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Pediatrics*

! ! "!!question!on*Klinefelter’s;!it!was!a!dude!with!gynecomastia!long!legs!with!
wide!hips.!!said!he!had!small!firm!balls,!what*type*of*tumor*is*he*
susceptible*to.!Don’t!know,!notes!!just!so!extragonadal!germ!cell!tumor!and!
breast!cancer!nonseminomatous*germ*cell*tumors;*sacrocoxygeal*
teratoma*tumors*(most*common)!

! ! "!!neonatal!necrotizing!enterocolitis!question.!something!about!GI!issues!after!
first!feeding!and!being!!premature"!get!“fever,!bloody!stools,!abdominal!
distension(air!in!the!walls!of!intestine!on!x"ray"!pneumatosis!intestinalis)”"!
coagulative*necrosis*extending*into*muscular*layer*in*the*terminal*
ileum*(complications:!sepsis,!shock,!DIC,!ATN"!all!from!bacteria,!late:!
malabsorption)!

"!!question!on!biliary*atresia.**pathological!bilirubin!levels:!Total!bilirubin!!>15!
mg/dl!(!Hyperbilirubinemia)!–!Conjugated!bilirubin!>!2!mg/dl"!Inflammation*and*
fibrosing*stricture!of!the!hepatic*and*common*bile*ducts!(perinatal!type),!Portal*
tract*edema!and!fibrosis!(extra!hepatic!obstruction"!embryonic!type)!(good!
survival)!

! ! "!!I!think!2!questions!on!Cystic*fibrosis.*1!just!described!it!and!asked!what!
the!defect!was!!and!answer!was!the!CFTR*gene.!!

! ! "!!Phenylketonuria!prognosis:!mental!retardation!(irreversible!brain!damage,!
ch.!12q)!

! ! "!!question!on!neuroblastoma!and!what!gives!poor!prognosis.!!

Poor:!Deletion!distal!1p!and!gain!of!distal!17q!"!poor!prognosis!,!N"myc!
amplification!Telomerase!overexpression!"!poor!prognosis,!!age:!>!5!years!!
Good:!Tyrosine!kinase!receptor!A!(Trk"A)"!increased!expression!,!Stage!4S"!
metastasis!only!to!skin.!Liver,!bone!marrow!
!
! "!! !description!given!for*Retinoblastoma!with!white*pupil!(red!eye,!poor!
vision).!asked!association"!Ewing’s!Sarcoma!(&osteogenic!sarcoma,!
pinealoblastoma)!

- question!asking!about!retinoblastoma*gene!(deletion*of*13q)*answer!was!
osteogenic!sarcoma!!
!! ! ! extra!notes:!Flexner"Wintersteiner!–!cuboidal!cells!
!
- Question!asking!about!bleeds!into!the!germinal!matrix!(intraventricular!
hemorrhage),!!what!is!the!risk!factor?!Something!to!do!with!mother!
!
- picture!of!medulloblastoma!of!the!
cerebellum!and!asking!what's!associated!with!it!
or!what!gives!bad!prognosis"!associated!with;*
Homer;*Wright*rosettes*(surround!neuropil"!
no!lumen),*bad*prognosis;*spread!to!cauda!
equine"!involve!leptomeninges=!pia!+!
arachnoid!mater)(drop!metastasis)!!
!
o pathoma!–!tumor!grows!rapidly!and!spreads!to!CSF!
!
- showed!picture!of!adult!with!ARPKD*(remember!that’s!the!RECESSIVE!
FORM..usually!in!children..can!survive!to!adult!sometimes)!…!what’s!the!
compication?!Ans:!liver!cirrhosiss!(from!congenital!hepatic!fibrosis)!(or!
mental!retardation)!

- !
- sponge!like!appearance!
!

!Bone*!

"!!Description!of!Osteoid*Osteoma"!w/!pain!relieved!by!aspirin!"!where!is!
this!tumor!most!!prominent.!notes!just!say!appendicular*skeleton*(scapula*
is*part*of*appendicular*skeleton.).!answer!choices!were!diaphysis,!
metaphysis,!growth!plate,!epiphysis,!and!scapula!!

! ! "!!description!for!someone!with!joint!issues.!x!ray!given,!shows*no*joint*
space*and!subchondral!cysts.!what’s!associated!with!that?!Rheumatoid!
arthritis.!!
• Papillary!synovial!hyperplasia!!
• Chronic!inflammation!!
• Organizing!fibrin!!
• Pannus!!
• Erosion!of!underlying!cartilage!!
• Narrow(fused)joint!space!!
System:!
Soft!tissue"Rheumatoid!nodules,!!Lung!involvement!,!Vasculitis!(Acute!
necrotizing!vasculitis),!Uveitis!
Complications:!
• Life!Expectancy!by!3"7!yrs!!
• End"stage!lung!disease!!
• Vasculitis!&!its!complications!!
• Systemic!amyloidosis!!
• Iatrogenic!effectsof!Tx"Immunosuppression!!
!

! ! "!!2"3!questions!on!Paget*disease.!(“increased!hat!size,!lion!facies”)!
• Osteolytic!on!x"ray!is!very!dark!and!radiolucent!Osteosclerosis!is!very!
bright,!radiopaque!‘mosaic!pattern’!on!histology!due!to!haphazard!
laying!of!bone!–!cement!lines!and!resorption!pits,!!
• Genetic!predisposition!–!p62!–!inc!Rank"RankL!signaling!
• Blood:!Ca,!Phosphate,!and!PTH!levels!are!NORMAL,!ALP!high!!
• Urine:!elevated!hydroxyproline(!due!to!high!collagen!turnover!)!
• From!paramyxovirus!!stimulates!IL"6!!!osteoclasts!activated!
Question:*
• what!is!the!end*stage*complication!"!high*output*cardiac*
failure!!
• other!complications!–!sarcoma,!giant!cell!tumor!
(osteoclastoma),!extra!osseous!hematopoiesis!!

! ! questions!on*osteoporosis,!mostly!asking!about!mineral*levels"!all!normal!!

• One!was!dealing!with!someone!with*corticosteroids!or!cushings!
(activate!RANK!!osteoclast)!*increased*calcium,*ALP,*increased*
phosphate*and*normal*PTH!(know!the!relation!and!what!will!be!
elevated!as!far!as!calcium,!phosphorus,!and!PTH)!!
! ! !

"!!Question!on!secondary!PTH"!increased*calcium,*ALP,*PTH,*decreased*
phosphate!!

