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(Created page with "{{WBRQuestion |QuestionAuthor=Gonzalo A. Romero, M.D. [mailto:gromero@wikidoc.org] |ExamType=USMLE Step 1 |MainCategory=Pathology |SubCategory=Neurolog...")
 
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|MainCategory=Pathology
|MainCategory=Pathology
|SubCategory=Neurology, Reproductive
|SubCategory=Neurology, Reproductive
|Prompt=A 57- year old patient comes to the ER after presenting with visual hallucinations and visual deficits.  The symptoms have been gradually worsening over the last 6 months.  His family history is insignificant.  His wife denies any history of trauma or drug ingestion.  The physician on call performs a thorough history and physical examination.  His vitals are within normal limits. The physician encounters on neurological exam a right hemianopsia with macular sparing, and becomes concerned that the patient may have a stroke or a tumor. A CT scan is ordered and shown below:
|Prompt=A 57- year-old male patient comes to the ER after presenting with visual deficits.  The symptoms have been gradually worsening over the last 6 months.  His family history is insignificant.  His wife denies any history of trauma or drug ingestion.  The physician on call performs a thorough history and physical examination.  His vitals are within normal limits. The physician encounters on neurological exam a right hemianopsia with macular sparing, and becomes concerned that the patient may have a stroke or a tumor. A CT scan is ordered and shows a mass in the posterior fossa.  Following 48 hours of admission the patient develops a Grand-mal seizure and undergoes respiratory arrest.  Despite aggressive resuscitation measures the patient dies.  The team on call is concerned about malpraxis and orders an autopsy with the wife’s consent.  Upon entering the skull, the pathologist notices a tumor arising from the membranes covering the brain. A specimen under the microscope shows the picture below.  Which of the following ovarian tumors is also associated with the latter histologic findings of this tumor?
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[[File:WBR0505.jpg|center|pix200]]
 
|Explanation=This patient is presenting with visual hallucinations and visual deficits which have been worsened over time and right hemianopsia with macular sparing, on CT scan a tumor rising from the occipital region of the meninges correlate with the clinical findings. The histo-pathologic findings of laminated, concentric, calcific spherules are also known as Psammoma bodies which are diagnostic for a meningioma compressing the occipital lobe. Psammoma bodies are also found in:
Following 48 hours of admission the patient develops a Grand-mal seizure and undergoes respiratory arrest.  Despite aggressive resuscitation measures the patient dies.  The team on call is concerned about malpraxis and orders an autopsy with the wife’s consent.  Upon entering the skull, the pathologist notices a tumor arising from the membranes covering the brain. Microscopically a specimen shows spindle cells concentrically arranged in whorled pattern, and laminated calcifications.  Which of the following ovarian tumors is also associated with the latter histologic findings of this tumor?
|Explanation=Laminated, concentric, calcific spherules are also known as Psammoma bodies, which are encountered in:
# Papillary adenocarcinoma of thyroid
# Papillary adenocarcinoma of thyroid
# Serous papillary cystadenocarcinoma of the ovary
# Serous papillary cystadenocarcinoma of the ovary

Revision as of 19:37, 24 September 2013

 
Author [[PageAuthor::Gonzalo A. Romero, M.D. [1]]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Pathology
Sub Category SubCategory::Neurology, SubCategory::Reproductive
Prompt [[Prompt::A 57- year-old male patient comes to the ER after presenting with visual deficits. The symptoms have been gradually worsening over the last 6 months. His family history is insignificant. His wife denies any history of trauma or drug ingestion. The physician on call performs a thorough history and physical examination. His vitals are within normal limits. The physician encounters on neurological exam a right hemianopsia with macular sparing, and becomes concerned that the patient may have a stroke or a tumor. A CT scan is ordered and shows a mass in the posterior fossa. Following 48 hours of admission the patient develops a Grand-mal seizure and undergoes respiratory arrest. Despite aggressive resuscitation measures the patient dies. The team on call is concerned about malpraxis and orders an autopsy with the wife’s consent. Upon entering the skull, the pathologist notices a tumor arising from the membranes covering the brain. A specimen under the microscope shows the picture below. Which of the following ovarian tumors is also associated with the latter histologic findings of this tumor?
pix200
pix200
]]
Answer A AnswerA::Granulosa cell tumor
Answer A Explanation AnswerAExp::
Answer B AnswerB::Brenner tumor
Answer B Explanation AnswerBExp::
Answer C AnswerC::Serous cystadenocarcinoma
Answer C Explanation AnswerCExp::
Answer D AnswerD::Serous cystadenoma
Answer D Explanation AnswerDExp::
Answer E AnswerE::Kruckenberg tumor
Answer E Explanation AnswerEExp::
Right Answer RightAnswer::C
Explanation [[Explanation::This patient is presenting with visual hallucinations and visual deficits which have been worsened over time and right hemianopsia with macular sparing, on CT scan a tumor rising from the occipital region of the meninges correlate with the clinical findings. The histo-pathologic findings of laminated, concentric, calcific spherules are also known as Psammoma bodies which are diagnostic for a meningioma compressing the occipital lobe. Psammoma bodies are also found in:
  1. Papillary adenocarcinoma of thyroid
  2. Serous papillary cystadenocarcinoma of the ovary
  3. Meningioma
  4. Malignant mesothelioma

Educational Objective:
References: ]]

Approved Approved::No
Keyword WBRKeyword::Psammoma bodies
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