Cardio and GI Pathology Flashcards
1
Q
when do you see Kerley B-lines?
A
Left sided heart failure
2
Q
What are heart failure cells?
A
Mac’s w/ Hemosiderin in them IN the alveoli
3
Q
Where does Right sided heart failure usually come from, and if not that….what else would it be?
A
Usually comes from Left sided failure, but can also come from Cor-pulmonale (Pulmonary HTN)
4
Q
What kind of heart failure shows a heavy and engorged liver?
also splenomegaly
A
right sided
because of close vessel proximity of liver to right heart
5
Q
Tetralogy of falot and TGF are what kind of shunt?
A
Right to left shunt
6
Q
What are the 3 left to right shunts
A
ASV, VSD, AV septal defect
7
Q
of all the L to R ASD types shunts, the persistent oval window (90% of all ASD’s) is called…?
A
Secundum ASD
8
Q
This L to R ASD is from a defect located near AV valves
A
Primum ASD
9
Q
This L to R ASD is from an abnormal connection of right pulmonary veins with superior vena cava of the right atrium
A
Sinus Venosum ASD
10
Q
What are the 4 features of the Tetralagy of Fallot
A
VSD, overriding aorta, pulmonic stenosis, right vent hypertrophy.
11
Q
if a infant has cyanosis of the lower half of the body what type of coarctation does the patient have?
A
a coarc WITH a PDA
12
Q
If later in life a patient notices weaker lower pulses, and upper limb HTN, what type of coarc does the patient one
A
a coarc WITHOUT a PDA
13
Q
True or false: pulmonic stenosis/atresia commonly occurs by itself?
A
no, often associated with Right vent failure, PDA, or hypoplastic right ventricle.
14
Q
what are roth spots?
A
white lesions surrounded by hemmorage in the retina, classic sign of pericarditis
15
Q
what are janeway lesions?
A
red painless maculopapular lesions on hands and feet
16
Q
what are splinter hemmorages?
A
linear lesions under the neails (microemboli)
17
Q
what are osler nodes?
A
painful nodes in hands and feet
18
Q
what carditis will you need to meet duke criteria of : + culture of strep and/or HACEK group, staph aerus. Positive echo with valvular vegitation, and new heart murmur?
A
Endocarditis
19
Q
Tricuspid valve prolapse leads to what heart failure?
A
right sided heart failure
20
Q
what cardiomyopathy often leads to sudden death?
A
hypertrophic cardiomyopathy (vent and septal wall thickening encroaching/dysfunctioning on valves
21
Q
this “S” sound is common in children, and in adults may indicate decompensating heart failure.
A
s3 gallop
22
Q
this cardiomyopathy shows fibrous changes in the myocardium that decreases the ability of the chambers to enlarge (relax), and accept sufficient volume of blood.
A
restrictive pericarditis
23
Q
rheumatic fever can cause what 2 issues in the heart?
A
aortic stenosis and mitral valve stenosis
24
Q
marfans causes what in the heart?
A
mitral valve prolapse (weakening chordae tendinae)
25
failure to relax
achalasia
26
esophagus above LES dilates, mytenteric plexus may be absent, and dysfunction of inhibitory neurons and NO and VIP transmitters
primary achalasia
27
when achalasia may be due to chagas, polio, diabetic autonomic neuropathy, malignancy
seconday achalasia
28
most common type of diverticula
false diverticula: only mucosa and submocosa involved
29
diverticulum immediately distal to the UES
Zenker (will be halitosis)
30
diverticulum at midpoint of esophagus
traction
31
laceration of the esophagus common in excess vomiting
mallory-weiss syndrome (frank blood)\
| varices is darker.
32
inflammatory disease from reglux of gastric content
reflux esophagitis
| eosiniphils show up BEFORE n'phils and lymphocytes
33
what correlates with degree of reflux damage...clinical features or the duration?
duration
34
what type of metaplasia in reflux esophagitis
basal (walls thicken)
35
what type of metaplasia in barret esophagus
columnar (goblet cells show up)
36
red velvety mucosal patch is what disease?
barret esophagitis
37
patchy or entire esophagus covered by gray-white pseudomembrane
candidiasis esophagitis
38
punched out ulcers
herpes esophagitis
39
intracytoplasmic and intranuclear inclusion in the vascular epithelium in the base of the ulcers
CMV esophagitis
40
what are the %'s of carcinoma of the esophagus from proximal, mid, and distal?
