmonary HTN secondary to Group 3 Spontaneous idiopathic lung disease or hypoxia pneumothorax WHO classification of pulmonary HTN secondary to Group 1 Secondary tumors (common Most common pleural tumors thromboembolism sources: lung, breast) TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISTIAN JERELL S. COSME Page 12 of 27 For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISITIAN JERELL COSME For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. HEAD AND NECK QUESTIONS Most common cause of tooth loss < 35 years old Associated conditions with recurrent/persistent aphthous ulcers Most common fungal infection of oral cavity White pseudomembrane that can be scraped off A white patch or plaque that cannot be scraped off and cannot be characterized clinically or pathologically as any other disease Most common head and neck cancer Etiology of oral cavity SCCa Most common site of local metastasis of oral cavity SCCa Etiology of oropharyngeal SCCa Odontogenic cysts located in impacted/unerupted tooth Condition associated with multiple odontogenic keratocyst Odontogenic cyst associated with history of dental caries/trauma; location: apex of non-viable tooth Most common odontogenic tumor A patient presents with a mass on the right mandible in the posterior molar area. Biopsy: epithelial cells palisading around a stellate reticulum. Most common cause of bacterial pharyngitis/tonsillitis An adolescent male presents with recurrent epistaxis and nasal obstruction. A mass was seen in the posterior roof of the nasal cavity. Virus associated with nasopharyngeal carcinoma (NPCA) Most common location of NPCA Most radiosensitive type of NPCA Laryngeal lesion associated with voice abuse Most common benign laryngeal epithelial tumor Etiology of laryngeal papilloma Common bacterial causes of acute otitis media ANSWERS Dental caries Celiac disease, Inflammatory bowel disease, Behçet disease, immunocompromised Candida albicans Thrush Leukoplakia Squamous cell carcinoma Tobacco, Alcohol, Betel chewing, Sunlight, Pipe smoking Cervical lymph nodes High-risk HPV Dentigirous cyst Gorlin syndrome (Nevoid basal cell carcinoma syndrome) Radicular cyst Odontoma Ameloblastoma Group A beta-hemolytic streptococci (GABHS) Sinonasal tract angiofibroma Epstein-Barr virus Rosenmuller fossa Undifferentiated NPCA Reactive nodules Squamous papilloma Low-risk HPV (6 and 11) QUESTIONS Salivary gland lesions that occurs following sublingual duct damage Most common viral sialadenitis Bacterial sialadenitis can occur in the presence of Most common salivary gland tumor Salivary gland tumor associated with smoking; Morphology: papillary structures with central lymphoid stroma covered by double layer of oncocytic cells Most common primary malignant salivary gland tumor Most common location of pleomorphic adenoma, mucoepidermoid carcinoma, and Warthin tumor A cancer arising from a primary or recurrent pleomorphic adenoma Most common location of adenoid cystic carcinoma Most common form of adenoid cystic carcinoma ANSWERS Ranula Mumps Sialolithiasis Pleomorphic adenoma or benign mixed tumor Warthin Tumor Mucoepidermoid carcinoma Parotid gland Carcinoma ex pleomorphic adenoma Minor (palatine) glands Cribriform GASTROINTESTINAL TRACT QUESTIONS Most common type of tracheoesophageal fistula with esophageal atresia A neonate presents with recurrent vomiting. Maternal history: polyhydramnios; Imaging: double-bubble sign Most common congenital intestinal atresia Sequela of herniation abdominal contents into thoracic cavity in diaphragmatic hernia Herniation of visceral organs (intestines, liver) enclosed in a sac through a large umbilical ring Herniation of visceral organs (intestines) directly into the amniotic cavity, (-) sac Functional tissues in unusual locations, which can cause disease Most common true diverticulum and congenital anomaly of the GI tract Rule of 2 in Meckel diverticulum S. pneumoniae, H. influenzae, M. catarrhalis 2nd branchial arch remnant Drugs (Anticholinergics, Antihistamines, Antipsychotics, Antidepressants) ANSWERS Type C (distal TEF with proximal esophageal atresia) Duodenal atresia Imperforate anus Pulmonary hypoplasia Omphalocele Gastroschisis Ectopia/heterotopia Meckel diverticulum Most symptomatic < 2 y.o., within 2 feet from ileocecal valve, 2 inches in length, M:F (2:1), present in 2% of population (+) recurrent non-bilious vomiting, regurgitation; (+) Congenital Hypertrophic Origin of branchial cleft cyst olive-shaped abdominal Pyloric Stenosis mass Antibiotic associated with Most common cause of congenital hypertrophic Macrolides xerostomia pyloric stenosis Absence of ganglion cells in Most common inflammatory Mucocele the affected GI tract segment; salivary gland lesion constricted diseased segment Hirschsprung disease + dilated normal proximal segment TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISTIAN JERELL S. COSME Page 13 of 27 For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISITIAN JERELL COSME For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. QUESTIONS Most common esophageal functional obstruction A patient presents with dysphagia. Barium studies reveal a corkscrew esophagus. False diverticula above the upper esophageal sphincter, (+) halitosis, regurgitation Triad of dysphagia, irondeficiency anemia, upper esophageal webs A patient presents with dysphagia. Manometry reveals incomplete LES relaxation, ↑ LES sphincter tone, aperistalsis Etiopathogenesis of primary achalasia Parasitic infection that can cause secondary achalasia Intestinal metaplasia within the esophageal epithelium (squamous → columnar with goblet cells) A patient presents with hematemesis, severe vomiting/retching following binge drinking. Spontaneous rupture of the esophagus resulting into leakage of contents into the mediastinum → mediastinitis (chest pain) Most common cause of esophageal varices Most dreaded complication of esophageal varices Usual site of esophageal squamous cell carcinoma Risk factors for esophageal squamous b cell carcinoma Usual site of esophageal adenocarcinoma Risk factors for esophageal adenocarcinoma Pathogenesis of NSAIDinduced gastritis Proximal duodenal ulcers in burns Esophageal, gastric, and duodenal ulcers in patients with ↑ intracranial pressure (ICP) Most common organism associated with chronic gastritis, peptic ulcer disease, and gastric cancer Enzyme produced by H. pylori that increases ammonia production which raises intragastric pH Conditions associated with autoimmune atrophic gastritis Antibodies present in autoimmune atrophic gastritis Most common complication of peptic ulcer disease Most common gastric malignancy A diffusely infiltrative type of gastric cancer marked by thickened, rigid gastric wall with flattened rugae ANSWERS Nutcracker esophagus Diffuse esophageal spasm Zenker or Pharyngoesophageal diverticulum Plummer-Vinson syndrome Achalasia Degeneration of nitric oxide-producing neurons Trypanosoma cruzi infection Barrett esophagus Mallory-Weiss Tear Boerhaave syndrome Liver cirrhosis due alcoholic liver disease Bleeding Middle third ↓ Fruit/Vegetable diet, Hot drinks, HPV, Caustic injury, Achalasia, Plummer-Vinson syndrome Distal third Chronic GERD, Smoking, Radiation ↓ Synthesis of mucosal protective prostaglandins Curling ulcers Cushing ulcers QUESTIONS Only malignancy that can be cured by antibiotics Most common site of neuroendocrine neoplasms Most common abdominal mesenchymal tumor Origin of GIST Overall most common cause of intestinal obstruction Most common cause of intestinal obstruction in children <2 years Usual sites of ischemic bowel diseases Most important risk factor for thrombosis in ischemic bowel disease A patient presents with chronic diarrhea, worsened by gluten intake. Intestinal biopsy: villous atrophy + crypt hyperplasia Pruritic blistering lesion associated with celiac disease Hallmark of Crohn Disease Inflammatory bowel disease with marked pseudopolyp formation, higher malignant potential and toxic megacolon incidence Role of smoking and appendectomy in Crohn disease False diverticula in the sigmoid colon that presents with painless lower GI bleed; common in elderly population Type of colorectal adenoma with highest malignant potential Most important characteristic that relates to malignancy risk of colorectal adenoma Autosomal dominant condition associated with >100 colorectal polyps and mutation in APC, “gatekeeper of colonic neoplasia” Extracolonic tumors seen in Lynch syndrome ANSWERS MALT Lymphoma (H. pylori eradication) GIT, particularly small intestine Gastrointestinal stromal tumor (GIST) Interstitial cells of Cajal Hernia Intussusception Colon (watershed areas: splenic flexure, rectosigmoid) Atherosclerosis Celiac disease Dermatitis herpetiformis Non-caseating granulomas Ulcerative colitis Increases risk Diverticular disease Villous adenoma Size (>4cm) Familial