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SEC B Prefinal Evals - Complete Recall Answer Key (Robbins-Based)

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IMAGE 1 - VSA & MCQ (Questions 1-18)

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VSA ANSWERS

• Robbins confirms: "Liposarcoma, a malignant tumor of adipose tissue, is the most common sarcoma of adulthood." Deep soft tissues of proximal extremities and retroperitoneum.
• Hint: Lipoma = most common BENIGN soft tissue tumor; Liposarcoma = most common MALIGNANT (sarcoma). Don't confuse the two.

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• Pathognomonic features. Heliotrope = violaceous/pink discoloration of eyelids + periorbital edema. Gottron papules = flat-topped violaceous papules over dorsal interphalangeal joints.
• Hint: "Gottron = Got them on the knuckles." Both features = PATHOGNOMONIC = only found in dermatomyositis.

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• Robbins: nuclei palisading in rows leaving anuclear zones = Verocay bodies. Antoni A (cellular) and Antoni B (loose) areas.
• Hint: Verocay = Schwannoma. Antoni A is cellular and dense; Antoni B is loose and myxoid.

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• Hint: RA affects SMALL joints (MCP, PIP) symmetrically. Late stage = ankylosis, boutonniere, swan-neck deformity.

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• Robbins/Harrison confirms: NMO (Devic disease) is caused by anti-AQP4 antibodies. Also anti-MOG in some cases.
• Hint: NMO = optic neuritis + transverse myelitis. AQP4 is a water channel on astrocytic foot processes. Remember: "NMO = Not Multiple sclerosis" - it's a separate entity.

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• Context: Meningioma involves the calvarium/skull. Alternatively: Paget disease affects calvarium in >70% adults.
• Hint: Paget disease of bone = calvarium, skull, vertebrae. "Cotton wool" appearance on X-ray.

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• Monosodium urate crystals = needle-shaped, negatively birefringent (yellow when parallel to compensator).
• Hint: Gout = MSU crystals (negative birefringence, yellow, NEEDLE-shaped). Pseudogout = calcium pyrophosphate (positive birefringence, blue, RHOMBOID-shaped).

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• MELAS = Mitochondrial Encephalomyopathy, Lactic Acidosis, Stroke-like episodes.
• Maternal inheritance (mitochondrial DNA mutation - most commonly MT-TL1 gene, tRNA-Leu).
• Hint: All mitochondrial diseases = maternal inheritance. MELAS, MERRF, Leber's optic neuropathy = mitochondrial.

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MCQ ANSWERS

• Aseptic meningitis: CSF shows lymphocytic pleocytosis, normal glucose, no organisms on culture. Causes: enteroviruses (most common), HSV-2, HIV.

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• Median nerve compressed at carpal tunnel. Symptoms: pain/numbness in thumb, index, middle finger. Worsened by flexion. Phalen test, Tinel sign positive.
• Hint: "CTS = Carpal Tunnel Syndrome. Median nerve. Think mouse/wrist position."

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• e.g., Guillain-Barre syndrome (GBS) = acute inflammatory demyelinating polyradiculoneuropathy.

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• Seronegative spondyloarthropathies (Ankylosing spondylitis, Reactive arthritis, Psoriatic arthritis, IBD-arthritis) = ALL associated with HLA-B27.
• Hint: "B27 = Backbone (ankylosing spondylitis). Rheumatoid factor is NEGATIVE = seronegative."

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• Keratoconus = progressive conical deformation of cornea. Fleischer ring (iron deposits), Vogt's striae, breaks in Bowman membrane.

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• Reactive gliosis (astrocytosis) = universal response of CNS to injury. Astrocytes proliferate and form glial scar. Marker of any prior CNS injury.
• Hint: In CNS: astrocytes = scar-forming cells. GFAP (Glial Fibrillary Acidic Protein) is the marker. "Glia = CNS scar."

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• In ischemia/hypoxia: neurons show eosinophilic cytoplasm + nuclear pyknosis = "red neurons." Seen as early as 12-24 hours after ischemic injury.
• Hint: Red neurons = earliest sign. Later: ghost cells, then neuronophagia (macrophages eating dead neurons), then gliosis.

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• BCC = most common eyelid malignancy AND most common skin tumor overall.
• Hint: Rodent ulcer = BCC. Rarely metastasizes but locally invasive.

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• Desmoid tumor (aggressive fibromatosis) = mutation in beta-catenin gene (CTNNB1) or APC gene (familial).
• Hint: Desmoid tumor = deep fibromatosis = beta-catenin. Associated with Gardner syndrome (APC mutation).

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• Primary VZV infection = Chickenpox. Reactivation in dorsal root ganglion = Shingles (Herpes Zoster).
• Hint: VZV stays latent in DRG. Reactivation = dermatomal distribution pain and vesicles = Shingles.

