Quick Review of Pathology for clinicians and senior students. CNS degenerations, alzheimers, parkinsons

1. “Those who cannot work with their hearts achieve but a hollow, half-hearted success that breeds bitterness all around.” - Wings of Fire: An Autobiography of Dr. APJ Abdul Kalam.

2. Quick Pathology Review Pathology of CNS Degenerations System : Central Nervous System Class : Degenerations. Topic : Alzheimers disease. Shashidhar Venkatesh Murthy A/Prof.& Head of Pathology School of Medicine & Dentistry James Cook University Australia.

3. CPC 35- CNS-Deg: Core Learning Issues(CLI) Major CLI: Pathology of degenerative disorders of CNS. Dementia – clinical types, pathophysiology. Global Degenerations - Alzheimer’s disease System Degenerations - Parkinson’s disease. Minor CLI: Amyotropic Lateral Sclerosis. Pathology of Motor neurone disease. (PNS deg) Picks disease, Fronto-temporal dementia, Huntington’s disease. Demyelinating diseases – Multiple sclerosis (Myelin deg)

4. A 46 year man, presents with yearlong history of initiating movement, depression. On examination he has a hand tremor that ceases when he is asked to pick up a pen. A biopsy from his substantianigra would show image similar to one on the top compated to normal at the bottom. What is the most likely diagnosis? Huntington’s disease. Alzheimer’s disease. Pick’s disease. Parkinson’s disease Multiinfarct dementia. Briefly discuss pathogenesis of this condition? List 2 gross and Microscopic feature of this disease? List 6 other clinical features & how do you differentiate from Alzheimers ?.

5. A 74y man, long time nursing home resident with 8 year history of progressive withdrawal and apathy. Severe loss of short-term memory and lsunoriented to time or place . He commits suicide, Image shows appearance of his brain. What is the most likely diagnosis? Huntington’s disease. Alzheimer’s disease. Frontotemporal dementia. Pick’s disease. Senile dementia. Briefly discuss pathogenesis of this condition? List 3 gross and Microscopic feature of this disease? List 3 common diseases of dementia and 3 specific organ degeneration.

6. A 65 year old woman with 3y history of emotional disturbances, irritability, irresponsible and difficulty with activities of daily living. Now she has difficulty talking. Image shows appearance of her brain. What is the most likely diagnosis? Huntington’s disease. Alzheimer’s disease. Pick’s disease. Parkinson’s disease Multiinfarct dementia. Briefly discuss pathogenesis of this condition? List 3 gross and Microscopic feature of this disease? List 3 differentiating features of Alzheimers & this disease?.

7. 85 year woman progressive loss of memory, depression, increasingly dependent for routine activities for the past 8 years. No focal neurologic signs, but cannot remember 3 objects after 5 minutes. She dies of pulmonary embolism following hip fracture. Image shows biopsy of her neocortex stained with silver stain. What is the most likely diagnosis? Huntington’s disease. Alzheimer’s disease. Frontotemporal dementia. Pick’s disease. Senile dementia. Briefly discuss pathogenesis of this condition? List 3 gross and 3 Microscopic feature of this disease? List 3 common diseases of dementia and 3 specific organ degeneration.

8. A 71 year old woman presents with 2 year history of emotional outbursts, worsening confusion, and difficulty in speech . Although she can name 3 objects after 5 minutes, she cannot draw a clock. Image shows biopsy of her cortex stained for tau protein. What is the most likely diagnosis? Huntington’s disease. Alzheimer’s disease. Pick’s disease. Parkinson’s disease Multiinfarct dementia. Briefly discuss pathogenesis of this condition? Describe the Microscopic feature shown in the image? Differentiate clinical features from Alzheimer's disease?

9. A 28 year old woman with ataxia, diplopia on lateral gaze and flashes of light on eye movement. CSF analysis shows increased proteins, lymphocytes and oligoclonalIgG bands and normal glucose. Image shows gross specimen of brain with lesions typical of this disease. What is the most likely diagnosis? Parkinson’s disease MCA infarct. Lacunar Infarcts. Multiple sclerosis. Viral encephalitis. Briefly discuss etiology & pathogenesis of this condition? Describe the gross features shown in the image? List other clinical features? What is the prognosis of this condition?

10. A 35 year old HIV +ve man with Kaposisarcoma has a 3 day history of headache and confusion followed by seizures and hemiparesis. CT scan showed multiple ring-enhancing lesions. Image shows Gross appearance and MRI of a brain typical of this disorder. What is the most likely diagnosis? Multiple Aspergilloma. Cerebral TB lesions. Multiple Abscesses. Multiple sclerosis plaques. Cerebral metastases. What does “ring enhancing” lesion mean? Briefly discuss etiology and pathogenesis? List other pathologic findings expected in the brain of a AIDS patiets?.

11. A 59 year old man presents with rapidly progressive decline in mental funciton for past 6 weeks. Clumsiness in walking and eating. O/E impaired attention span, verbal and non verbal memory, spatial skills and judgment. Image shows microscopic appearance of his neocortex biopsy. What is the most likely diagnosis? Healing infarct. Lewy body disease. Creutzfeldt-Jakob disease. Active MS plaque. AIDS – viral encephalitis. Briefly discuss etiology & pathogenesis of this condition? (Prions, PrP) Describe the Microscopic features shown in the image? Briefly discuss epidemiology of this condition? (mad cow)

12. A 48 year old man with a year long history of worsening jerky, choreo-athetoid movements of all limbs, bradykinesia and rigidity. Image shows coronal section of a brain specimen showing typical features of his disease. What is the most likely diagnosis? Picks disease. Lewy body disease. Huntington’s disease. Multiple sclerosis. Amyotropic lateral sclerosis. Briefly discuss pathogenesis of this condition? (Trineucleotide repeat dis) Describe the gross features shown in the image? what other clinical features are expected in this disease?

13. A 41 year old woman with progressive weakness and ataxia for 2 weeks, becomes lethargic and then comatose. MRI shows multiple areas of signal intensity with rim enhancement. Image shows biopsy with immunostain (bottom). What is the most likely diagnosis? Multiple Aspergilloma. Cerebral TB lesions. Multiple Abscesses. Cerebral metastases. Toxoplasmosis. Briefly discuss etiology and pathogenesis? Briefly discuss 3 common types of meningitis (bacterial, viral & fungal) Briefly discuss cerebral tuberculosis?.

14. A 436 year old woman came to ED with severe headache, neck stiffness, nausea and vomiting and drowsiness. She had sore throat for 3 days preior with arthalgia, myalgia and low grade fever. On P/E alert, but inappropriate affect. Temp 98.7, pulse 100, RR 20, BP 110/70. Neck stiff, but Kernig & Brudzinski signs neg, no rash, Image shows her gram stained CSF specimen. What is the most likely etiologic agent? Toxoplasmagondii. Candida albicans. Neisseriagonorreae. Streptococcus pneumoniae. Neisseriameningitidis. Briefly describe etiology and pathogenesis of septic meningitis? Briefly discuss 3 common types of meningitis (bacterial, viral & fungal) Briefly describe common CSF findings in health and disease?

15. “Life is a difficult game. You can win it only by retaining your birthright to be a person.” - Wings of Fire: An Autobiography of Dr. APJ Abdul Kalam.