adenomatous polyposis Endometrial, Ovarian, Urothelial, Pancreatic, Brain, Skin (+) Mucocutaneous pigmentation, (+) Multiple Peutz-Jegher syndrome Helicobacter pylori hamartomatous GI polyps Most common malignancy of Colorectal adenocarcinoma the GI tract Laterality of colon cancer Urease that presents as polypoid Right-sided exophytic mass, and irondeficiency anemia Type 1 DM, Hashimoto Laterality of colon cancer thyroiditis, Addison that presents as annular disease, Graves disease “napkin-ring” constriction, Antibodies against H+-K+changes in bowel habits due Left-sided ATPase (proton pump) and to obstruction, and apple intrinsic factor (IF) core deformity in barium Bleeding studies Most common site of distant Liver Gastric adenocarcinoma metastasis from colon cancer Functional GI disorder characterized by recurrent Proctalgia fugax Linitis plastica sharp, fleeting anorectal pain Most common cause of Fecalith appendicitis TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISTIAN JERELL S. COSME Page 14 of 27 For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISITIAN JERELL COSME For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. QUESTIONS Most common appendiceal tumor Malignant clinical syndrome characterized by mucinous ascites secondary to a mucinous neoplasm in the appendix or ovaries ANSWERS Carcinoid tumor Pseudomyxoma peritonei LIVER, GALLBLADDER, PANCREAS QUESTIONS Pathologic effects of reversible injury to the liver Deeply eosinophilic apoptotic bodies seen in viral hepatitis ANSWERS Steatosis, Cholestasis, Ballooning Acidophil bodies in Yellow fever patients Councilman body Liver enzyme specific to the liver Most severe form of liver disease (80-90% parenchymal loss) Most common drug causing acute liver failure Alanine transaminase (ALT) Microscopic finding in liver cirrhosis Signs of hyperestrogenemia in cirrhosis Most common intrahepatic cause of portal HTN Etiology of hepatic encephalopathy Hyperdynamic circulation causes renal hypoperfusion → RAAS activation → Systemic vasoconstriction →↓GFR Most common cause of chronic viral hepatitis Hepatitis viruses transmitted via the fecal-oral route Hepatitis viruses transmitted via the parenteral route Histologic hallmark of HBV Histologic findings of the liver in HCV infection Duration of chronic hepatitis infection A teenage woman presents with fatigue and jaundice. She is a non-alcoholic drinker. Labs: (-) hepatitis profile, ↑ IgG, AST, ALT. Liver biopsy reveals fibrosis, lymphocytes + plasma cells within hepatocytes, rosette formation of hepatocytes around dilated canaliculi Conditions associated autoimmune hepatitis Acidophil body Liver failure Acetaminophen Parenchymal nodules surrounded by dense bands of fibrosis (scarring) Palmar erythema, Spider angioma, Gynecomastia in males Cirrhosis Impaired detoxification of NH3 Hepatorenal Syndrome QUESTIONS Protein that binds copper; low in Wilson Disease Green to brown deposits in descemet membrane in corneal limbus in Wilson disease patients Most common diagnosed inherited hepatic disorder in infants and children Cancer associated with Wilson disease, hereditary hemochromatosis, alpha-1antitrypsin deficiency Conjugated hyperbilirubinemia with autosomal recessive pattern of inheritance MRP2 mutation with dark discoloration of the liver Enzyme that is absent or deficient in unconjugated hyperbilirubinemia Charcot triad in ascending cholangitis Persistent jaundice beyond 14-21 days after birth Autoimmune cholangiopathy associated with Sjö gren syndrome, Hashimoto Thyroiditis, scleroderma Autoantibody positive in 95% of PBC patients Hepatitis A and E virus Hepatitis B, C, and D virus Ground glass hepatocytes Lymphoid aggregates/follicles, Bile duct injury, Steatosis >6 months Kayser-Fleischer ring α-1-antitrypsin deficiency Hepatocellular carcinoma Dubin-Johnson syndrome, Rotor syndrome Dubin-Johnson syndrome UGT1A1 Fever, jaundice, RUQ pain Neonatal cholestasis Primary biliary cirrhosis (PBC) AMA Primary sclerosing cholangitis (SPC) Autoantibody positive in 65% of PSC patients ANCA Characteristic microscopic finding of bile ducts in PSC Congenital dilatation of the common bile duct Disorder characterized by hepatic vein outflow obstruction either thrombotic or nonthrombotic in origin Benign hepatic tumor with well-circumscribed, unencapsulated, with central stellate scar Conditions associated with hepatocellular adenoma Autoimmune hepatitis Ceruloplasmin Autoimmune cholangiopathy associated with IBD (UC) Radiologic finding in PSC Hepatitis C virus ANSWERS Most common primary liver malignancy Tumor marker for HCC Most common location of extrahepatic cholangiocarcinoma Most common malignant tumor of the liver Most common benign liver tumor Most common liver tumor of early childhood Most common biliary tract disease Beading of contrast medium Onion-skin fibrosis and stricture Choledochal cysts Budd-Chiari syndrome Focal nodular hyperplasia Obesity, metabolic syndrome, OCP and anabolic steroid use Hepatocellular Carcinoma (HCC) α-fetoprotein (AFP) Junction of right and left hepatic ducts (Klatskin tumor) Type 1 DM, Thyroiditis, Celiac sprue Metastatic tumors vANA, Anti-Smooth muscle Cavernous hemangioma actin (Anti-SM/SMA), AntiDiagnostic antibodies in type soluble liver antigen/liverHepatoblastoma 1 autoimmune hepatitis pancreas antigen (AntiSLA/LPA), AntiCholelithiasis mitochondrial (AMA) Female sex, Estrogen cAnti-liver kidney Risk factors for cholelithiasis exposure, Obesity, Rapid Diagnostic antibodies in type microsome-1 (Anti-LKM-1) weight loss, Advancing age 2 autoimmune hepatitis against CYP2D6, Anti-liver Hemolysis, Ileal cytosol-1 (Anti-ACL-1) dysfunction/bypass, Biliary Cirrhosis, diabetes Etiology of pigment stones Classic triad of tract infections (E. coli, mellitus, skin pigmentation hemochromatosis Ascaris, Clonorchis) “bronze skin” TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISTIAN JERELL S. COSME Page 15 of 27 For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISITIAN JERELL COSME For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. QUESTIONS Most common cause of acute and chronic cholecystitis Mucosal outpouching GB in chronic cholecystitis Extensive dystrophic calcification of the GB wall Most important risk factor for gallbladder carcinoma Most common congenital anomaly of the pancreas Patients with pancreatic divisum are at risk for Metabolic disorders that cause acute pancreatitis A more specific marker for acute pancreatitis Most common cause of chronic pancreatitis Clinical features associated with chronic pancreatitis Most common outcome of pancreatic pseudocyst Most common location of pancreatic adenocarcinoma Most important environmental risk factor for pancreatic adenocarcinoma Paraneoplastic syndrome associated with pancreatic adenocarcinoma Tumor marker elevated in pancreatic adenocarcinoma ANSWERS Gallstones Rokitansky-Aschoff sinuses Porcelain gallbladder Gallstones Pancreatic divisum Chronic pancreatitis ↑ Triglycerides, Hypercalcemia Lipase Long-term alcohol abuse Abdominal pain, pancreatic insufficiency malabsorption, diabetes mellitus Regression Head Smoking Trousseau syndrome (migratory superficial vein thrombophlebitis) CA 19-9 KIDNEY QUESTIONS Hematuria, azotemia, variable proteinuria, edema, and hypertension >3.5 g/day proteinuria, hypoalbuminemia, hyperlipidemia, lipiduria Azotemia→Uremia progressing for months to years Most common cause of nephritic syndrome in children Electron microscopy finding in PSGN Antibody tests used to aid in the diagnosis of PSGN Syndrome of progressive loss of renal function characterized by nephritic syndrome often with severe oliguria Hallmark of RPGN in light microscopy Etiology of Type I RPGN Etiology of Type II RPGN Etiology of Type II RPGN A 20-year-old male smoker presents with hemoptysis and hematuria. Lab findings include elevated creatinine, urea; (+) anti-GBM antibodies Most common cause of nephrotic syndrome in children ANSWERS Nephritic syndrome Nephrotic syndrome Chronic renal failure Post-streptococcal acute glomerulonephritis Subepithelial humps on GBM Antistreptolysin O (pharyngeal infection), anti-DNase B (pyoderma) Rapidly progressive glomerulonephritis (RPGN) Crescents - proliferating parietal epithelial cells + Infiltrating leukocytes anti-GBM antibodies Immune complexmediated ANCA Goodpasture syndrome Minimal change disease (MCD) QUESTIONS Alternative term for MCD attributed to the lipid and protein-laden proximal tubule cells Conditions associated with MCD in adults Drugs associated with membranous nephropathy Infections associated with membranous nephropathy Electron microscopy findings in membranous nephropathy Most common cause of nephrotic syndrome in adults in the US Also known as “dense deposit disease” due to the permeation of extremely electron-dense structure in the lamina densa Most common