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• Anti-Citrullinated Protein Antibodies (ACPA/Anti-CCP) = highly specific (~95%) for RA, present in ~70% of RA patients. More specific than RF.
• Hint: ACPA > RF in specificity. RF = also in SLE, Sjogren's, etc. ACPA = more specific to RA.

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IMAGE 2 (Questions 19-36)

• Hint: Seronegative = RF NEGATIVE. RA = seropositive (RF +ve). The "exception" = RF is present in RA, absent in seronegative spondyloarthropathies.

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• "Bunch of grapes" appearance. Common in children in vagina, bladder, nasopharynx.
• Hint: Botryoides = grape-like. Embryonal type. Most common soft tissue sarcoma in CHILDREN.

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• Cystic dilation of 4th ventricle + absent/hypoplastic cerebellar vermis + enlarged posterior fossa.
• Hint: Dandy-Walker = 4th ventricle cyst + cerebellar vermis hypoplasia. Enlarged posterior fossa is KEY.

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• Proliferative diabetic retinopathy: new vessels grow through ILM into vitreous.

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• AD features: memory loss, apraxia, agnosia, aphasia, personality change.
• Hint: Tremor + rigidity + bradykinesia = Parkinson's (dopamine deficiency). AD = amyloid plaques + neurofibrillary tangles = COGNITIVE decline, not motor.

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• Corpus callosum = largest white matter commissure connecting hemispheres.
• Hint: Agenesis of CC = colpocephaly (bat-wing ventricles). Associated with Dandy-Walker and other midline defects.

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• Eosinophilic cytoplasmic inclusions in neurons (Purkinje cells, hippocampal neurons). PATHOGNOMONIC for rabies.
• Hint: Negri bodies = Rabies. Bullet-shaped virus. Intracytoplasmic. Hippocampus + cerebellum.

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• Heberden's nodes = bony enlargement at DIP joints = feature of Osteoarthritis.
• RA spares DIP joints! RA affects MCP and PIP.
• Hint: "Heberden = Hard bone = OA at DIP." "Bouchard nodes = OA at PIP." RA = MCP + PIP, NOT DIP.

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• Kuru plaques = amyloid plaques in prion diseases (CJD, kuru). PrPSc accumulation.
• Hint: Prion diseases = spongiform encephalopathy + kuru plaques + no inflammation. "Prions are MISFOLDED proteins (PrPSc)."

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• WHO CNS Grade 4. Most common malignant brain tumor in CHILDREN. Located in cerebellum (posterior fossa).
• Hint: Medulloblastoma = Grade 4, children, cerebellum, Homer-Wright rosettes, spreads via CSF (drop metastases).

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• Brain laceration = tearing of brain parenchyma (gliding contusions at coup and contrecoup sites).
• Hint: Contusion = bruise without tearing. Laceration = actual tearing of brain tissue. Occurs with skull fractures or penetrating injuries.

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• Most common = POAG. Caused by increased resistance to aqueous outflow via trabecular meshwork. Painless, gradual peripheral vision loss.
• Hint: POAG = most common, painless, open angle. Closed-angle = PAINFUL acute attack, halos, red eye.

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• Hint: Obstructive (non-communicating) = block within ventricles. Communicating = block at arachnoid granulations.

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• Most common site of NTD is lumbosacral. Contains meninges + spinal cord/nerve roots.
• Hint: Spina bifida occulta (no herniation) < Meningocele (meninges only) < Myelomeningocele (meninges + cord/nerves). Most severe = myelomeningocele.

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• Epidural hematoma = rupture of middle meningeal artery, associated with temporal bone fracture.
• Hint: Epidural = ARTERIAL (middle meningeal artery), lens-shaped/biconvex on CT, lucid interval. Subdural = VENOUS (bridging veins), crescent-shaped.

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• NF2 features: Merlin (schwannomin) mutation (chromosome 22), BILATERAL vestibular schwannomas (CN VIII), meningiomas, ependymomas.
• The answer students were unsure about: All listed options (bilateral vestibular schwannomas, merlin mutation, meningiomas, ependymomas) ARE features of NF2 - so the "not correct" may relate to a specific distractor in the original MCQ.
• Hint: NF1 = neurofibromas + café-au-lait spots + Lisch nodules (chromosome 17). NF2 = bilateral acoustic neuromas (chromosome 22 - "NF2 = chromosome 22").

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• RANKL (Receptor Activator of NF-kB Ligand) expressed by synovial cells in RA = stimulates osteoclast differentiation = bone erosion.
• Hint: RANKL = drives bone destruction in RA. Denosumab = anti-RANKL antibody (used in osteoporosis/bone mets).

