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UWorld > 6.20.16 Pathoma > Flashcards

6.20.16 Pathoma Flashcards

1
Q

What type of bacteria usually cause ascending cholangitis?

A

Enteric, Gram negative

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2
Q

What is Porcelain gallbladder? What is the risk of leaving this untreated?

A
  • Dystrophic calcification of the gall bladder secondary to chronic cholecystitis
  • Predisposes to gallbladder cancer
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3
Q

What part of the white pulp of the spleen is enlarged in viral infections?

A

Periarterial lymphatic sheath (PALS)

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4
Q

what is the step before the spinothalamic tract?

A

cross ant white commissure

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5
Q

What is a gallstone ileus? How do these occur?

A

-Gallstone that enters and obstructs the small bowel–usually the result of a fistula development between the gallbladder and the duodenum, which allows for a large stone to pass through and obstruct the ileocecal junction

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6
Q

What is the cause of SSC of the esophagus?

A

Irritation of the esophagus

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7
Q

What are the two viral causes of mononucleosis?

A
  • EBV infection predominate

- CMV less common cause

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8
Q

What is chronic cholecystitis?

A

Chronic inflammation of the gallbladder due to longstanding chemical irritation from cholelithiasis

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9
Q

Why is it that estrogen increases the risk for cholelithisais? (2)

A
  1. Increases HMG-CoA reductase and cholesterol synthesis

2. Estrogen also increase cholesterol receptors on liver

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10
Q

How does biliary atresia present? What type of bilirubin is elevated in this disorder?

A
  • Jaundice, progressing to cirrhosis early in life

- Direct (conjugated) bili is elevated

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11
Q

How does ascending cholangitis present?

A

Sepsis, jaundice, and abdominal pain

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12
Q

What will happen to a gallbladder in acute cholecystitis if left untreated?

A

Rupture

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13
Q

What poses an increased risk of developing ascending cholangitis? How?

A

Choledocholithiasis– decreased flow of bile allows bacteria to grow upwards in the bile duct

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14
Q

—–Where does lymph flow in the upper 1/3 of the esophagus? Middle? Distal?—–

A
  • —–Upper = cervical nodes
  • Middle = mediastinal or tracheobronchial nodes
  • Lower = celiac and gastric nodes——
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15
Q

How does cholestyramine cause an increased risk for cholelithisasis?

A

Decreased reuptake of bile acids, which is needed for solubility

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16
Q

What is the treatment for chronic cholecystitis?

A

Cholecystectomy

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17
Q

—-What is the classical presentation of gallbladder carcinoma?—-

A

—-Cholecystitis in an elderly women—-

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18
Q

What is the classic presentation of acute cholecystitis? (3)

A
  • RUQ pain with radiation to the right scapula
  • Fever + leukocytosis
  • N/v
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19
Q

Where does the EBV virus remain dormant?

A

B cells

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20
Q

How do Achalasia and esophageal webs lead to SCC?

A

Irritation via food degradation sitting in the esophagus

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21
Q

dorsal column: fx

A

fine touch, position sense

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22
Q

What is biliary atresia?

A

Failure to form, or early destruction of the extrahepatic biliary tree

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23
Q

What cancer is associated with cholecystitis?

A

Adenocarcinoma from the gland cells of the gallbladder

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24
Q

What is the major risk factor for the development of gallbladder adenoCA

A

Gallstones

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25
Q

spinothalamic tract: fx

A

pain, temp, touch

26
Q

How does stasis in the bile duct lead to gallstones?

A

Bacteria deconjugate the heme into bili, leading to bili

27
Q

How does cirrhosis increase the risk for gallstones?

A

Decreased production of bile salts

28
Q

What are the three causes of cholelithiasis?

A
  • Supersaturation of cholesterol or bilirubin
  • Decreased phospholipids / bile acids
  • Stasis
29
Q

What is acute cholecystitis?

A

Acute inflammation of the gallbladder caused by an impacted stone in cystic duct and bacterial overgrowth

30
Q

What are the causes of bilirubin stones? (2) How do they appear grossly?