type of glomerulonephritis worldwide; Clinical features include hematuria during or immediately after a GIT/GUT infection Alternative term for IgA nephropathy A child presents with hematuria, joint pains, abdominal pain, and purpuric rash on buttocks and extensor surfaces of arms and legs. What is the most likely diagnosis? A male patient presents with hematuria, sensorineural deafness, and lens dislocation. What is the most likely diagnosis? Characteristic electron microscopy finding of the kidney in Alport syndrome Most common cause of acute kidney injury Endogenous substances that can cause toxic acute tubular necrosis (ATN) Distribution of necrosis and length of affected segment in ischemic ATN Distribution of necrosis and length of affected segment in toxic ATN Affected segments in ischemic ATN Affected segments in toxic ATN ANSWERS Lipoid nephrosis Lymphoma, leukemia Penicillamine, Captopril, Gold, NSAIDs Chronic HBV, HCV, Syphilis, Schistosomiasis, Malaria Spike and Dome appearance: Subepithelial deposits EM along GBM; Effacement of foot processes Focal segmental glomerulosclerosis Membranoproliferative glomerulonephritis type II IgA nephropathy Berger disease Henoch-Schönlein Purpura (HSP) Alport Syndrome Basket weave appearance of GBM: Pronounced splitting and lamination of lamina densa Acute tubular injury/necrosis Hemoglobin, Myoglobin, Ig light chains, Bilirubin Patchy, short Extensive, long Proximal straight tubule, ascending limb of Henle’s loop Proximal convoluted tubule, ascending limb of Henle’s loop A patient was treated with oral TMP-SMX for her UTI. On day 8 of treatment, she developed fever, maculopapular rash, and eosinophilia. Creatinine was 1.9 mg/dL (baseline SCr 0.7 mg/dL). What is the most likely diagnosis? Acute drug-induced interstitial nephritis Drugs associated with acute drug-induced interstitial nephritis Sulfonamides, Methicillin/Ampicillin, Rifampin, Thiazides, NSAIDs, allopurinol, cimetidine, checkpoint inhibitors TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISTIAN JERELL S. COSME For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Page 16 of 27 TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISITIAN JERELL COSME For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. QUESTIONS Most common causative agent of UTI ANSWERS Eschierichia coli Tubular changes seen in chronic pyelonephritis Thyroidization and atrophy Etiology of nephrosclerosis or sclerosis of renal arterioles/small arteries Extravasation of plasma proteins and basement membrane matrix deposition Most common cause of renal artery stenosis Most likely cause of renal artery stenosis in a 30-yearold female Most common etiology of renal infarct Type of infarct observed in ischemia of the kidneys Blood vessel compressed in Nutcracker Syndrome Blood vessels compressing the left renal vein in Nutcracker Syndrome Anomalies associated with autosomal dominant polycystic kidney disease (ADPKD) Most common cause of death in ADPKD patients Anomalies associated with autosomal recessive polycystic kidney disease (ARPKD) Most common cause of death in ARPKD patients Advancing age, Hypertension, Diabetes mellitus Clinical feature/s of bilateral partial urinary tract obstruction Clinical feature/s of bilateral complete urinary tract obstruction Most common type of urolith Most important determinant of urolith formation Type of renal stone formed in basic pH, has a coffin-lid appearance and is associated with Proteus infection Type of renal stone occupying the renal pelvis or calyces Renal stones formed in acidic pH Type of renal stone associated with diseases with rapid cell turnover such as leukemia Most common malignant tumor of the kidneys Classic triad of renal cell carcinoma Most important risk for for renal cell carcinoma >50% of renal cell carcinoma cases metastasize in which organ Most common histologic type of renal cell carcinoma; associated with Von HippelLindau Psammoma bodies may be present in this histologic type of renal cell carcinoma LOWER URINARY TRACT AND MALE GENITAL TRACT QUESTIONS Most common cause of hydronephrosis in infants and children Most common and serious congenital anomaly of the urinary bladder Hyalinization Sequelae of bladder exstrophy Atherosclerosis Partial patency of the urachus result in the formation of Cancer associated with urachal cyst and intestinal metaplasia of the urinary bladder Most common cause of acute cystitis Viruses associated with hemorrhagic cystitis Commonly associated drug with hemorrhagic cystitis Polypoid cystitis is commonly associated with Type of urinary bladder cancer linked to Schistosoma haematobium infection Most common bladder tumor Most important risk factor for urothelial tumor formation A 4-year-old female presents with painless hematuria, frequency and recurrent UTI. Imaging revealed hydronephrosis and a grapelike lesion inside the urinary bladder. What is the most likely initial diagnosis? Most common urinary bladder sarcoma in adults Non-infectious urethritis associated with conjunctivitis and arthritis Fibromuscular dysplasia Embolism (from cardiac mural thrombus) White infarct Left renal vein Superior mesenteric artery (anterior), abdominal aorta (posterior) Liver cysts, Intracranial berry aneurysms, Mitral valve prolapse Coronary or Hypertensive heart disease Congenital hepatic fibrosis in patients who survive infancy Renal failure in infancy Impaired urine concentrating ability (Nocturia, Polyuria), Hypertension Oliguria, Anuria Calcium stones Supersaturation Magnesium Ammonium Phosphate (Struvite) stones Staghorn calculi Calcium oxalate, Uric acid, Cystine stones Uric acid Renal cell carcinoma Hematuria, Flank Pain, Mass Smoking Lung Clear Cell Renal cell carcinoma Papillary Renal cell carcinoma Common infectious etiology of urethritis Type of carcinoma seen in the proximal urethra Type of carcinoma seen in the distal urethra Abnormal opening on the ventral shaft of the penis Associated disease with hypospadia Abnormal opening on the dorsal shaft of the penis Associated disease with epispadia Long-term consequence of phimosis and balanoposthitis Etiology of condyloma acuminatum or genital warts Perinuclear cytoplasmic vacuolization of squamous epithelial cells; indicative of HPV infection HPV-related penile intraepithelial neoplasia (PeIN) PeIN associated with older men. Lesion is solitary. ANSWERS Ureteropelvic junction obstruction Vesicoureteral reflux Infections, Colonic glandular metaplasia, ↑ risk of Adenocarcinoma Urachal cyst Adenocarcinoma Coliforms (E. coli, Proteus, Klebsiella, Enterobacter) Adenovirus, BK virus Cyclophosphamide Indwelling catheter use Squamous cell carcinoma Urothelial tumors Smoking Embryonal rhabdomyosarcoma (Sarcoma botyroides) Leiomyosarcoma Reactive arthritis (Reiter syndrome) N. gonorrhoeae, C. trachomatis, Ureaplasma urealyticum Urothelial carcinoma HPV-related Squamous cell carcinoma Hypospadia Cryptorchidism Epispadia Exstrophy of the bladder ↑ risk for penile cancer Low-risk HPVs (HPV 6 > HPV 11) Koilocytosis/Koilocytic change Bowen disease, Bowenoid papulosis TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISTIAN JERELL S. COSME For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Bowen disease Page 17 of 27 TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISITIAN JERELL COSME For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. QUESTIONS PeIN associated with younger men. Lesions are multiple.. High-risk HPV types HPV oncogenic viral product that inactivates p53 HPV oncogenic viral product that inactivates RB and increases p16 Surrogate marker of HPV infection Most common site of arrest in cryptorchidism Type of cancer associated with cryptorchidism Common etiology of epididymitis and orchitis in childhood Common etiology of epididymitis and orchitis in childhood Epididymo-orchitis pattern of involvement in tuberculosis Epididymo-orchitis pattern of involvement in syphilis Adolescents with a bell clapper deformity of the testis is at risk for this urologic emergency Most common cause of painless testicular enlargement Most common testicular tumor Most common GCT Prognosis of seminomatous GCTs Primary route of metastasis of non-seminomatous GCTs Tumor marker used to assess testicular tumor burden Most common testicular GCT in infants and children up to 3 years Central capillary surrounded by tumor cells within a space lined by tumor cells; seen in yolk sac tumor Elevated tumor marker in choriocarcinoma Most important predictor of biologic behavior of teratoma Sex-cord stromal tumor that can elaborate androgens and estrogens Eosinophilic, rod-shaped inclusions seen in the microscopy of Leydig cell tumors Most common testicular tumor in men > 60 years A 50-year-old male presents with fever, chills, dysuria. PE showed tender, boggy prostate on DRE. What is the most likely diagnosis? Most common form