"!!Question!on!scurvy,!bleeding!gums!presentation,*Failed*hydroxylation*of*
proline*and*lysin/vitamin*c**deficiency**

! ! "!!Picture!of!dude!with!achondroplasia*(short*guy;*midget)*=*activating!
mutation!fgfr3*!
!!!!!!!!(Fibroblast!Growth!Factor!Receptor3!inhibits!cartilage!proliferation,!thus!
suppress!growth.!Presents:!shortened!limbs!and!ribs,!bulging!forehead.!
(Normal!longevity,!intelligence!and!reproductive!status)!
!
! ! "!!osteogenesis*imperfecta!question!with!child!with!broken!bones!–!
deficiency!in!type*1*collagen!!
!!!!!!!!Mutations!in!the!gene!encoding!α1!and!α2!chains!of!type!I!collagen!(glycine!
replaced)!!abnormal!polypeptides!that!can!not!be!arranged!in!triple!helix!!
!!!!!!!!too*little*bone*(brittle!bone!disease):!thin!cortex/medulla!!vulnerable!to!
fractures.!also!affects!joints,!ears,!eyes,!teeth!and!skin.!!
!
!
! ! "!!Marfan’s*description,!said!hyperflexible!joints!and!scoiliosis...!it!said!a!
skin!problem!(stretch!marks!on!their!skin)!asked!genetic*aberration;*
Mutation!in!locus!of!fibrillin*gene*on*chromosome*15!

"Elher"!Danlos"!single!gene!disorders!defects*in*collagen*synthesis*or*structure*
(same!presentation!w/!hypertensible!skin).*Bone!is!osteopenic,!
kyphoscoliosis,!spondolisthesis!!

!! ! "!!Question!on!chondrosarcoma.!it!was!a!pelvic!bone!issue!(!Low!grade!(1/3)!
do!not!metastasize,!but!may!recur!and!dedifferentiate,!high!grade"!
metastasize)!(arise!from!enchondroma)!affects!metaphysis!

- old*dude*with*bowed*legs…ask!blood!chemistry!..I!think!they!want!you!
to!think!osteomalacia/rickets…but!I!think!it’s*Paget*disease*osteolytic*
phase;*decrease/*increase*ALP*(seen*in*older*adults*with*bowing*
legs).*coz!I!only!remember*bowed*legs*being*mentioned*in*children*
(rickets)!
!

**GI**

! ! "!!gastrointestinal*stromal*tumor*(GIST)*(interstitial!cells!of!Cajal!(pace!
maker),!can!happen!anywhere!in!GIT,!but!60%=stomach,!treat!with!
Gleevac/Imatinib)!"!CD117*(c;kit).!CML!also!treated!with!Gleevac!
- Amoebic*colitis*(chronic!destructive!colitis!with!flask!shaped!ulcers,!
fecal!oral!route,!gradual!dysentery,!organisms!engulf!RBC,!resemble!IBD!
on!biopsy,!treated!w/!antiparasitic!agent)!"complication:*liver*abscess!
(FROM!RAJ!SLIDES,!NOT!IN!OUR!NOTES)!
– Diverticulosis!also!has!flask!like!structures!which!could!lead!to!
perforation!!

!!

! ! "!!squamous*cell*carcinoma*risk*factor*;*smoking!!

! ! "!!pernicious!anemia!questions"!autoimmune!cause,!destroys!parietal!cells!
(Auto"Ab!to!IF!and/or!parietal!cells)"!!!achlohydria,!hyper!gastinemia!!ECL!
hyperplasia!(neuroendocrine!hyperplasia,!intestinal!metaplasia!
(adenocarcinoma),!fundus!+!body!=!antralized)!
!! ! B12!def."">!neurological!problems,!!
!
! ! "!!2!questions!on!Meckel*diverticulum;*mimics!appendicitis!
– Due!to!incomplete!involution!of!vitelline*duct**
– Rule*of*“2”:*
– Affects!2%!of!the!normal!population,!Occurs!within!2!feet!of!the!
ileocecal!valve,!Averages!2!inches!(5!cm)!in!length!
– Out!pouching!on!the!anti"mesenteric!side!that!includes!all!layers!of!
GIT*(true*diverticulum)!!
– Complications,!(usually!by!2!yrs!old):!Hemorrhage,!ulceration+/"
perforation,!Intestinal!obstruction,!Diverticulitis,!Fistula!!
!
! ! "!!celiac*sprue*(gluten,!atrophic!villi,!hyperplastic!crypts,!increased!inflamm!
cells)!description!and!image!"!something!dealing!with!folate*malabsorption!
(affects!distal!duodenum!and!proximal!jejunum)"can!also!get!iron!deficiency!
anemia!

!
! ! "!!Tropical*sprue!"!some!girl!visits!caribbean!and!comes!back!with!villous!
!atrophy!or!something"!can*affect*entire*small*intestine,!responds*to*
antibiotics,*caused*by*viral/bacterial/serology=negative!

! ! "!!Hirschsprung*association*(“male!with!delayed!passage!of!meconium,!
constipation,!abdominal!distension”)*;*Down*syndrome(10%),*most!
common!congenital!intestine!obstruction,!rectum!always!affected"!no!
ganglion!cells!in!meissner!and!auerbach*,!dilation!+!hypertrophy!)!

! ! "!!description!given!for!diverticulitis*(due!to!lack!of!fiber!increased!
intramural!pressure!herniation!of!colonic!wall.!Lower!abdominal!pain,!
constipation,!diarrhea,!flatulence!(farting),!fever).!asked!what!the!
complication*was:!fistula*(perforation)*!

! ! "!!description!of!a!Jewish!girl!with!crohn’s*disease*(,!terminal!ileitis,!Jews,!
delineated!patches!(skip!lesions),!transmural,!non!caeseating!granulomas,!
fistula/stricture!formation,!“creeping!fat”,!cobblestone,!string!sign!on!barium!
swallow)!!bloody!diarrhea,!abdominal!pain,!mental!stress,!malabsorption,!
long!narrow!thickened!segments!of!SI)!"!asked*assoiation:*ASCA*antibodies*
(Raj*slides)!!!!!what!kevin!put!HLA"DR7!and!!DQ4!!(not!in!our!notes)!!!!!!!!!!!!!!!!

! ! "!!pretty!sure!there!was!another!question!about!crohn’s!but!I!don’t!remember!!

