Dobson #1 Flashcards by erin flaherty

Who is more likely to get periodontitis and why?

down syndrome patients because they are more likely to get leukemia

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What makes up the normal flora in healthy gingiva?

facultative gram positive

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what is the composition of plaque?

anaerobic and microaerophilic gram negative bacteria

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what is important for protection against candida infection?

neutrophils, macrophages, and Th17 cells

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histologic features of candida?

pseudohyphae and bidding yeast

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name an example of a deep fungal infection

zygomycetes can cause Mucor–> rhinocerebral mucromycosis

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who does mucormycetes primarily affect?

diabetics, and the fungus may spread from nasal sinuses to the orbit and brain

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what is scarlet fever due to?

pyrogenic toxin from group A beta hemolytic bacteria

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most at risk for HPV related cancers of head and neck?

white, non-smoking 35-55 men

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what cancer is associated with premalignant lesions?

classic opscc

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What is over expressed in HPV oral SCC?

p16

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what is over expressed in oral cancer caused by alcohol/tobacco?

Cyclin D1

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what is the most frequent cause of xerostomia?

medications: anticholinergic, antidepressant/antipsychotic, diuretic, antihypertensive, sedative, muscle relaxant, analgesic, and antihistamine drugs

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bacterial cause of sialadenitis?

staph aureus/ strep viridans (secondary to stone)

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What is the most common lesion of the salivary glands?

mucocele

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how do mucocele’s appear?

blue translucent hue

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how can nonspecific sialadenitis be characterized?

unilateral involvement of a single gland

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what are the genetic aberrations associated with pleomorphism adenoma?

PLAG1 overexpression

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histologic feature of pleomorphism adenoma?

epithelial elements and mesenchymal elements

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what’s important to remember about mucoepidermoid carcinomas?

prognosis is dependent on grade

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what is an omphalacele?

when the abdominal musculature is incomplete and viscera herniate into the ventral membranous sac

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what is gastroschisis?

when all the layers of the abdominal wall fail to develop- from the peritoneum to the skin

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what are the complications associated to meckel diverticulum?

complications related to ectopic gastric or pancreatic tissue

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What is pyloric stenosis associated with?

turner syndrome and trisomy 18; or erythromycin or azithromycin within first 2 weeks of life

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what is Hirschspring disease?

aganglionic megacolon due to arrested migration of NCCs into the gut

How does Hirschspring disease present?

functional obstruction and the rectum is always involved

what are 3 functional causes of esophageal obstruction?

nutcracker esophagus, DES, and systemic sclerosis

what is a complication due to increased esophageal pressure?

Zenker diverticulum

what are esophageal webs associated with?

GERD, C-GVHD, and celiac disease

achalasia is characterized by a triad of what?

incomplete LES relaxation, increased LES tone, and aperistalsis of the esophagus

what is the cause of primary achalasia?

ganglion cell degeneration

where does the tear occur in mallory-weiss syndrome?

gastric side of the gastroesophageal junction

where does the tear occur in Boerhaave's syndrome?

complete rupture at the distal esophagus

what is the most frequent cause of esophagitis?

reflux of gastric contents into the lower esophagus

how can you determine the cause of viral esophagitis?

the endoscopic appearance

how does HSV viral esophagitis look?

it typically causes punched-out ulcers

how does CMV viral esophagitis look?

CMV causes shallower ulcerations and is marked by characteristic nuclear and cytoplasmic inclusions

where are most of the benign neoplasms of the esophagus located?

most are submucosal

what is are the characteristics of benign neoplasms of the esophagus?

most are mesenchymal, with smooth muscle tumors being the most common

there are 2 malignant neoplasms of the esophagus- what are they?

squamous cell carcinoma and adenocarcinoma

what geographic distribution is at more risk for squamous cell carcinoma of the esophagus?

iran, central china, Hong kong

what is the highest risk group for squamous cell carcinoma of the esophagus?

>45, males, african americans 8x more likely

where do most squamous cell carcinomas of the esophagus occur?

in the middle third of the esophagus

what are 3 specific risk factors for esophageal scc?

if you have tylosis, HPV (+/-), HIV

what is typically the first symptom of an esophageal scc?

aspiration of food due to an acquired TE fistula

where are the highest rates for esophageal adenocarcinoma?