of prostatitis Most common benign prostatic disease in men > 50 years old ANSWERS Bowenoid papulosis HPV 16, 18, 31, and 33 E6 E7 QUESTIONS Ultimate mediator of prostatic growth formed by Type 2 5-α-reductase Most common site of nodular prostatic hyperplasia Risk factors for prostatic adenocarcinoma p16 Inguinal canal Testicular germ cell tumors on BOTH testes Gram-negative rods E. coli, Pseudomonas Epididymis→Testis Testis→Epididymis Testicular torsion Tumors Germ cell tumors (GCT) Seminoma Favorable (radio- and chemosensitive) Hematogenous Lactate dehydrogenase (LDH) Yolk sac tumor Most common site of prostatic adenocarcinoma Gleason pattern with discrete prostatic glands Gleason pattern with no gland formation observed Computation of Gleason score Prostatic adenocarcinoma produce blastic lesions on the bones by spreading hematogenously via the Sites of distant metastasis of prostate cancer in decreasing order of frequency (hematogenous route) Screening for prostate cancers starts at age Reference range of PSA Recommendation for a >75 y.o. patient with PSA >4 ng/mL and suspicious DRE Sperm motility less than reference value Morphologically normal spermatozoa percentage less than reference value Leydig cell tumor Crystalloids of Reinke Testicular lymphoma Acute bacterial prostatitis Chronic abacterial prostatitis Nodular prostatic hyperplasia (NPH) Dihydrotestosterone (DHT) Transition zone, Inner periurethral zone Advancing age, androgen excess, race (African Americans, family history in 1st degree relatives, inherited mutations,diet (Charred meats, animal fat) Peripheral zone Gleason pattern 3 Gleason pattern 5 Most dominant pattern + 2nd most dominant pattern Batson plexus Lumbar spine, proximal femur, pelvis, thoracic spine, ribs 45 0-4 ng/mL Biopsy Asthenozoospermia Teratozoospermia FEMALE GENITAL TRACT QUESTIONS Most serious complication of gonorrhea in women Risk factors associated with polymicrobial cause of PID Schiller-Duval bodies Human chorionic gonadotropin (hCG) Age (prepubertal male benign; postpubertal malignant) ANSWERS Complications of chronic PID Age at which a Bartholin cyst is biopsied to rule out malignancy Stage of syphilis where condyloma lata appear Most common histologic type of carcinoma in the vulva Etiology of septate vagina Septate vagina and vaginal adenosis are associated with in utero exposure to which drug Most common malignant tumors of the vagina originate from the Most common site of primary squamous cell carcinoma of the vagina Vaginal mass with grape-like clusters protruding from the vaginal orifice of an infant Most common site of squamous intraepithelial lesion (SIL) ANSWERS Pelvic inflammatory disease (PID) Induced abortion, dilatation and curettage, and surgical procedures Infertility and tubal obstruction, ectopic pregnancy, pelvic pain, and intestinal obstruction > 40 years Secondary syphilis Squamous cell carcinoma Failure of Mullerian duct fusion Diethylstilbestrol (DES) Cervix Posterior wall at ectocervicovaginal junction Sarcoma botyroides Transformation zone TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISTIAN JERELL S. COSME For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Page 18 of 27 TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISITIAN JERELL COSME For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. QUESTIONS Basaloid cells and mitosis within lower 1/3 of epithelium, Koilocytic atypia A 50-year-old female presents with post-coital bleeding. On examination, a finger-like mass was seen on the cervical introitus. Biopsy showed fibrovascular stroma lined by endocervical epithelium. What is the most likely diagnosis? Basaloid cells and mitosis to upper 2/3 of epithelium Full thickness basaloid cell proliferation and mitosis CIN classified as high-grade SIL 80% of cervical carcinomas are of this histologic type Most common cause of death Cellular infiltrates identified in chronic endometritis Ectopic endometrial tissue outside the uterus Endometrial tissue in deep myometrium Cyst filled with old menstrual blood due to ectopic endometrial implants in the ovaries A patient on tamoxifen presents with AUB. D&C was performed. Pathology report showed cystically dilated glands in fibrous stroma. Etiology of endometrial hyperplasia without atypia Etiology of atypical endometrial hyperplasia and endometrioid carcinoma Most common invasive cancer of the FGT Type I endometrial carcinoma histologic type/s Type II endometrial carcinoma histologic type/s Most common histologic type of endometrial carcinoma Endometrioid carcinoma associations Serous carcinoma associations Most common tumor in women Diagnostic triad for uterine leiomyosarcoma Most common site of tubal pregnancy Serous tubal intraepithelial carcinoma (STIC) is a precursor to A 30-year-old patient complains of menstrual irregularities, hirsutism and acne. TVS showed bilaterally enlarged ovaries with multiple small follicles. What is the most likely diagnosis? Most common ovarian tumors Most commonly benign surface epithelial tumors Most commonly malignant surface epithelial tumors ANSWERS Low-grade SIL/Cervical Intraepithelial Neoplasia (CIN) 1 Endocervical polyp CIN 2 CIN 3 CIN 2, 3 Squamous cell carcinoma Complications of urinary tract obstruction Plasma cells Endometriosis Adenomyosis Chocolate cyst or ovarian endometrioma Endometrial polyp Prolonged estrogen stimulation PTEN loss/mutation Endometrial carcinoma Endometrioid Serous, Clear cell, Carcinosarcoma Endometrioid carcinoma Age 55-65 years, ↑ Estrogen, Hypertension, DM, Obesity Age 65-75 years, Atrophic uterus, Thin physique Leiomyoma Marked cell atypia, tumor cell necrosis, increased mitosis Ampulla Ovarian high-grade serous carcinoma Polycystic ovarian syndrome or SteinLeventhal syndrome Surface epithelial tumors QUESTIONS Elevated tumor markers in surface epithelial tumors Most common histologic type of ovarian cancer Mutated genes associated with ovarian serous carcinoma Protective factors for ovarian serous carcinoma Ovarian tumor with transitional/urothelial-like epithelium in a fibrous stroma Tumors associated with dermoid cysts and Brenner tumor Accumulation of mucinous material within the abdominopelvic cavity due to mucin-secreting tumor cells Ovarian counterpart of seminoma GCT predominant in children and young women GCT predominant in reproductive age Most common ovarian GCT A subtype of teratoma characterized by a cystic mass lined by skin-like structures Grading of immature teratoma is based on the amount of A patient with mature cystic teratoma presents with psychosis and seizures. What is the paraneoplastic syndrome associated with this tumor? A postmenopausal woman presents with AUB and a large adnexal mass. She consequently underwent surgery. Pathology report showed round/oval cells with scant cytoplasm and nuclear grooves (coffee bean nuclei). Most metastatic tumors to the ovary come from primary tumors of Signet ring cell carcinoma from GIT metastatic to both ovaries Abnormal gestations characterized by hydropic villi chorionic villi with trophoblastic proliferation Karyotype of partial mole Karyotype of complete mole Embryo/fetus, amnion, and fetal RBCs are only present in Uterine size larger for dates, hCG levels >100,000 mIU/mL and higher rate of subsequent gestational trophoblastic neoplasia Ovarian cysts associated with hydatidiform mole due to elevated hCG Most common gestational trophoblastic neoplasm Distant sites of metastasis of gestational choriocarcinoma ANSWERS CA-125 and HE4 High-grade serous carcinoma BRCA1, BRCA2 40-59 years with OCP intake or tubal ligation Brenner tumor Mucinous carcinoma Pseudomyxoma peritonei Dysgerminoma Immature teratomas, Yolk sac tumor Mature cystic teratomas, Dysgerminomas Mature cystic teratoma Dermoid cyst Neuroepithelium Anti-NMDA receptor encephalitis Granulosa cell tumor Mullerian origin (uterus, fallopian tube, contralateral ovary, pelvic peritoneum) Krukenberg tumor Hydatidiform mole Triploid (Diandric triploidy - 2 Sperm + 1 Ovum) Paternal-only diploidy Partial Mole Complete Mole Theca-lutein cysts Gestational choriocarcinoma Lungs > Vagina > Brain > Liver > Bone > Kidney Serous, mucinous Endometrioid TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISTIAN JERELL S. COSME For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Page 19 of 27 TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISITIAN JERELL COSME For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. BREAST QUESTIONS Cells that are histologically absent in invasive carcinomas of the breast A postpartum, nursing mother developed fever accompanied by pain and erythema of her right breast. What is the most likely diagnosis? Fat necrosis of the breast occurs following a Fat necrosis occurs due to the saponification of fat by this enzyme A patient with Hashimoto’s thyroiditis complains of a palpable left