! ! "!!there!were!2!questions!on!C.*Diff*pseudomembranous*colitis:!!
! "!associated!with!broad!spectrumantibiotics!(toxin!mediated),!
rectosigmoid!!affectd!with!raised!yellow!plaques.!See!fibrinopurulent"
necrotic!debris,!surface!epithelium!becomes!denuded,!damaged!crypts!
distended!my!mucupurulent!exudate!(forming!mushroom!cloud),!
pseudomemebrane!formation,!can!delelop!toxic!megacolon!
Mircro!vignette:!
“An old woman comes to the doctor with a fever and loose bowels. Her diarrhea
occurs in tremendous volumes, she complains, although she does not remember
ever seeing blood. She has an unremarkable recent past medical history, except
for an infection a few weeks earlier that was treated with clindamycin.
Sigmoidoscopy of her colon reveals yellow-white plaques, which the doctor
predicted after analyzing her stools for toxins.”
!

!
! ! "!!peutz!jeger!poly!description!given!with!mucosal!pigmentation!and!
arborizing!polyp!"!!asked!what!a!complication!is:!breast!cancer!(also!
pancreas,!lung,!ovary,!uterus)(no!malignant!colon!potential).(!Arborizing!
network!of!smooth!muscle!extending!into!polyp!and!surrounds!glands.!
Glands!are!lined!by!non!dysplastic!epithelium!rich!in!goblet!cells)!

! ! "!!question!about!colon!cancer.!there!were!actually!2!I!think.!but!one!had!
description!of!!old!man!with!iron!deficiency!anemia!and!something!else.!
asked!the!gene!defect...!idk!b/c!the!description!was!for!Lynch!syndrome!and!
none!of!the!answer!choices!were!MLH1!and!MSH2.!it’s!PMS2!(MLH1,!MSH2!
MSH6!and!PMS2)!

! ! "!!question!about!the!liver!and!a!metastasis!to!it!(there!was!no!raise!in!AFP!or!
whatever);!answer!is!colon.!NO!inc!in!AFP!can!also!be!found!in!
hepatoblastoma!(poor!prognosis)!

! ! "!!description!of!carcinoid!with!guy!with!diarrhea!flushing!and!wheezing;!
answwer:!already!metastasized!by!the!time!you!found!it!in!the!Small!
intestine!(most!common!location!SI!and!appendix)!

! ! "!!liver!cancer!=!^!alfa!feto!protein.!!(AFP!–!HCC,!hepatoblastoma,!yolk!sac!
tumor,!testicular!tumor,!mixed!germ!cell!tumor)!

! ! "!!there!were!a!couple!questions!on!hepatitis!pretty!sure,!one!was!dealing!
with!someone!they!said!was!an!IV!drug!user!making!you!think!viral,!but!don’t!
remember!what!the!!question!asked.!!

! ! "!!description!given!for!granulomatous!destruction!of!bile!ducts!=!anti!
mitochondrial!!antibodies.!(Primary!biliary!cirrhosis.!INTRAhepatic!bile!
ducts.)!

! ! "!!there!were!a!few!liver!tumor!questions.!one!had!the!description!of!a!female!
on!an!oral!!contraceptive!pill!so!know!all!the!details!of!hepatic!adenoma!
because!that’s!what!it’s!associated!with.!another!had!an!image!with!a!mass!
showing!hepatocellularcarcinoma!(HCC);!I!think!the!answer!might!have!been!
aflatoxin.!I!put!clonorchis!sinensis!cuz!the!question!said!something!about!an!
asian!guy!I!was!like!wtf!idk.!!!!From!Raj!slides!the!most!common!cause!of!HCC!
in!US!is!from!cirrhosis.!Globally!from!Hep!B.!Class!slides!just!say!all!the!things!
that!give!you!cirrhosis!and!aflatoxins,!thoratrast,!anabolic!steroids.!!
Clonorchis!sinensis!(parasite)!can!cause!cholangiocarcinoma.!!

!images!for!HCC" "!

!
! ! "!!carcinoma!of!gall!bladder!described!"!what!is!the!risk!factor,!idk!what!the!
answer!choices!were,!I!probably!got!it!wrong.!!Gall!stones!(carcinogenic!
derivates!of!bile!may!play!a!role),!parasites!,!and!pyogens!

! ! "!!description!of!acute!pancreatitis!after!gallstones!(80%!associated!w/!
gallstones!and!alcohol)!important!causes:!

Acute Pancreatitis-Clinical Features Acute Pancreatitis


• Usually severe epigastric pain
with nausea and vomiting • Characterized by acute onset of abdominal pain resulting
– Pain can vary from mild to very from enzymatic necrosis and inflammation of the pancreas
severe OTHER CAUSES OF

• Constant, intense and is


EPIGASTRIC PAIN (GIT)
• 80% cases are associated with GALLSTONES and
referred to upper back • Esophagitis (reflux) ALCOHOLISM
• Release of enzymes, toxins • Gastritis
• Other important CAUSES include
and cytokines in circulation • Peptic ulcers
Infections –Mumps, Coxsackie and Mycoplasma
leads to activation of systemic • Cholecystitis
inflammatory response Acute ischemia – Shock, trauma, vascular thrombosis, embolism,
vasculitis etc.
Hyperlipoproteinemias (uncommon)
Drugs –Diuretics, Azothioprine, Estrogens, sulfonamides etc
• Chronic alcoholic patient with epigastric pain and vomiting –
! • Questions for Hx? DDx? Investigations? !

Acute Pancreatitis-Clinical Features


Acute Pancreatitis-Morphology • Leukocytosis
• DIC
• Focal areas of fat necrosis in pancreas and • Hemolysis
peripancreatic tissues and abdominal cavity • Peripheral vascular collapse
• Chalky white areas of Ca++ deposition • Shock with ATN, ARDS
(saponification)- Appear radiopaque on radiographs • Hypocalcemia (due to saponification)- tetany
• Severe cases–necrosis of pancreatic tissue (acini, • Raised amylase levels in first 24 hours
ducts and islets) with hemorrhage (Hemorrhagic • Followed by lipase with in 72-96 hours
pancreatitis) • Complications-
– ARDS
– ATN
– Pancreatic abscess

!!!!!! !
"!!another!question!on!pancreatitis!asking!which!enzyme!present.!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Acute!pancreatitis:!first!24!hrs!–!amylase,!72"96!hrs!–!lipase.!!!!!!!!!!!!!!!!!!!!!!!!
Chronic!pancreatitis:!destruction!of!parenchyma!–!no!amylase!or!lipase!!