20 - 50 - 30
41
tumors of the esophagus are usually
malignant
42
what is the cell type of esophageal carcinoma?
sqamos cell
43
gray white plaque thickenings (as opposed to pseudomembrane candidiasis)
malignant esophogeal carcinoma
44
Barret's esophagus usually leads to what type of malignancy
Adrenocarcinoma (malignant tumor WITH glandular differentiation)
45
what does Adenocarcinoma look like?
Flat or raised patches of intact mucosa in the distal portion, either nodular or infiltrative (more aggressive)
46
Pancreatic heterotopsias
pancreatic tissue in the stomach
47
diaphragmatic hernia
development of the stomach in the thoracic cavity
48
a patient with projectile vomiting, non-bilious regurg, and visible ovoid mass in region of pyloris has
pyloric stenosis
49
how does stress affect GI tract?
sympathetic outflow increases with stress
50
the presence of n'phils ABOVE the basement membrane, with possible erosion and edema signifies what pathology?
acute gastritis
51
the most common cause of chronic gastritis is...
H. Pylori infection
52
how does H Pylori cause ulcer formation in chronic gastritis
H Pylori produces an enzyme urease which urea into amines with increase stomach Ph allowing further colonization of H Pylori. It then express cytotoxins that form peptic ulcers
53
in chronic gastritis, how does the body respond locally
Nphils fight in the grandular and surface epithelial cells, lymphoid aggregates, increased mitosis in neck region of gastric glands. columnar metaplasia (same as barrets). Atrophy, dysplasia (removal of cells faster than proliferation)
54
where are peptic ulcers most likely to occur
first portion of the duodenum
55
are peptic ulcers usually solitary/diffuse, and acute/chronic?
solitary, and chronic
| areas exposed to gastric juices
56
Are peptic ulcers sharply punched out with clean appearance or the opposite?
peptic ulcers are sharply demarcated, and punched out, with clean appearance
57
what is the clean appearance of peptic ulcers due to?
pepsin removing the debris
58
what are the 4 layers of a peptic ulcer?
thin fibroid debris
n'phils with inflammator infiltrate
granulation tissue w/ monocytes
fibrous collagenous base
59
how does peptic ulcer disease usually manifest?
pain 1-3 hours after foot, occasional first presenting symptom might be microcytic hypochromic anemia
60
what is more deadly? perforation or bleeding from peptic ulcer
perforation
61
what is more common from peptic ulcer? bleeding or perforation
bleeding
62
what differentiates acute gastritis ulceration from peptic ulcer disease?
acute gastritis ulceration is caused by a strong external source such as STRESS OR NSAIDS (could be endogenous however like stress)
63
stress ulcers can take the shape of..shock, burns, TBI (ICH increase), sepsis, etc....true or false?
True
64
What is the classic presentation of acute gastric ulceration?
MULTIPLE lesions, small, found anywhere with no scarring, and can heal completely.
65
what are two physical types of polyps that are benign?
sessil (no stalk)
| pedunculated (stalk)
66
which other type of usually benign polyp has a higher malignant potential?
adenomatous polyp
67
what are inflammatory polyps?
submucosal "abscesses" with eosinophils
68
What are hamartomatous polyps?
a bunch of hodge-podge cells that dont belong, they are benign, and dont invade anywhere.
69
what do we also call hamartomatous polyps?
Peutz-Jergen's polyps
70
these lesions of poorly defined borders with heaped up rings are OPPOSITE to what other pathology with clean, well demarcated lesions?
Peptic ulcer disease
| We are talking here about gastric carcinoma
71
Where do gastric carcinomas commonly occur?
lesser curvature
| BUT ulcerative lesions on greater curvature are likely malignant if you see them
72
if you detect gastric carcinoma, if the prognosis good?
no, it is often too late.
73
besides H pylori, what are some other causes of gastric carcinoma?
smoking, nitrates (food preservatives), water, pickled foods, etc.
74
which histological subtype of gatric carcinoma shows identifiable precursor lesions?
intestinal, or diffuse?
Intestinal
| diffuse has no precursor lesions
75
What are Signet Ring Cell?
"Diffuse" type gastric carcinoma cells with nucleus pushed to the side. ASSUME CANCER
76
early gastric carcinoma...
| advanced gastric carcinoma.....
...stops at submucosa (better prognosis)
| ...extends into the muscular wall
77
what is the term for growth that protrudes up into the lumen
exophytic
78
Gastric carcinoma, and many other cancers, often metastasize to what nodule above the clavicle?
Virchow (sentinel) supraclavicular nodule
79
A pt. presents with weight loss, anorexia, nausea, and dysphagia, she likely has
gastric carcinoma
80
What gastric pathology shows B-Cell MALT lymphomas, and h pylori?