breast mass. Biopsy showed lymphocytic infiltrates and ductal and lobular atrophy. Proliferative breast diseases without atypia Cell adhesion molecule absent in atypical lobular hyperplasia or lobular neoplasia Papillary fronds covered by epithelial and myoepithelial cells, growing within a dilated duct; presents with bloody nipple discharge Histologic subtype of ductal carcinoma in-situ (DCIS) that has abundant central luminal necrosis Malignant epithelial cells in the nipple-areola epidermis; presents with eczematous nipple lesion; associated with invasive cancer or DCIS Most common and deadly malignancy of women globally Most common genes implicated for single gene familial breast cancers (80-90%) Gene more associated with ovarian cancer and triplenegative breast cancer Gene associated with male breast cancer Overexpression of this gene implies poorer prognosis but is more amenable to treatment with trastuzumab Most common type of invasive breast carcinoma (IBC) ANSWERS Myoepithelial cells Acute mastitis History of breast trauma/surgery Tissue/blood lipase Lymphocytic mastopathy Usual ductal hyperplasia, sclerosing adenosis, complex sclerosing lesion E-cadherin Intraductal papilloma Comedo DCIS Paget Disease of the Breast Invasive Breast Carcinoma BRCA1, BRCA2 BRCA1 BRCA2 HER2 Invasive breast carcinoma of no special type QUESTIONS Excess estrogen in males produces this unilateral/bilateral swelling of the areola Most important cause of gynecomastia Chromosomal disorder associated with male breast cancer ANSWERS Gynecomastia Liver cirrhosis Klinefelter syndrome ENDOCRINE SYSTEM QUESTIONS Infarction or hemorrhage of the pituitary gland producing sudden neurologic impairment Most common cause of hyperpituitarism Most common hyperfunctioning pituitary tumor Hyperfunctioning of this cell type produces gigantism in children and acromegaly in adults Development of large, destructive pituitary adenomas post-adrenalectomy for Cushing syndrome Pituitary macrotumors measure New term for pituitary adenoma based on WHO 5th edition New term for pituitary carcinoma based on WHO 5th edition Most common hormone produced by functional metastatic PitNET Evidence of hypopituitarism appear at this percentage of parenchymal loss Arachnoid and CSF herniate through a sellar diaphragm defect and compress the pituitary Postpartum hypopituitarism caused by significant blood loss after delivery Type of lung cancer that produces syndrome of inappropriate ADH excess Pathology in central diabetes insipidus (DI) ADH level, serum and urine osmolality in central DI ANSWERS Pituitary apoplexy Functioning anterior pituitary neuroendocrine tumor (PitNET)/adenoma Prolactinoma Somatotroph (produces GH) Nelson syndrome ≥ 1 cm Pituitary neuroendocrine tumor (PitNET) Metastatic pituitary neuroendocrine tumor ACTH 75% Primary sella syndrome Sheehan syndrome Small cell lung carcinoma ADH deficiency ADH - Low; Serum Osm Normal to high; Urine Osm - Low Unresponsiveness of renal tubules to ADH ADH - High; Serum Osm Normal to high; Urine Osm - Low Special type of IBC with Invasive lobular discohesive cells assuming a carcinoma Pathology in nephrogenic DI single file or ‘Indian filing’ Type of breast carcinoma ADH level, serum and urine where tumor cells plug dermal Inflammatory carcinoma osmolality in central DI lymphatics producing a peau d’orange appearance Hypothalamic suprasellar Most important prognostic tumor derived from vestigial factor of IBC in the absence of Lymph node metastasis remnants of the Rathke pouch, Craniopharyngioma distant metastasis a diverticulum from the Most common benign tumor of embryonic buccal cavity Fibroadenoma the female breast Histologic subtype of Breast tumor composed of the craniopharyngioma proliferation of both epithelial characterized by squamous Adamanatinomatous and stromal components with Phyllodes tumor epithelium with peripheral leaf-like fronds protruding into palisading, stellate reticulum, cystically dilated spaces Most common breast sarcoma Angiosarcoma TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISTIAN JERELL S. COSME Page 20 of 27 For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISITIAN JERELL COSME For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. QUESTIONS “wet” keratin or “machine oil” fluid, dystrophic calcification ↑ T3/T4 → ↓ TSH ↑ TSH → ↑ T3/T4 One of the earliest and most consistent features of hyperthyroidism Most common arrhythmia encountered in hyperthyroidism other than sinus tachycardia Autoantibodies present in Hashimoto thyroiditis Hashimoto thyroiditis microscopic findings Hashimoto thyroiditis patients have increased risk to develop these neoplasms Painless thyroid enlargement in a postpartum patient; (+) Anti-TPO; Thyroid biopsy lymphoplasmacytic infiltrates with germinal centers only Painful thyroid enlargement following a history of URTI; Thyroid biopsy - lymphocytic infiltration, granulomas with multinucleated giant cells Most common cause of endogenous hyperthyroidism Disease-causing autoantibody in Graves disease Graves disease patients are at risk to develop these conditions Accumulating substance that causes exophthalmos in Graves ophthalmopathy Scaly thickening and induration of the skin overlying the shins in Graves disease Most common cause of goiter Features favoring thyroid malignancy Distinguishing feature of follicular carcinoma from follicular adenoma Most common thyroid malignancy A specific feature of papillary thyroid carcinoma wherein the nucleus is optically clear and devoid of chromatin Fast-growing thyroid malignancy that has 100% mortality within 6 months Thyroid malignancy associated with amyloid deposition and IHC positive with calcitonin Most common cause of primary hyperparathyroidism Most common cause of secondary hyperparathyroidism Skeletal disorder associated with late-stage primary hyperparathyroidism ANSWERS Primary hyperthyroidism Secondary hyperthyroidism Cardiac manifestations Atrial fibrillation Anti-thyroglobulin, antithyroid peroxidase Lymphoplasmacytic infiltrates with germinal centers, Oncocytic change in thyrocytes, Fibrosis Marginal zone lymphoma, Papillary thyroid carcinoma Subacute lymphocytic (painless) thyroiditis Granulomatous (De Quervain) thyroiditis QUESTIONS Reliable criteria differentiating parathyroid carcinoma from adenoma Renal manifestations of hyperparathyroidism Most common cause of hypoparathyroidism The presence of Chvostek and Trousseau signs is suggestive of this electrolyte abnormality Autoantibodies against pancreatic islet cells in T1DM Most important susceptibility genes for T1DM Most important environmental factor causing T2DM Most common cause of death in T2DM patients T2DM macrovascular complications T2DM microvascular complications Nodules of pink hyaline material in the glomerulus of patients with diabetic nephropathy Unequivocal criteria for pancreatic neuroendocrine tumor malignancy Most common pancreatic neuroendocrine tumor Graves Disease Thyroid-stimulating immunoglobulin (TSI) SLE, pernicious anemia, Type 1 DM, Addison disease Glycosaminoglycan Pretibial myxedema Iodine deficiency Solitary nodule, Young, Male patient, History of radiation, Nonfunctioning “cold” nodules Capsular and/or vascular invasion Papillary carcinoma Orphan Annie nucleus Anaplastic carcinoma Whipple triad of insulinoma A patient presents with severe GERD and peptic ulceration despite intensive PPI treatment. H. pylori is not detected. Which pancreatic tumor is most likely present? Pancreatic tumor with features of diabetes, necrolytic migratory erythema, and anemia WDHA syndrome of VIPoma Abdominal striae, obesity, dorsocervical fullness (buffalo hump), moon facies, ↑ 24-hour urine free cortisol ACTH-secreting pituitary adenoma Most common cause of Cushing syndrome overall Most common endogenous cause of Cushing syndrome Hypertension, hypokalemia, ↑ Aldosterone ↓ Renin ↑ Renin ↑ Aldosterone Medullary carcinoma Parathyroid adenoma Causes of secondary hyperaldosteronism ANSWERS Metastasis and Local invasion Nephrolithiasis, nephrocalcinosis Surgical removal Hypocalcemia Anti-insulin, GAD, and ICA2 HLA DR3/DR4 (Ch6) Central/Visceral obesity Myocardial infarction Coronary, cerebrovascular, and peripheral arterial disease Retinopathy, Nephropathy, Neuropathy Kimmelstiel-Wilson lesion/Nodular glomerulosclerosis Metastasis, Vascular invasion, Local infiltration Insulinoma Hypoglycemia <50 mg/dL, Neuroglycopenic symptoms, Relief upon parenteral glucose administration Gastrinoma Glucagonoma Watery diarrhea, Hypokalemia, Achlorhydria Cushing syndrome Cushing disease Exogenous steroids Cushing disease Primary hyperaldosteronism or Conn syndrome Secondary hyperaldosteronism Renal hypoperfusion Nephrosclerosis, Renal artery stenosis, Arterial hypovolemia; Pregnancy Most common cause enzyme deficient in congenital adrenal 21-hydroxylase hyperplasia