! ! "!!carcinoma!of!the!head!of!the!pancreas!obstructing!second!part!of!the!
duodenum!"!!migratory!thrombophlebitis.!Obstructive!Jaundice!–!Trousseau!
sign!(migratory!thrombophlebitis)!

FGS*

! ! "!*leiomyoma*risk*factor*–*nulliparous*African*American*women!
(asymptomatic!NO!malignant!potential!20"40!years,!estrogen!dependent!
growth,!lead!to!infertility!and!uterine!bleeding,!whirling!bundles!of!smooth!
muscle)!Menorrhagia,!metrorrhagia.!Acute!pain!–!Red!degeneration!if!it!gets!
too!big.!CAN!MIMIC!fibroadenoma!!

! ! "!!cervical*cancer*risk*factor*;*early*sex*(also,!HPV,!multiple!partners,!
chlamydia).!May!present!with!post"coital!bleeding!

! ! "!!description!of!pre;eclampsia*(HTN,*proteinuria,*gestational*
edema)!asked!what!the!predisposing**factor!is:!Primigravida,!over!35!years!age,!
Multiple*pregnancies,!Hydramnios,*Preexisting*hypertension,*Hydatidiform!
mole! !
!

! ! "!!description!of!an!ovarian!teratoma!and!asked!what!the*risk*was!(for!this!
specific!question!and!answer!choices!available):!torsion*(also!squamous!cell!
carcinoma)!

! ! "!girl!with!the!description!of!inguinal*lymphadenopathy.!asked!the!
association:*2!types!inguinal!is!mentioned!is!squamous!carcinoma!(HPV)!
and!vulvar!carcinoma!(HPV).!!

! ! "!!question!describing*fibroadenoma!with!a!mobile!discrete!mass!=*
neoplasm*of**(intralobular)stromal*cells.*(Phyllodes!which!is!a!sarcoma!is!
a!neoplasm!of!periductal!stromal!cells)*

! ! "!!question!describing!phyllodes*tumor...!very*big*tumor!and!something!
about!clefts;!asked!what!feature!will!make!it!malignant:!stromal*
overgrowth*(>10HPF).*Spreads!through!blood!

! ! ;**breast*cancer:!of!the!options!given!what!has!the!highest*association*=*
familial*history**(1st!is!gender)*

! ! "!!there!was!a!question!about!dysgerminoma*or*seminoma.!can’t!remember!
which!one!!but!basically!it!described!a*tumor*down*there*with*big*cells!and!
scant!stroma!and!!asked!which!breast*tumor*has*the*same*shit:*medullary!
(fried!egg).!(Fried!egg!appearance:!Seminoma,!dysgerminoma,!Hairy!cell!
leukemia,!oligiodendroglioma,!parietal!cells!of!the!stomach,!medullary!
carcinoma!of!the!breast)!(large!uniform!round!cells,!clear!cytoplasm,!central!
regular!neuclei,!no!stroma)!

! ! "!!description!given!for!Paget’s*breast!(single!sided,!Older!female,!w/!oozing!
ulcerated!nipple,!perinuclear!halo"!Toker!cells!Er",!Her2!+)!with!the!
intraepithelial!cell.!asked!what!the!*prognosis*is*based*on!for!this!person!=!
features!of!underlying**intraductal*carcinoma!!

! ! "!!something!else!about!better*prognosis*of*breast*cancer!(Major:!distant!
metastasis,!then!spread!to!axillary,!Minor:!receptors)"I!put!lacking*Her*2neu!!
! ! "!!PCOD*questions:!(enlarged!ovaries,!female!with!secondary!amenorrhea,!
excessive!facial!hair!(hirtuism),!OBESE,!high!glucose!(insulin!resistance,!^LH,!
decreased!FSH)!
!!!!!!!!!!! "!question!!asked!about*what*it*can*cause"!answer!was!endometrial*
hyperplasia*(due!to!excess!estrogen).!Can!also!cause!FCC,!breast!cancer,!
infertility,!Type!II!diabetes!(insulin!resistance),!Follicular!cyst*
*
!!!!!!!"!!there!was!something!that!described!somebody!who!had!a!granulosa*cell*
tumor(!^estrogen,!precocious!puberty,!menorrhagia,!endometrial!
hyperplasia,!uterine!bleeding):!!answer*was*Call;Exner*bodies*(cuboidal*
granulosa*cells*with*central*arrangement).!Perimonopasual.!Tumor!
maker!is!inhibin.!Other!ovary!can!have!follicular!cyst.!!!

! ! "!!description!given!for!Meig’s*syndrome!(benign!tumor!of!fibroblasts!
(fibroma)"!plump!spindle!cells!with!fats,!!w/!pleural!effusion!(hydrothorax)!
and!ascites!association);!asked!association*=*basal*cell*nevus**syndrome*
(Gorlin)*

! ! "!!description!of!lichen*sclerosus!(affects!Vulva"!postmenopausal,!
autoimmune!nature"!high!level!of!T!cells,!scaly!plaques,!think!parchment!like,!
dense!collagen!,!slightly!increased!risk!of!ca),!(pathoma!–!thinning!of!the!
epidermis!and!fibrosis,!may!present!as!white!patch!with!parchment!like!
vulvar!skin):!!asked!what!it’s!associated*with:*autoimmune*in*nature!
!
! ! "!!there!was!a!description!of!something!that!sounded!like!pseudomyxoma*
peritonei*(jelly*belly;*mucoid*material)!(it!had!spots!of!!stuff!all!in!the!
peritoneum!bi"lateral),!and!the!question!asked!what*it*was*associated*with"!
primarily!extraovarian!(appenicieal),!secondary!spread!to!ovary!and!
peritoneum)"fatal.!Can!also!get!jelly!belly!with!mucinous!(surface!epithelium)!
ovarian!tumor!