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• In MS: shadow plaques = areas of incomplete/partial remyelination with thin myelin sheaths. Appear as "shadow" of original plaque on histology.
• Hint: Shadow plaques = remyelination attempt in MS. Complete lesions = white plaques. Active lesions = foamy macrophages.

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IMAGE 3 - Genpath Lec Prefinals Evals 1

• McCune-Albright syndrome = polyostotic fibrous dysplasia + café-au-lait spots + precocious puberty.
• Hint: "McCune-Albright = 3 Ps: Pigmented skin, Precocious puberty, Polyostotic fibrous dysplasia."

• BCC = locally aggressive but RARELY metastasizes (<0.1%).

• Dysplastic/atypical nevi are precursors to melanoma. ABCDE rule.
• Hint: ABCDE = Asymmetry, Border, Color, Diameter >6mm, Evolution.

• Autoimmune destruction of adrenal cortex. Features: hyperpigmentation, hypotension, hyperkalemia, hyponatremia.

• 90% benign, 90% unilateral, 90% adrenal, 90% sporadic, 90% adults = "Rule of 10s"
• Causes episodic hypertension + palpitations + headache + sweating.
• Hint: Remember "10% rule" (10% bilateral, 10% malignant, 10% extra-adrenal, 10% children, 10% familial).

• Occurs at epiphysis of long bones. Soap-bubble appearance on X-ray.

• Hypergranulosis = increased granular layer, seen in conditions with increased keratinization (e.g., lichen planus - "saw-tooth" rete ridges + hypergranulosis).

• Pustule = <1cm pus-filled raised lesion. >1cm = abscess/bulla with pus.

• "Rodent ulcer" = BCC. Peripheral palisading of basaloid cells.

• Papule <5mm elevated. Nodule = elevated >5mm with depth.

• SJS = mucocutaneous drug reaction. <10% BSA involvement (vs TEN = >30%).
• Hint: SJS < 10% BSA. Overlap = 10-30%. TEN = >30% = most severe = toxic epidermal necrolysis.

• "Jock itch." Caused by Trichophyton rubrum/Epidermophyton floccosum.

• Alpha cells = glucagon. Beta cells = insulin. Delta cells = somatostatin. PP cells = pancreatic polypeptide.

• Features: moon face, buffalo hump, central obesity, striae, hypertension, diabetes.

• Horn cysts (pseudo-horn cysts) = invaginations of keratin in seborrheic keratosis. "Stuck-on" appearance.

• Ischemic necrosis of anterior pituitary after postpartum hemorrhage and shock.
• Hint: Sheehan = postpartum. Failure to lactate = first symptom (prolactin deficiency).

• WF syndrome = bilateral adrenal hemorrhage due to N. meningitidis septicemia = DIC + shock + adrenal failure.
• "Except shock" = shock IS a feature, so the answer "shock" might be the distractor in the MCQ saying shock is NOT a feature - but shock IS a feature of WFS.
• Hint: WFS = Meningococcemia + adrenal hemorrhage + DIC + shock + skin petechiae.

• Osteoprotegerin (OPG) is a DECOY receptor for RANKL = inhibits osteoclast formation = protects bone.
• Hint: RANK-RANKL-OPG axis: RANKL activates osteoclasts; OPG blocks RANKL = protective.

• Acanthosis = thickening of stratum spinosum. Papillomatosis = irregular upward projection of dermis.

• Erlenmayer flask = failure of normal bone remodeling = osteopetrosis ("marble bone disease").
• Hint: Osteopetrosis = "stone bone" = dense but brittle. Osteoclasts fail to resorb. Erlenmayer flask deformity at distal femur/proximal tibia.

• H. influenzae type b = most common cause of bacterial meningitis in children (pre-vaccine era). Now largely prevented by Hib vaccine.

• Blue small round cells from neural crest. Adrenal medulla. N-MYC amplification = poor prognosis.
• Hint: Neuroblastoma = children + adrenal medulla + N-MYC + Homer-Wright rosettes + elevated urine catecholamines (VMA/HVA).

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IMAGE 4 - 30B-24 Fedrick Angelina

• Small blue round cells, Homer-Wright pseudorosettes, from adrenal medulla.

• Most common cause overall = exogenous steroids.
• Most common ENDOGENOUS cause = pituitary ACTH-secreting adenoma = Cushing disease.
• Hint: Cushing disease (pituitary) is the most common ENDOGENOUS cause. Cushing syndrome = any cause of hypercortisolism.

• SQSTM1 (sequestosome 1/p62) mutation = most common familial Paget disease mutation.
• Also paramyxovirus involvement postulated.
• Hint: Paget = elevated ALP + normal Ca/P + mosaic/woven bone + "cotton wool" skull.

• WNT signaling promotes chondrocyte and osteoblast proliferation/differentiation in bone development.

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QUICK EXAM HACKS - TOP HINTS TO CRACK THESE QUESTIONS

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