Bilateral adrenal hemorrhage Von Recklinghausen as a complication of disease of bone or Waterhousemeningococcemia causing osteitis fibrosa cystica Friderichsen syndrome primary acute adrenocortical insufficiency TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISTIAN JERELL S. COSME Page 21 of 27 For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com Renal failure This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISITIAN JERELL COSME For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. QUESTIONS Eponym of primary chronic adrenocortical insufficiency Hormone elevated in Addison disease that causes skin hyperpigmentation Features differentiating secondary from primary adrenal insufficiency Most common adrenocortical tumor Medullary chromaffin cell tumor that produces catecholamines Only reliable criterion of malignancy for pheochromocytoma ANSWERS Addison disease MSH or melanocytestimulating hormone Hyperpigmentation (↓ MSH); ACTH stimulation test: (+) – ↑ in cortisol Adrenocortical adenoma Pheochromocytoma Metastasis QUESTIONS Acanthosis nigricans is a cutaneous marker of these malignancies Soft pedunculated mass on the skin; fibrovascular cores lined by benign squamous epithelium Tan/dark brown plaque with keratin-impacted pores on dermoscopy The abrupt appearance of of multiple seborrheic keratoses caused by an associated malignancy Blue-gray elastic fibers in the dermis that serve as a marker of sun damage; seen in actinic keratosis Most important risk factor for squamous cell carcinoma of the skin Pheochromocytoma rule of 10 10% are extra-adrenal, bilateral, biologically malignant, and not associated with hypertension MEN 1 Syndrome eponym Wermer syndrome Features of MEN 1 syndrome 3 Ps: Primary hyperparathyroidism, pancreatic tumor, pituitary tumor Other risk factors for SCCA of the skin MEN 2A Syndrome eponym Sipple syndrome Most common type of skin cancer Clinical features of MEN2A syndrome MEN 2B Syndrome eponyms Clinical features of MEN2B syndrome Pheochromocytoma, Medullary thyroid carcinoma, Parathyroid hyperplasia Wagemann-Froboese syndrome, MEN 3, Mucosal neuroma syndrome Pheochromocytoma, Medullary thyroid carcinoma, Neuromas, Ganglioneuromas, Marfanoid habitus Gene mutation in MEN1 MEN1 loss Gene mutation in MEN2A, 2B RET gain-of-function Syndrome associated with multiple BCCs, medulloblastoma, odontogenic keratocysts, etc. Type of hypersensitivity observed in acute eczematous dermatitis (contact with external antigen e.g. poison ivy) Infections associated with erythema multiforme Drugs associated with erythema multiforme SKIN QUESTIONS Nested melanocytic proliferation without architectural/cytologic atypia Linear melanocytic proliferation along basal epidermis Most deadly skin cancer Most important risk factor for malignant melanoma Growth phase of melanoma that has metastatic potential Type of melanoma located in any cutaneous site except palms and soles; Intermittently sun-exposed skin Type of melanoma located in on-hair bearing acral skin; Unrelated to sun exposure Measures the depth of invasion of melanoma from the top of the granular layer to the deepest point of invasion Thickened, hyperpigmented skin with a “velvet-like” texture in flexural areas seen in obese and DM patients Clinical features of BCC ANSWERS Melanocytic nevus Simple lentigo Malignant melanoma Sun exposure Vertical growth phase Superficial spreading melanoma Acral melanoma Breslow thickness A patient presents with multiple plaques with scaling on the elbow, knee, and scalp regions. Nail pitting and onycholysis are present. What is the most likely diagnosis? Pinpoint bleeding on lifting of psoriasis scales Appearance of new skin lesions on previously unaffected skin secondary to trauma Collection of neutrophils in the stratum corneum; a cardinal sign of psoriasis Biochemical etiology of seborrheic dermatitis Infectious etiology of seborrheic dermatitis Civatte bodies or necrotic basal keratinocytes are present in 6Ps of lichen planus ANSWERS Gastrointestinal malignancies Fibroepithelial polyp (Acrochordon, Skin Tag) Seborrheic keratosis (SK) Leser-Trélat sign Solar elastosis UV radiation Ionizing radiation, Immunosuppression, HPV infection (5 and 8), Coal tar, Arsenic, Old burn scars, chronic ulcers, draining osteomyelitis Basal cell carcinoma (BCC) Pearly, telangiectatic papules→Ulceration (Rodent ulcer), extensive local invasion Nevoid BCC (Gorlin) syndrome Type IV Hypersensitivity HSV, Mycoplasma, Histoplasma, Coccidioides, S. typhi, M. leprae Sulfonamides, Penicillin, Barbiturates, Salicylates, Hydantoins, antimalarials Psoriasis Auspitz sign Koebner phenomenon Munro microabscesses ↑ Androgens, ↓ Dopamine (Parkinson) Malassezia furfur, HIV Lichen planus Pruritic, purple, polygonal, planar, papules, and plaques Most common type of Pemphigus vulgaris pemphigus Pathology in pemphigus IgG against desmoglein vulgaris (Desmosomes) TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISTIAN JERELL S. COSME Page 22 of 27 For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com Acanthosis nigricans This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISITIAN JERELL COSME For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. QUESTIONS Immunofluorescence finding in pemphigus vulgaris Pathology in bullous pemphigoid Immunofluorescence finding in bullous pemphigoid Clinical sign that differentiates pemphigus vulgaris from bullous pemphigoid Disease associated with dermatitis herpetiformis Pathology in dermatitis herpetiformis Acne-causing bacteria that converts lipids into proinflammatory fatty acids Papules with central black plug (due to oxidized melanin) Causative agent of verruca vulgaris vPink, pearly papule with umbilical center; curd-like material can be expressed from umbilication Etiology of impetigo Focal suppurative inflammation of skin and subcutaneous tissue Deeper suppurative infections that spreads laterally and superficially Chronic suppurative infection of the apocrine glands Infection of the palmar side of fingertips Nail bed infection Other term for Staphylococcal Scalded Skin Syndrome ANSWERS Epidermis, intercellular → Lace-like pattern IgG against BPAGs (Hemidesmosomes) Basement membrane → Linear pattern QUESTIONS Faulty bone mineralization caused by vitamin D deficiency; results in bone softening and weakening Pemphigus: (+) Nikolsky sign Clinical features of rickets Celiac disease Open comedones Skeletal disorder in CKD and dialysis patients resulting from secondary hyperparathyroidism Mosaic pattern of lamellar bone with cement lines →Jigsaw-puzzle appearance Low-risk HPVs Most dreaded complication of Paget’s Disease of Bone IgA against gliadins cross reacts against reticulin Cutibacterium acnes Molluscum contagiosum S. aureus (bullosa), S. pyogenes (contagiosa) Furuncle Carbuncle Hidradenitis Felon Paronychia Ritter disease BONES, JOINTS, SOFT TISSUE QUESTIONS Disruption of the migration and condensation of mesenchyme Global disorganization of bone and or cartilage Most common skeletal dysplasia Most common cause of lethal dwarfism Usual cause of death in thanatophoric dysplasia Gene mutation in achondroplasia and thanatophoric dysplasia Most common cause of inherited disorder of connective tissue Genes mutated in osteogenesis imperfecta Pathology in osteogenesis imperfecta Decreased bone mass (T score = -1 – -2.5 SD) Severe osteopenia that significantly increases the risk of fracture (T score < 2.5 SD) Risk factors for osteoporosis ANSWERS Dysostosis Dysplasia Achondroplasia Thanatophoric dysplasia Respiratory insufficiency FGFR3 gain of function Osteogenesis imperfecta (Brittle bone disease) COL1A1, COL1A2 Deficient Type I collagen synthesis Osteopenia Osteoporosis Advanced age, physical inactivity, calcium and vitamin D deficiency, estrogen deficiency Stage of fracture healing on Day 0-1 Stage of fracture healing on Week 0-1 Type of bone deposited in week 2-3 of fracture healing Type of bone formed in week 3-months of fracture healing Most common etiologies of avascular necrosis Site commonly involved in avascular necrosis due to the absence of collateral circulation Most common bacterial cause of osteomyelitis Bacteria associated with osteomyelitis in sickle cell anemia patients Region of the bone where osteomyelitis in children is commonly located Region of the bone where osteomyelitis in adults is commonly located In acute osteomyelitis, destruction of the bone produces draining sinuses called as Living shell around a devitalized infected bone Osteoid osteoma tumor size and pain response to NSAIDs Osteoblastoma tumor size and pain response to NSAIDs Most common primary bone sarcoma Secondary osteosarcoma risk factors Most common site of osteosarcoma Radiologic findings suggestive of osteosarcoma Most common metastatic site of osteosarcoma Most common benign bone tumor Common site