- question!on!ectopic*pregnancy!(Fertilized!ovum!implanted!outside!the!!!!!
uterine!cavity;!seen!in:!fallopian!Tubes!(scarring),!cervix,!ovary,!
abdomen),!spontaneous!abortion!(vaginal!bleeding),!!
!
! ! "!!question!on!hydatiform*mole"!More!common!in!Far!East!,!Large!
edematous,!avascular!villi,!Degeneration!of!stroma,!Proliferation!of!
trophoblasts!,!Partial!or!complete,!grow!abnormal!edematous!villi!of!
placenta,!proliferation!of!trophoblasts,!larger!uterus/^B"HCG!for!date!!!!!!!!
Hydatiform!mole!–!uterus!filled!with!translucent!grape!like!clusters,!def!of!
fetal!blood!vessels.!!
Complete!–!ovum!had!lost!all!of!its!structures.!46xx!or!46xy.!May!produce!bilateral!
theca!lutein!cysts.no!fetal!parts!seen.!!
Partial!–!ovum!+!2!sperm!=!69!XXY.!Fetal!parts!may!be!seen!
!!
*
Male*Genital*

! ! "!!there!were!3"4!questions!where!the!stem!included!info!about!the!prostate.!
1!the!!question!asked!where!it!could!spread!to!and!the!manifestation!there,!2!
asked!in!BPG!!what!region!of!the!prostate!it’s!in.!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
BPH!–!hyperplasia!(not!hypertrophy).!Non!neoplastic!–!no!malignant!
potential.!Treat!with!5!alpha!reductase.!Central!located!">!urethral!
compression!(complications).!Dec!testosterone.!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Prostate!Cancer!–!Risk!factor!–!high!fat!diet,!family!history!(HPC1!gene,!
RNASEL!gene)!usually!in!the!peripheral!zone.!Can!spread!to!the!seminal!
vesicles,!LN,!distants!mets!

! ! "!!description!of!cryptorchidism:!what!type!of!tumor!associated!with!it:!
answer!is!germ!cel,!but!that!wasn’t!a!choice!on!the!test!so!I!put!seminoma.!
but!I!think!mixed!type!or!!whatever!was!also!a!choice!so!idk!wtf!they!want.!!
Cryptochidism!–!35x!increase!in!chance!for!germ!cell!tumor:!seminoma,!non"
seminoma,!embryonal,!teratoma,!choriocarcinoma,!yolk!sac!tumor!

! ! "!!Description!given!for!seminoma!and!asked!what’s!associated!with:!
excellent!response!to!!radiotherapy.!Non!seminoma!good!response!to!
chemotherapy!!

! ! "!!Someone!had!a!solitary!lesion!on!the!shaft!of!the!penis,!can’t!remember!
what!the!rest!!of!the!description!was,!but!pretty!sure!it!was!HPV.!Other!
choices!were!HSV!(vesicles),!and!things!that!cause!ulceration!like!syphillis!!!!
Bowens!disease!–!solitary,!on!the!shaft,!plaque!(scaly),!associated!with!
visceral!malignancies.!Progress!to!invasive!Sq!cell!carcinoma.!!!!!!!!!!!!!!!!!!!!!
Erythroplasia!of!Queyrat!–!solitary!or!multiple,!on!glands!and!prepuce,!red!
patch,!shiny!plaque.!Progress!to!invasive!Sq!cell!carcinoma!

!Renal*!

! ! "!!renal*cell*carcinoma!is!in!which!part!of!kidneys!"*tubular!epithelial!cells!!
! ! "!!know!all!of!where!the!deposits!are!and!what!diseases!have!which.!you!need!
this!to!!solve!the!questions!for!at!least!5!questions:!!
SUBENDOTHELIAL*DEPOSITS:!
! ! ! ! "!type!1!membrano!proliferative!glomerulonephritis"!tram!
track!
"!diffuse!proliferative!glomerulonephritis"!(rapid!prog!
glomerulonephritis"!type!II"!w/!SLE)!
! ! ! ! "!amyloidosis)!
! ! ! ! "!IgA!
SUBEPITHELIAL!DEPOSITS:*
- membrano!proliferative!nephropathy!
- post!strep!GN!
!
! ! "!!post*strep*GN*;*humps!(subepithelial!humps!and!bumbs)!

! ! "!!creatinine!used!because!=!freely*filtered**

! ! "!!know!which!diseases!have!low!complement!or!altered!compliment!***!this!
was!2"3!!questions:!(Low*compliment:!SLE!(3&4),!membranoproliferative!
glomerulonephritis"!type!2,!cryoglobulinemia,!bacterial!endocarditis),!!
(variable*compliment:!Rapidly!progressive!glomerulonephritis)!
!

! ! "!!post*strep*GN!"!complement*levels*low!!

! ! "!!!another!post*strep*question,!but!I!can’t!remember:!(hyper!cellular!on!LM!
and!proliferation!of!mesangium,!!99%*of*time=*full*recovery,!<1%!of!time:!
results!in!compensatory!hyperfilration,!glomerular!sclerosis,!can!become!
RPGN)!

!
! ! "!!question!on!a!9!year!old!with!proteinuria!and!pedal!edema!"!minimal*
change!!

! ! "!!description!given!for!membranous*nephropathy*(spike*and*dome)!
asked!what!the!!indicator!was!for!prognosis:!>!10!gm!proteinuria!>50!years!

! ! "!!question!on!membrano;proliferative!having!subendothelial!deposits!in!
type*I!

- question!on!what!the!earliest*lesions*in*diabetic*nephropathy:!expansion!
of!
mesangial!matrix!&!thickening!of!GBM!(first!morphological*change),!first*
functional*change=*hyperfiltration,*biochemical:*microalbuminuria!

! ! "!!question!on!amyloidosis!secondary!to!someone!who!had!Rheumatoid!
arthritis!for!15!!years;!answer!=!associated!with!SAA!(remember!RBC"HORT)!

! ! "!!question!on!IgA*nepropathy;!description!was!something!post*infection*
(respiratory!illness!or!GI!illness!(celiac))!

! ! "!!description*for*lupus*given;!asked!kidney!disease:!diffuse*proliferative.*
there!are!6!!different!types!class*4*which*is*the*most*common!and!class*6!
is!associated!with!global*sclerosis!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Type!1!–!minimal!mesangial!(mesangial!immune!deposits!on!EM!and!IF)!!!!
Type!2!–!mesangial!proliferative!(mesangial!expansion!and!hypercellularity)!
Type!3!–!Focal!segmental!proliferative!(subENDOthelial!and!mesangial!
deposits)!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Type!4!–!Diffuse!proliferative!(subENDOthelial!and!mesangial!deposits,!
crescents!and!necrotizing!lesions,!MOST!COMMON!AND!MOST!SEVERE,!low!
complement,!high!anti"DNA!levels)!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Type!5!–!Membranous,!subEPIthelial,!!thickening!of!GBM!(same!as!idiopathic!
membranous!nephrotic)!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Type!6!–!Advanced!sclerosing,!interstitial!fibrosis,!tubular!atrophy,!!

! ! "!!type!of!casts!in!ATN!–*granular/muddy!brown!(can!also!see!epithelial!
casts)!