A
  • extravascular hemolysis
  • Biliary tract infections

-Black or darkly pigmented stones

31
Q

What is the IBD that increases the risk for cholelithisasis? Why?

A
  • Crohn’s disease

- Ileum is damaged, so there is poor uptake of bile acids and salts, causing precipitation of cholesterol

32
Q

What are the three infectious agents that increase the risk for the development of a gallstone (hint: 1 bacteria + 2 parasites)?

A
  • E.coli
  • Ascaris lumbricoides
  • Clonorchis sinensis
33
Q

What way does the trachea shift with a pneumothorax? Tension pneumothorax?

A

Toward in normal, away if tension

34
Q

What is the classical s/sx of chronic cholecystitis?

A

Vague RUQ pain after eating

35
Q

What are the five key complications that can result from gallstones?

A
  1. Biliary colic
  2. Acute and chronic cholecystitis
  3. Ascending cholangitis
  4. Gallstone ileus
  5. Gallbladder CA
36
Q

What ethnicity has a higher rate of cholelithiasis?

A

Native americans

37
Q

What is the major complication that can occur with a tension pneumothorax?

A

Compression of the heart

38
Q

Where are B cells found in a lymph node?

A

Cortex

39
Q

Where are the T cells present in the spleen?

A

Around the blood vessels

40
Q

What is the T cell type that predominates in infectious mononucleosis? What does this result in (3)?

A

CD8 + T cells

  • Generalized LAD
  • Splenomegaly
  • High white count
41
Q

What is the definitive test for mono?

A

EBV viral capsid antigen

42
Q

What are the s/sx of SCC of the esophagus? (3)

A
  • Progressive dysphagia
  • Hematemesis
  • Hoarse voice/cough
43
Q

How does clofibrate increase the risk for gallstones?

A

It increases the rate of HMG CoA reductase action, leading to increased cholesterol synthesis, and decreases bile acid

44
Q

What is the cause of tension pneumothoraces?

A

Penetrating chest wall injuries cause a hole whereby air can come in, but cannot leak out.

45
Q

What is ascending cholangitis?

A

Bacterial infection of the bile ducts

46
Q

What is the most common cause of pneumothorax? In whom is this seen?

A

Rupture of an emphysematous bleb

Tall Young males

47
Q

What are the histological characteristics of mononucleosis?

A

Atypical lymphocytes with a large, odd shaped nucleus

48
Q

A negative monospot usually indicates that what virus is usually causing the mono-like symptoms?

A

CMV

49
Q

What is the most common type of gallstones in the west? How do they appear on imaging?

A
  • Cholesterol stones

- Usually radiolucent (don’t appear)

50
Q

How long do patients with mono have to avoid contact sports d/t the chance of splenic rupture?

A

1 year

51
Q

What does the monospot test assess for?

A

-IgM to heterophile antibodies

52
Q

What is in the white pulp part of the spleen? Red pulp?

A

Red pulp = blood

White pulp = cells

53
Q

What is the long term complication of chronic cholecystitis?

A

-Porcelain gallbladder–dystrophic calcification of the gallbladder

54
Q

What is biliary colic?

A

Intermittent RUQ abdominal pain caused by contractions of the gallbladder against a stone.

55
Q

Why is alk phos elevated in gallbladder issues?

A

Alk phos a key component of the endothelial cells of the gallbladder tract

56
Q

What are Rokitansky-Aschoff sinuses? What disease are these seen in?

A

gallbladder mucosa that dives down into the wall. Classic for chronic cholecystitis

57
Q

A rash can develop if a patient with Mono is given what abx?

A

PCN

58
Q

What is the most common esophageal cancer worldwide? Where in the esophagus does this usually arise?

A
  • SCC

- upper or middle third of the esophagus

59
Q

Which are of the lymph node will be enlarged in a viral infection?

A

Paracortex

60
Q

What is the most common type of esophageal cancer in the West? What is this usually associated with? Where in the esophagus does this usually occur?

A
  • Adenocarcinoma
  • Barrett’s esophagus
  • Distal 1/3
61
Q

Why is it that esophageal SCC can present with hoarse voice?

A

Invasion of the SCC beyond the BM may lead to compression of the recurrent laryngeal nerve

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