involved in osteochondroma Osteochondroma can transform into which sarcoma Syndrome of multiple enchondromas, Spindle cell hemangiomas, Risk for brain gliomas ANSWERS Rickets (Pediatric), Osteomalacia (Adults) Craniotabes (Softened skull bones), Frontal bossing, Squared head, Rachitic rosary, Pigeon breast deformity, Lumbar lordosis, Bowing of legs Renal osteodystrophy Paget’s Disease of Bone Secondary sarcoma (Osteosarcoma > Fibrosarcoma) Organizing hematoma Soft callus/bone callus Woven bone Lamellar bone Fractures, corticosteroid use Medullary cavity Staphylococcus aureus Salmonella Metaphysis Epiphysis, Subchondral Sequestrum Involucrum <2 cm, pain relieved by NSAIDs > 2 cm, pain not relieved by NSAIDs Osteosarcoma Paget disease of bone, bone infarcts, previous radiation Metaphysis - Knee Sunburst periosteal reaction, Codman triangle (Periosteal lifting) Lung Osteochondroma Metaphysis - Knee, Pelvis, Scapula, Ribs Chondrosarcoma Maffucci syndrome TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISTIAN JERELL S. COSME For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Page 23 of 27 TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISITIAN JERELL COSME For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. QUESTIONS Genetic mutation in Ewing sarcoma Common site involved in Ewing sarcoma Rounded cell clusters around a central fibrillary core seen in Ewing sarcoma Radiologic findings suggestive of Ewing sarcoma Skeletal disorder associated with McCune-Albright syndrome Most common skeletal malignancy Blastic bone lesions Lytic bone lesions Most common form of arthritis Osteophytes at the DIPJ Osteophytes at CMCJ or PIPJ of the hand Most common inflammatory arthritis HLA type associated with RA Most common joints involved in RA PIP Hyperextension, DIP flexion PIP Flexion, DIP Hyperextension IgM/IgG against IgG Fc region Early specific marker for RA Most commonly involved joint in gout Pathologic hallmark of gout Appearance of monosodium urate crystals in polarized microscopy Crystals deposited in pseudogout Most commonly involved joint in pseudogout Appearance of CPP crystals in polarized microscopy Infectious etiology of suppurative arthritis in late adolescents and young adults Infectious etiology of suppurative arthritis in children <2 years old Examples of seronegative spondyloarthropathies Most commonly involved joint in Ankylosing spondylitis Triad of reactive arthritis Most common soft tissue tumor of adulthood Most common sarcoma of adulthood Most common soft tissue sarcoma in children and adolescents ANSWERS t(11;22) ESWR1::FLI1 Diaphysis - Long bones, Pelvis, Ribs Homer-Wright rosettes Lytic, infiltrative, multilayered periosteal reaction (Onion-skin lesion) Fibrous dysplasia (+ Caféau-lait spots + Precocious puberty) Metastasis Prostate Kidney, Lung, GIT, Melanoma PERIPHERAL NERVOUS SYSTEM AND SKELETAL MUSCLE QUESTIONS A 30-year-old male patient presents with symmetric ascending paralysis and areflexia following a history of diarrhea. What is the most likely diagnosis? Microbial infections associated with GBS CSF finding in GBS Swan neck deformity Most common chronic acquired inflammatory peripheral neuropathy Most common cause of peripheral neuropathy Characteristic pattern of involvement in diabetic neuropathy Accumulating substance that causes osmotic damage in diabetic neuropathy Most common inherited peripheral neuropathies Boutonniere deformity: Autoantibodies linked to myasthenia gravis (MG) Osteoarthritis Heberden nodes Bouchard nodes Rheumatoid arthritis (RA) HLA-DR4 Small joints of hands and feet Rheumatoid factor Anti-citrullinated peptide antibody (ACPA) 1st MTP of big toe Tophus Needle-shaped, (-) Birefringence (Yellow) Calcium pyrophosphate dihydrate (CPPD) Knee Rhomboid, (+) Birefringence (Blue) N. gonorrhoeae H. influenzae Ankylosing spondylitis, Reactive arthritis Sacroiliac joint Arthritis, Conjunctivitis, Urethritis Lipoma Liposarcoma Rhabdomyosarcoma Thymic abnormalities associated with myasthenia gravis Electrophysiology finding in MG Autoantibodies linked to Lambert-Eaton myasthenic syndrome (LEMS) Lung cancer associated with LEMS Electrophysiology finding in LEMS Most common inflammatory myopathy in children Dermatomyositis in adults usually occur as a form Morphologic hallmark of dermatomyositis Lilac-colored rash on upper eyelids Dusky red patches on knuckles, elbows, and knees Autoantibodies associated with Gottron papules and heliotrope rash Autoantibodies associated with interstitial lung disease, Nonerosive arthritis, Skin rash (“mechanic’s hands”) Similar symmetric proximal muscle weakness involvement with dermatomyositis but absent cutaneous manifestations Genetic mutation in Duchenne muscular dystrophy (DMD) ANSWERS Guillain-Barre Syndrome (GBS) Campylobacter jejuni, CMV, EBV, and Mycoplasma Albuminocytologic dissociation - ↑ CSF protein without significant ↑ in inflammatory cells Chronic inflammatory demyelinating polyradiculoneuropathy Diabetes Mellitus Distal symmetric sensory polyneuropathy (Glove and stocking pattern) Sorbitol Charcot-Marie-Tooth disease Antibodies to postsynaptic ACh receptor Thymic hyperplasia, thymoma ↓ response with repeated stimulation Antibodies to presynaptic Ca channel Neuroendocrine lung carcinoma ↑ response with repeated stimulation Dermatomyositis Paraneoplastic disorder Perifascicular atrophy Heliotrope rash Gottron papules Anti-Mi2 Anti-Jo1 Polymyositis Total absence of dystrophin (Deletion/Frameshift) Truncated version of dystrophin (↓ activity) Genetic mutation in Becker muscular dystrophy Enzyme elevated in early stages of DMD but decreased in Creatine kinase the late stages Etiology of schwannoma NF2 loss TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISTIAN JERELL S. COSME Page 24 of 27 For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISITIAN JERELL COSME For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. QUESTIONS Type of schwannoma located in the cerebellopontine angle, attached to vestibular branch of CN VIII Cell-dense area of palisading spindle cell fascicles in schwannoma Cell-poor areas with prominent myxoid stroma Most common peripheral nerve sheath tumors Etiology of neurofibroma Etiology of neurofibromatosis type 1 Etiology of neurofibromatosis type 2 Malignant peripheral nerve sheath tumors, optic nerve gliomas, pheochromocytoma, Lisch nodules, Cafe au lait spots Schwannoma, meningioma, ependymoma ANSWERS Vestibular schwannoma Antoni A Antoni B Neurofibroma NF1 loss (Neurofibromin, Ch17) loss → ↑ RAS signaling NF2 (Merlin, Ch22) loss Neurofibromatosis type 1 Neurofibromatosis type 2 CENTRAL NERVOUS SYSTEM QUESTIONS Earliest morphologic marker of neuronal cell death or acute neuronal injury Most important pathologic marker of CNS injury Type of cerebral edema observed in infection, inflammation and tumors occurring due to increased vascular permeability Type of cerebral edema observed in generalized hypoxic injury where the ionic balance of cells are disrupted Type of hydrocephalus which occurs due to ↓ CSF resorption by arachnoid granulations i.e., in healed subarachnoid hemorrhage Type of hydrocephalus when a focal obstruction within the ventricular system is present Cerebral artery compressed in subfalcine herniation Neurovascular structures compressed in transtentorial (uncal) herniation Linear/Flame-shaped hemorrhagic lesions in midbrain/pons Compression of this structure in tonsillar herniation causes cardiac and respiratory depression Most common CNS malformation Deficiency of this vitamin is a known risk factor for NTDs Extension of spinal cord and meninges through a vertebral column defect Most common site of encephalocele This cranial dysraphism occurs due to a failure in the closure of the anterior neural tube ANSWERS Red neurons Gliosis - astrocytic hyperplasia and hypertrophy Vasogenic edema Cytotoxic edema Communicating hydrocephalus Noncommunicating hydrocephalus Anterior cerebral artery Ipsilateral CN III and Posterior cerebral artery (PCA), and cerebral peduncle Duret hemorrhages Brainstem Spinal dysraphism (Spina bifida) Folic acid Myelomeningocele Occiput Anencephaly QUESTIONS Incomplete separation of cerebral hemispheres across midline Absence of white matter bundles that carry cortical projections from one hemisphere to another Small posterior fossa causing downward extension of cerebellar tonsils and medulla through the foramen magnum Low-lying cerebellar tonsils through foramen magnum Hypoplasia/agenesis of the vermis resulting in cystic enlargement of 4th ventricle Fluid-filled cavity in the inner portion of the cord Most common route of CNS infection Viruses with retrograde spread in the nervous system Most common cause of acute pyogenic meningitis overall Common etiologies of acute pyogenic meningitis in newborns Common etiologies of acute pyogenic meningitis in teen and young