! ! "!!some!other!question!with*ATN!"!answer!dealt!with!not*reabsorbing*
bicarbonate!!

! ! "!!another!ATN!question!for!which!the!answer!had!to!do!with!the!mechanism!
being!the!!person!had!blood*loss;*HYPOVOLEMIC;*ISCHEMIC*!

;*! Person!hiking…got!into!accident..lost!a!lot!of!blood..ask!what!kind!of!
cells/casts!would!you!see!in!urine?…so!you!know!he’s!hypovolemic!and!
would!lead!to!ischemia…">!acute!tubular!necrosis!">!any!ACUTE!damages!
that!lead!to!cell!death!would!shed!granular!AKA!muddy!brown!cast.!
Know!your!other!casts!as!well.!!
- If!damage!has!been!there!for!a!long!time!it!would!shed!Waxy!cast,!such!as!in!
hydronephrosis.!(rememeber!cervical!cancer!is!microinvasive,!meaning!it!
doesn’t!really!spread!anywhere!else!except!for!the!bladder!wall!or!it!
obstructs!the!bladder!or!something!so!it!can!lead!to!hydronephrosis…">!renal!
failure.!Which!I!THINK!is!the!number!one!complication!of!cervical!
cancer…not!positive.!
"!Hyaline!cast!for!someone!who’s!dehydrated!or!having!a!fever,!it!could!be!a!
normal!physiological!response!
"!WBC!cast…pyelonephritis…drug!induced!AIN..(drug!induced!AIN!you!would!
also!see!high!eosinophil!count)!
"!RBC!cast"!anything!to!do!with!kidney!damage!you!would!see!rbc!CAST!vs!if!you!
just!see!RBC!(non!distorted!red!cells)!in!urine…that!means!it’s!a!post!renal!
problem!(e.g.!bladder).!!
!
!
! ! "!!there!was!an!acute*interstitial*nephropathy!question,!don’t!remember!
what!it!asked!though.!spoke!about!eosinophilia*and!all!that!–!(AIN:!Type!4!
hypersens,!penicillin,!NSAIDS,!diuretics,!WBC!casts,!increased!BUN!&Cr,!
usually!complete!recovery,!

! ! "!!there!were!3"4!questions!on!polycistic*kidney*disease;!one!gave!the!
symptoms!and!asked!the!gene,!another!dealt!with!a!huge!kidney!at!birth;!idk!
just!know!all!the!details!!secondary!sclerosis!can!occur!

"!!2"3!questions!on!Alport’s*;!question!would!describe!a!kidney!problem!and!
someone!with!deafness;!(alpha!5"!gene:!type!4!collagen!(Mutations!COL4A4!
&!COL4A5!genes),!age:!5"20,!

"!Alport*EM;*Thinning*and*splitting*lamination!*basket*weave*
appearance!

! ! "!!kidney!tumor!associated!with:*VHL;*Renal*cell*carcinoma*(VHL:*RCC,*
pheochromocytoma,*ocular*angioma)*

! ! "!!question!on!bladder!cancer;!answer!had!both!smoking!and!napthylamine!as!
choices!!but!it’s!smoking!since!it’s!the!greatest!risk!factor.!there!was!another!
one!on!bladder!cancer!for!which!the!answer!was!schistosomiasis;!1!or!both!of!
the!questions!spoke!about!painless!hematuria!in!the!stem.!!!!!!!!!!
Shistosomiasis!!!Sq!cell!carcinoma.!Smoking!!!Transitional!carcinoma!

!Endocrine:!!

! ! "!!description!of!a!small*cell*lung*tumor*and*ectopic*ACTH!production,!
can’t!remember!!what!question!asked!though.!2˚!Cushings.!Run!a!1mg!
overnight!dexamethasone!test!to!rule!out!pituitary!adenoma.!!

! ! "!!question!on*addisons,!know!mineral!levels!!everything!is!low,!but!ACTH!
is!high!due!to!no!negative!feedback.!(potassium,!sodium,!and!renin!also!high)!
Run!a!short!syncathen!test!(administer!ACTH!analog)!to!test!whether!not!
realizing!ACTH!

! ! "!!asked!how!to!use!dexamethasone!to!test!^!cortisol!due!to!pituitary!tumor"!
give!high*dose*DST:!cortisol*levels*decrease*when*it’s*due*to*a*pituitary*
tumor,*but*remain*high*when*it’s*due*to*ATCH*from*small*cell*
carcinoma!!
! ! "!!know!sensitive/specific*tests*for!growth!hormone!tumor!and*
acromegaly;!our!answer!!was!GTT*with*GH*measurement*(in!normal!
people,!GH!levels!fall!following!oral!glucose!administration),!also*can*check*
IGF;1!

! ! Diabetes:!!

• question!on!HLA!associations"!type*1=*HLA;DR3*&*DR4/*DQA1*DQB1!
• question!on!mechanism!of!type!I!(young!thin!w/!high!glucose)"!!
autoimmune*destruction*of*Beta*cells*by*T;cells*(ICA;islet*cell*AB’s*
seen)*(triggered*by*a*viral*infection:*molecular*mimicry)!
• question!on!lady!presumed!to!have!injected*insulin!so!how!do!you!
check"!check*C;Peptide*levels,*c;peptide*will*still*be*low*when*
injected*w/*exogenous*insulin!!
• question!on!!(older!+!obese!w/!high!glucose)!mechanism*of*type*2*
diabetes*etiology!(insulin!resistance!here):*obesity!!increased*
production*of*Fatty*acids*and*TNF*by*adipose*tissue!!metabolized!to!
TAG!!high!TAG!inhibits*insulin*signaling,!and!genetic!defect!causes!
primary!B!cell!defect)!
• question!on!which!one!you!see!amyloidosis*in;*Type*2*DM*(pancreatic*
pathology)Localized*amyloidosis*(also*seen*in*medullary*carcinoma*
of*the*thyroid)!
• question!of!someone!who!has!DKA!"!knowing!it!was!type!I"!asked!a!
question!(virus/stress!causes!cortisol!release!antagonize!
insulin!osmotic!diuresis!dehydrated),!ketones!cause!vomiting!(area!
postrema),!give!saline!infusion!
• question!asking!for!the!risk!of!someone!with!type!II!that!has!a!sugar!
reading!of!400"!high!risk!for!dehydration!*COMA*(HHS:*>600*serum*
glucose),*but*NO*ketosis!
! ! "!!two!questions!dealing!with!ADH!secretion*and*hyponatremia!or!
hyperosmotic!urine.!one!the!person!had!a!surgery!for!anterior!pituitary.!–!
can!lead!to!coma/death,!causes:*post;op*stress,*intra*caranial*disease;*
encephalitis,*meningitis,*Small*cell*carcinoma,*pneumonia,*TB,*Drugs!!
SIADH!(which!can!be!caused!by!the!things!above)!will!lead!to!hyponatremia.!
If!severe!can!cause!neurological!symptoms,!coma!and!death.!(dec!serum!
osmolality,!inc!serum!osmolality)!
! ! "!!There!were!a!couple!questions!where!the!answer!choice!was!the!type!
where!it!was!an!arrow!with!T3,!T4,!TSH,!and!something!else,!so!you!have!to!
know!how!each!go!up!and!down!with!disease!!