Gastric lymphomas
| treat with antibiotics, kills 50% of them
81
T or F: colon contains vili?
false
82
a string like gut lumen is called a________, and occurs most often in the___________?
atresia, duodenum
83
what is the rule of 2's in meckel's diverticulum?
| 4 of them
2% of population, 2 inches long, 2 feet from colon, before age 2.
84
If you dont have a meissner or auerbach plexus in the (usually sigmoid) colon present, what are you?
toxic megacolon / Hirschsprung's Disease
85
Viruses can often shorten vili, destroy brush borders, and more by damaging mucosal epithelium, in what pathology?
Diarrhea
86
What do we call diarrhea from ingestion of pre-formed toxins like...staph aureus, v. cholera, c. perfringens, b. cereus?
Enterotoxin mediated diarrhea
| self limited to 1 day
87
can organisms preformed or not, become sytemic causing systemic symptoms?
yes
88
osmolarity of stool needs to only be ______mOsm/L higher than plasma to cause osmotic diarrhea
50 mOsm/L
89
output needs to exceed what amount to be considered diarrhea
500ml/day
90
if you see yellow pastry like diarrhea think....
malabsorption
91
what can increase osmotic diarrhea?
bile salts, magnesium salts, lactulose therapy, dissacharides
92
Zollinger ellison syndrome is...
so much HCL produced that pancreatic enzymes will not work.
93
how does celiac disease work?
gluten triggers inflammatory response from CD8 (cytotoxic t-cells) and its "transglutaminase" antibodies to attack body's villi. Causes malabsorption of all nutrients. Causing osmotic diarrhea.
94
Shigella, salmonella, c. jejuni, and e. histolyca all cause....?
dysentery, the infectious type
| an exudative disease
95
what causes the IBS type of dysentery?
Presence or absence of some kind of gut flora and mediated by CD4+ T cells
96
Crohn's is a type of dysentery causing IBS that is what type of reaction from the body?
Delayed type hypersensetivity reaction
| it occurs anywhere between mouth to anus
97
It presents many findings in the gut, but namely
| skip lesions....which are what?
several sharply demarcated areas with intact mucosa between them.
98
and string sign, which is what?
thick and rubbery small intestine, providing for a narrowed lumen
99
what is ulcerative colitis?
a continuous lesion in the colon starting in the rectum and travelling proximally.
100
Ulcerative colitis shows psuedopolyps, which are?
Islands of healthy muscosa within a large ulcerative lesions.
101
Vascular infarction of the bowel is reversible, until it involves what layer?
the muscularis layer
| grade: transmural
102
which type of hemmorhoid is painful?
external (inferior) hemmorhoids from the pudendal nerve. (superior is splanchnic)
103
which is the only type of diverticulum that can be seen in the ascending colon?
true diverticulum
104
acquired/false diverticula are comonly found where and contain how many layers of GI?
descending and sigmoid, containing 2 layers.
105
what is a consequence of endometriosis or crohns that can lead to adhesions
internal herniation
106
intusucception in an adult signifies presence of a...
tumor
107
twisting of the loops of the bowel.....
volvulus
108
how common are small intestine tumors?
exceedingly rare (3-5% of all GI tumors)
109
TRUE OR FALSE, crohns pt's can increase risk of small intestine tumors?
true
110
what is the risk for malignancy in hyperplastic (smooth, nipple like lesioned) polyps in the colon?
virtually none
111
polyps that are 1-3cm, smooth or slighly lobulated, occuring in the context of polyposis (50-100), mean what?
risk of malignancy
112
in what condition do 5--2500 polyps develop?
Familial Adenomatous Polyposis
| prophylactic colonectomy recommended
113
When colorectal lesions appear later in life "de-novo", this is called?
lynch syndrome
| hereditary non-polyposis colorectal cancer syndrome
114
What age bracket [10 year group] is most likely to get colorectal carcinoma?
60-80
115
what are the risk factors for colorectal carcinoma?
caloric intake, refined carbs, red meat, and decreased protective micronutrients and fiber.
116
in the proximal colon of colorectal carcinoma you see pedunculated polyps...what do you see in the descending colon?
a "napkin ring", annular lesions with heaped up borders and beaded boundaries, with an ulcerated center.
117
with endocrine cell tumors, the appendix and rectum do not mets, but what tumors in what two areas of the lower GI do?
Ileum and Colon
118
what may be the confirmatory diagnosis for acute appendicitis?
elevated white count