US, UK, Canada, australia

who is the highest risk group for esophageal adenocarcinoma?

caucasians, 7x more common in men

What are the risk factors for esophageal adenocarcinoma?

barrett esophagus, tobacco, radiation

where are esophageal adenocarcinomas commonly found?

distal 1/3 esophagus

what do esophageal adenocarcinomas look like microscopically?

the tumors typically produced mucin and form glands

how do esophageal adenocarcinomas commonly present?

pain or difficulty swallowing, progressive weight loss, hematemesis, chest pain, and vomiting

what is the most common cause of diffuse atrophic gastritis?

autoimmune gastritis

what happens to long-standing chronic gastritis that involves the body/fundus?

it could lead to mucosal atrophy and/or intestinal metaplasia--> both are risk factors for adenocarcinoma

when looking for H. pylori, what stain should you use?

warthrin-starry stain

5 features of autoimmune gastritis?

1. antibodies to parietal cells and IF 2. reduced serum pepsinogen I (chief cells are collateral damage) 3. Endocrine cell hyperplasia 4. Vitamin B12 deficiency 5. defective gastric acid secretion

what is gastrin secretion like in autoimmune gastritis?

it is markedly increased BECAUSE THE ANTRUM IS SPARED DUH SO G CELLS ARE THERE AND CAN STILL STIMULATE GASTRIN

what could come from Type B chronic gastritis?

peptic ulcer, adenocarcinoma, MALToma

what could come from type A chronic gastritis?

atrophy, pernicious anemia, adenocarcinoma, carcinoid tumor

how is lymphocytic (an uncommon form of gastritis) characterized?

by thickened folds covered by small nodules with central aphthous ulceration

how do peptic ulcers appear?

are solitary; round-oval, sharply punched out defect; HEAPED UP MARGINS= MALIGNANCY NOT PUD

where are peptic ulcers most common?

proximal duodenum

How is intestinal metaplasia recognized?

by the presence of goblet cells

what are two diseases that causes hypertrophic gastropathy?

Menetrier disease and zollinger-ellison syndrome

what are the risk factors associated with zollinger-ellison syndrome?

multiple endocrine neoplasia

what etiology of hypertrophic gastropathy is associated with adenocarcinoma?

menetrier disease

what is the causes of menetrier disease?

over expression of TGF-alpha

what are the symptoms associated with menetrier disease?

hyponatremia, weight loss, diarrhea

what are the symptoms associated with Zollinger-ellison syndrome?

peptic ulcers

how is zollinger ellison syndrome characterized?

doubling of the oxyntic mucosal thickness

what is the most common benign tumor of the stomach? (polyp)

inflammatory and hyperplastic polyps

what are inflammatory and hyperplastic polyps associated with?

H. pylori

what is the most common malignancy of the stomach?

adenocarcinoma

what geographical region has a higher risk of adenocarcinoma of the stomach?

japan, chile, costa rica, and eastern europe

early symptoms of both types of adenocarcinoma of the stomach include what?

dyspepsia, dysphagia, and nausea

incidence of cancer of the gastric cardia is on the rise. Why so?

barrett esophagus and may reflect the incidence of chronic GERD and obesity

what are the two types of gastric adenocarcinomas?

diffuse gastric cancer and intestinal type gastric cancer

what is a key step in the development of diffuse gastric cancer?

loss of E-cadherin

what is the histology of diffuse gastric cancer?

signet ring cells that are discohesive and do not form glands; large intracellular mucin vacuoles that push nucleus to the periphery= signet ring cells

what is a morphological feature of diffuse gastric cancer?

linitis plastica: appearance when there are large areas of infiltration, diffuse rugal flattening, and a thick rigid wall

What is intestinal type gastric cancers-bulky cancer strongly associated with?

APC mutations; mutations that result in increased signaling via the Wnt pathway; and gain of function mutation in gene encoding B-catenin

most gastric adenocarcinomas involve what?

the antrum- the lesser curvature is involved more often than the greater

which translocation is most common in MALToma?

t(11;18)(q21;q21)

what are the most common symptoms of MALToma?

dyspepsia and epigastric pain

histologically, how does MALToma look?

takes the form of a dense lymphocytic infiltrate in the lamina propria- the lymphocytes infiltrate the gastric glands focally to create diagnostic lymphoepithelial lesions

What are the clues that you are dealing with a neuroendocrine tumor (carcinoid tumor)?

cutaneous flushing, sweating, bronchospasm, colicky abdominal pain, circumscribed yellow mass, salt and pepper chromatin, neurosecretory granules

what is the most common mesenchymal tumor of the abdomen?

GIST

what do GISTs arise from?

interstitial cells of cajal

when children present with GIST tumors what should you consider?

Carney syndrome triad and Carney-stratakis dyad--> increased risk in neurofibromatosis type 1

approximately 75% of all GISTS hace oncogenic, gain of function mutations in what?

the receptor tyrosin kinase KIT (cKIT)