! ! *

*
"!!There!was!a!question!of!follicular*carcinoma!=!answer!was!spreads*
hematogenously."no!symptoms!were!given,!just*a*picture*of*the*histology.**

!!!!!!!!!!!!!!!! !!!!!!!!!!!!!!!!!!!!!!!*
! ! "!Describing!medullary*thyroid*cancer*(tumor!making!lots!of!calcitonin).!
asked!what!u!need!to!look!for:!!pheochromocytoma*(MEN2!association)!

! ! "!pheochromocytoma,!what!do!u!look!for*in*the*urine:*increased*
catecholamine*metabolites:*metanephrines*and*vanillymandelic*acid*
(VMA),*(in*the*serum,*look*for*metanephrine)!

;***cretinism"!iodine!deficiency!(seen!in!children),!caused!by!maternal!
hypothyroidism!(pt!w/!mental!retardation,!short,!coarse!facial!features,!large!
tongue,!umbilical!hernia)!

! *Graves:!3!questions!

!1!asking!the!antibody"!stimulating!immunoglobulins!!

"!scalloped!margins,*germinal*center,!HLA"!B8,!DR3,!preoperative!iodine!given,!!
pretibial!myxedema,!exothalmos!

Hashimoto’s:!3!questions"!REMEMBER!hypothyroidism!w/!IODINE!LEVELS!ARE!
NORMAL"!HLA"DR3!and!HLA"DR5!
• 1!question!asked!about!the*antibody*present"!antimicrosomal*and*
antithyroglobulin*antibodies**
• "another!question"!!the!answer!!was*post!germinal*centers*(w/*Hurthle*
cells)!

!
"!question!on!MEN1*(3P’s"!para!thyroid!tumor,!pancreatic!islet,!ant!pituitary"!
prolactin)!
"!question!on!secondary*hyperparathyroidism*(due*to*low*calcium;*from*renal*
problem)*Low*calcium*stimulated*TSH*secretions*

Chart*for*adrenal*problems*

*
Forensics*

There!were!only!like!3!to!4!questions!on!forensics!I!think…!
!
- Question!described*carbon*monoxide*poisoning*(headache,!dizzy!naseau,!
cherry!red),!might!have!even!told!you!there’s!high!CO!level,!what’s!wrong"!
Impairs*release*of*oxygen*from*Hgb*(hypoxemia)*!

!
- One!on!anti*freeze*poisoning*(ethylene*glycol)…ask!what’s!most*likely*
cause*of*death"!Acute*tubercular*necrosis**(24;72*hrs)*OR!acute!
respiratory!failure,!OR!!heart!failure!(24hrs).!!!fetal!doze!100"200mL.!
Neurologic!0"12!hrs!(CNS!depression),!Cardio!12"24hrs!(compensatory!
hyperventilation,!HF),!Renal!24"72!(ATN).!HIGH!anion!gap,!calcium!oxalate!
crystals!(“sheafs!of!wheat”)!
!
- Trauma!to!head…basically!hinted!epidural*hemorrhage,!ask!which!artery,!
answer!choices!did!not!give!middle!meningeal!artery,!gave!middle!
CEREBRAL.!The!correct!answer!is!a!branch!of!maxillary!artery!(middle!
meningeal!artery).!This!one!was!tricky.!Make!sure!you!read!the!answer!
choices!carefully.!!
!

! ! !;**know*methanol*is*also*in*antifreeze!(typically!u!think!ethylene!glycol);!
poisoining!can!!lead!to!=*blindness.!Early!transient!euphoria.!6"30!blurred!
vision,!ab!pain,!vomiting!(metabolized!to!formic!acid),!Delayed!acidosis!!

! ! !

!
"!!toxic!effects!of*cocaine:!aortic*dissection.!

!
! ! "!!multiple!questions!about!hemorrhages!in!the!brain!!

Heme**

- Sickle!cell!!

- polycythemia!vera!!

- G6PD!"!question!asked!!hereditary!spherocytosis!!!

- couple!questions!on!megaloblastic!anemia!!

- pernicious!anemia!"!atrophic!gastritis!!

- aplastic!anemia!

- !thrombocytopenia!!!

- Coagulation!cascade!(think!question!dealt!with!factor!8)!!

- for!all!the!lymphomas!and!leukemias!know!the!presentation!and!all!the!
major!translocations.!!

- off!the!top!there!was!questions!on!ALL,*CML,*CLL,*Burkitt’s*lymphoma,*
AML,*Hairy*cell*leukemia,*and!a!few!questions!on*multiple*myeloma,*
know!about*Hodgkins*too!!