adults Most identifiable agent of acute aseptic meningitis CSF protein and mononuclear cells are markedly elevated in this type of meningitis Risk factors for brain abscess formation Morphologic findings in meningovascular neurosyphilis Virus associated with hemorrhagic necrotizing encephalitis of the temporal lobe Virus associated with microcephaly, periventricular calcification Cytoplasmic, round, eosinophilic inclusions in pyramidal neurons of the hippocampus and Purkinje cells of the cerebellum in rabies infection Most common cryptococcal infection in immunosuppressed patients Location of skull fracture associated with Raccoon sign and CSF rhinorrhea Location of skull fracture associated with CN III, IV, V, VI injuries, Carotid injury Most common type of skull fracture Mastoid hematoma Rapid neurologic deterioration with lucid intervals Blood vessel lacerated in epidural hematoma CT scan finding in epidural hematoma ANSWERS Holoprosencephaly Agenesis of corpus callosum Chiari II Malformation (Arnold-Chiari) Chiari I Malformation Dandy-Walker malformation Syringomyelia Hematogenous Rabies, VZV S. pneumoniae Group B streptococci, S. pneumoniae, L. monocytogenes, E. coli N. meningitidis, S. pneumonia Enteroviruses Tuberculous meningitis Acute bacterial endocarditis, Congenital heart disease (R→L shunts), Chronic pulmonary infections, Immunosuppression Obliterative endarteritis, Perivascular plasma cells, Gummas HSV CMV Negri bodies C. neoformans Anterior skull base Central skull base Temporal fracture Battle sign Epidural hematoma Middle meningeal artery Lentiform hyperdense lesion TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISTIAN JERELL S. COSME For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Page 25 of 27 TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISITIAN JERELL COSME For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. QUESTIONS Blood vessel lacerated in subdural hematoma CT scan finding in subdural hematoma Above which cervical vertebra is respiratory compromise expected in cases of spinal cord injury Crescent-shaped hyperdense lesion Neurons most susceptible to ischemic injury Pyramidal neurons of Hippocampus (Area CA1: Sommer sector), Cerebellar Purkinje cells, Pyramidal neurons in cerebral cortex (Layers III and IV) Most common location of watershed infarcts in global cerebral ischemia Most common site of deep parenchymal hemorrhage Etiology of lobar hemorrhage Most common type of intracranial aneurysm; Most common cause of spontaneous subarachnoid hemorrhage (SAH) Most common site of berry aneurysm Associated conditions with berry aneurysm Most common clinically significant vascular malformation Usual site of AV malformation A patient presents with multiple neurologic deficits separated in time and space and optic neuritis; CSF findings include moderate pleocytosis, mildly ↑ protein, ↑ IgG. What is the most likely diagnosis? CSF electrophoresis finding in multiple sclerosis Partial seizure that starts with one group of muscles then spreads “marches” to other groups of muscles Disease associated with rapid correction of hyponatremia Most common prion disease ANSWERS Bridging veins C4 ACA-MCA border Putamen Cerebral amyloid angiopathy – Amyloid (Aβ) deposits in vascular wall Saccular “Berry” Aneurysm Circle of Willis – ACAACoA junction (40%) ADPKD, Ehler-Danlos (Type IV), NF1, Marfan, Fibromuscular dysplasia, Coarctation of aorta Arteriovenous malformation MCA territory Multiple sclerosis QUESTIONS Most important risk factor for Parkinson disease Cytoplasmic, eosinophilic, round to elongated inclusions with a dense core and surrounding pale halo seen in Parkinson disease Parkinsonism + dementia + visual hallucination Trinucleotide repeated or expanded in Huntington disease Most common immediate cause of death Vitamin deficiency in Wernicke encephalopathy and Korsakoff syndrome Triad of ataxia, confusion, ophthalmoplegia Triad of confabulation, hallucination, amnesia Most common group of primary brain tumors Most common primary malignant brain tumor in adults Brain glioma with fried egg appearance of the tumor cells and chicken-wire appearance of the vasculature Etiology of oligodendroglioma Most common type of glioma Most common glioma in children; (+) Rosenthal fibers Perivascular pseudorosettes are seen in which brain tumor 2nd most common primary malignant tumor in children; (+) Homer-Wright pseudorosettes; (+) Drop metastasis Most common CNS neoplasm in adults Most common CNS neoplasm in immunocompromised individuals Oligoclonal IgG bands Jacksonian march Cerebral pontine myelinolysis Creutzfeldt-Jakob disease (CJD) ANSWERS Gaucher disease (Glucocerebrosidase) Lewy body (α-synuclein) Dementia with Lewy bodies CAG Pneumonia Thiamine Wernicke encephalopathy Korsakoff syndrome Glioma Glioblastoma multiforme Oligodendroglioma IDH1 or IDH2 mutation AND 1p/19q codeletion Astrocytoma Pilocytic astrocytoma Ependymoma Medulloblastoma Metastasis Primary CNS lymphoma EYE QUESTIONS Optic nerve tumors causing proptosis of the eye Most common primary tumor of the orbit Granulomatous lesion of the eyelid due to sebaceous gland drainage obstruction Most common malignancy of the eyelid Submucosal conjunctival elevations in sun-exposed areas of conjunctiva Common site of conjunctival tumors Condition associated with blue sclerae Cone-shaped cornea associated with Down syndrome, Marfan syndrome, atopy Drug associated with cataract formation Metabolic disease associated with cataract formation Type of glaucoma wherein the iris adheres to the trabecular meshwork, obstructing the outflow of aqueous humor ANSWERS Glioma, meningioma Vascular tumors Chalazion Central core with radiating spicules of amyloid seen in the Kuru plaques Basal cell carcinoma cerebellum of CJD patients Most common cause of Alzheimer disease (AD) Pinguecula, pterygium dementia in older adults (grows onto cornea) Associations with Alzheimer Trisomy 21, apoE (ε4) disease allele (Ch19) Limbus Focal spherical collections of dilated, tortuous axonal or Neuritic plaques (Aβ) Osteogenesis imperfecta dendritic process around a central amyloid core; Specific for AD Basophilic fibrillary structures; Keratoconus Not specific for AD but Neurofibrillary tangles correlates better with degree of (Ta) Corticosteroids dementia A patient presents with Galactosemia, DM, diminished facial expression, Wilson disease slow movement, stooped posture, festinating gait, Parkinson disease Angle-closure glaucoma rigidity, pill-rolling tremor. What is the most likely diagnosis? TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISTIAN JERELL S. COSME Page 26 of 27 For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISITIAN JERELL COSME For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. QUESTIONS Most common form of glaucoma Inflammation within vitreous humor Inflammation of retina, choroid, sclera Autoimmune disorders associated with uveitis Most common intraocular malignancy in adults Most common primary intraocular malignancy in adults Type of retinal detachment with full-thickness retinal defect Infarcts from choroidal vessel damage in hypertensive retinopathy Copper/silver wiring in hypertensive retinopathy Most common retinal vascular disease Earliest sign of nonproliferative diabetic retinopathy Neovascularization is present in these vascular disease of the retina ANSWERS Primary open-angle glaucoma Endophthalmitis Panophthalmitis Reactive arthritis, Behçet syndrome, Juvenile idiopathic arthritis Choroidal metastasis Uveal melanoma Rhegmatogenous Elschnig spots Retinal arteriosclerosis Diabetic retinopathy QUESTIONS A patient presents with sudden onset unilateral blindness. Fundoscopy showed diffuse retinal pallor and cherry red spot in the macula. What is the most likely diagnosis? Type of age-related macular degeneration where Drusen spots or Bruch membrane deposits are seen Most common primary intraocular malignancy in infants and young children Characteristic spoke-and-wheel shaped cell formation seen in retinoblastoma Atrophic, internally disorganized; often called as end-stage eye Chromosome where the RB gene is located Bilateral edema of the optic nerve or papilledema is a sign of ANSWERS Central retinal artery occlusion Dry/Atrophic age-related macular degeneration Retinoblastoma Flexner-Wintersteiner Rosettes Phthisis bulbi Chromosome 13 Increased intracranial pressure Microaneurysms Proliferative diabetic retinopathy, ischemic retinal vein occlusion, retinopathy of prematurity, wet agerelated macular degeneration END OF PATHOLOGY FLASHCARDS TOPNOTCH PATHOLOGY FLASHCARDS HANDOUT BY DR. CHRISTIAN JERELL S. COSME For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com This handout is only valid for the April 2024 batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Page 27 of 27

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