!
- fool!comes!in!with!swollen!jaw..!don’t!remember!if!they!showed!picture!or!
described!it..Burkitt’s!lymphoma..thinking!8;14!translocation!right!away…but!
question!asked!CD!marker….fuck!me!lol…answer!choices!
!
A) CD!19,!!CD!23!
B) CD!19!and!CD!20!
C) CD!19,!no!CD!20,!CD!10!
D) Don’t!remember!
!
- Answer!is!B,!I!guessed!right,!path!can!suck!my!dick.!Burkitt’s!should!have!
19,20!and!10.!19!and!20!are!usual!markers!for!B!cells!but!I!think!pathoma!
mentioned!there!is!one!B!cell!lymphoma!specifically!without!either!19!or!20.!
Look!it!up!
!
!
"!Showed!picture!of!owl!eeyed!nucleus,!Hodgkin!lymphoma,!ask!which!of!the!
following!is!true:!
A) extranodal!
B) unpredictable!pattern!
C) multiple!groups!of!nodes!
D) the!best!prognostic!factor!for!the!disease!is!STAGE!
!
!
- showed!picture!of!blood!smear!with!lots!of!neutrophils,!if!you!don’t!know!
how!neutrophils!look!by!now!don’t!take!the!exam…(multilobed!nucleus)!
- so!that’s!gonna!be!CML,!ask!translocation:!9;22.!!Remember!9;22!can!be!for!
ALL!as!well.!That’s!the!next!question.!!
!
- Gave!blood!values,!high!WBC,!!low!platelets!and!Rbc!I!think….doesn’t!matter,!
they!also!show!PB!smear!of!Lymphoblasts…know!how!they!look….so!you!
think!ALL.!The!question!ask!which!of!the!following!has!worst!prognosis:!!
!
a) 2"10!years!old!(good)!
b) hyperdiploidy!(good)!
c) WBC!count!of!5000!(normal!is!4000!to!11000!I!think,!so!this!is!actually!
towards!low!end,!which!is!GOOD)!
d) 9;22!translocation!(BAD,!the!good!kind!is!12;21)!
!
- Question!gave!Myelofibrosis!or!polycythemia!vera..forgot…asked!for!
mutation..!both!are!due!to!JAK2!mutation!
!
- After!you!get!splenectomy,!you!will!see!howel!jolly!bodies!
!
- Person!with!g6pd!deficiency…..i!think!in!stem!they!say!you!see!bite!cells…or!
they!like!to!say!that!person!experiences!anemia!after!taking!drugs….they!will!
never!give!you!fava!beans..even!though!they!highlight!the!shit!out!of!that!in!
lab..fuckers.!ask!what’s!the!best!way!to!diagnose..?!answer!choice!gave!test!
for!g6pd!enzyme!deficiency!in!blood!or!look!for!Heinz!body…I!put!Heinz!body!
but!not!sure!..because!u!are!already!seeing!bite!cells…!I!don’t!know!if!you!
would!still!see!Heinz!body,!that!threw!me!off…make!sure!to!know!!BEST!way!
to!diagnose.!!
!
!
NEURO*
!
Question!described!MS..!I!think!vision*problem*on*one*side!and!walking*retarded*
on*one*side!with*recurrence!or!some!shit..!answer!choice!gave!random!
lesions!found!or!something!and!some!other!ones..!Multiple,*well;*
circumscribed,*slightly;depressed,*glassy,*gray;*tan,*irregularly;*shaped*
lesions*(Plaques)!

Pathogenesis:!Patchy!loss!of!myelin:!grey!&!white!matter!*!
- Symptoms!related!to!area!involved!&!gray!matter!injury!may!correlate!best!
with!disability*!
- Usually!transient!and!recurrent!
- Risk:!HLADR15!
!
!
- Hungtington’s*–*trinucleotide*repeat*expansion**
!
!
Comment!
!
This!exam!is!not!horrible,!there!are!probably!20!percent!of!HARD!questions.!The!
others!are!simple!and!straighforward!as!long!as!you!know!your!class!slides!well.!It!
was!hard!for!everyone!because!you!have!9!topics!to!cover!and!the!question!
distribution!was!pretty!equal!except!for!peds!and!forensics.!!
!
!
!
!
!
!
First!Aid!stuff!
Tumor!Markers!
!
Gene! Tumor!
Oncogenes** !
BCR!–ABL! CML,!ALL!
c"kit! Gastrointestinal!stromal!tumor!(GIST)!
c"myc! Burkitt!lymphoma!
HER2/neu! Breast,!ovarian,!gastric!carcinomas!
RAS! Colon,!lung,!pancreatic!
RET! MEN!2A!and!2B!
Tumor*Suppressor*Genes* !
APC! Colorectal!Cancer!
BRCA1!and!2! Breast!and!ovarian!
P16! melanoma!
PTEN! Breast,!prostate,!endometrial!
Rb! Retinoblastoma,!osteosarcoma!
Tumor*Markers* !
ALP! Mets!to!bone,!Liver,!Paget!disease!of!
bone,!Seminoma!!
AFP! HCC,!hepatoblastoma,!yolk!sac!tumor,!
testicular!tumor,!mixed!germ!cell!tumor!
B"hCG! Hydatidiform!mole!and!
choriocarcinoma,!testicular!cancer,!
mixed!germ!cell!tumor!
CA!19"9! Pancreatic!adenocarcinoma!
CA!–!125! Ovarian!Cancer!
Calcitonin! Medullary!thyroid!carcinoma!
CEA! Colorectal,!pancreatic,!gastric,!breast,!
medullary!thyroid!carcinoma!
PSA! BPH,!prostate!adeno!
TRAP! Hairy!cell!leukemia!–!B!cell!neoplasm!
! !
!
!
!
!
!
! !
!
!
Classical*Presentations*
Clinical*Presentation* Diagnosis*
Abdominal!Pain,!Ascites,!hepatomegaly! Budd"Chiari!syndrome!(post!hepatic!
venous!thrombosis)!
Adrenal!hemorrhage,!hypotension,!DIC! Waterhouse"Friderichsen!syndrome!
(meningococcemia)!
Back!pain,!fever,!night!sweats,!weight! Potts!Disease!(vertebral!Tb)!
loss!
Bone!Pain,!bone!enlargement,!arthritis! Paget!disease!of!bone!
Cold!intolerance! hypothyroidism!
Conjugate!lateral!gaze!palsy,!horizontal! Multiple!Sclerosis!
diploplia!(bilateral)!
Cutaneous!dermal!edema!d/!t!CT! Myxedema!(Graves!–!pretibial)!
deposition!
Dry!mouth,!dry!eyes,!arthritis! Sjogren!syndrome!(AI!destruction!of!
exocrine!glands)!
Circular!grouping!of!dark!tumor!cells! Home"Wright!Rosetes!(neuroblastoma,!
surrounding!pale!neurofibrils! medulloblastoma,!retinoblastoma)!
Arthritis,!vasculitis,!non" Henoch"Schonlein!Purpura!
thrombocytopenic!purpura,!IgA!
nephropathy!
Pheochromocytoma,!RCC,!and!ocular!! Von!hippel!lindow!?!
Rectal!prolapse!and!nasal!poylps!in!child! Cystic!fibrosis!–!CFTR!gene!
Fair!skin,!blonde!hair,!blue!eye.!w/! PKU!–!PAH!gene!
mousy!oder!
Ewing!sarcoma,!osteogenic!sarcoma,! Associations!with!retinoblastoma!–!Rb1!
pinealoblastoma,!PNET! mutation!
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