Dobson #1 Flashcards
Who is more likely to get periodontitis and why?
down syndrome patients because they are more likely to get leukemia
What makes up the normal flora in healthy gingiva?
facultative gram positive
what is the composition of plaque?
anaerobic and microaerophilic gram negative bacteria
what is important for protection against candida infection?
neutrophils, macrophages, and Th17 cells
histologic features of candida?
pseudohyphae and bidding yeast
name an example of a deep fungal infection
zygomycetes can cause Mucor–> rhinocerebral mucromycosis
who does mucormycetes primarily affect?
diabetics, and the fungus may spread from nasal sinuses to the orbit and brain
what is scarlet fever due to?
pyrogenic toxin from group A beta hemolytic bacteria
most at risk for HPV related cancers of head and neck?
white, non-smoking 35-55 men
what cancer is associated with premalignant lesions?
classic opscc
What is over expressed in HPV oral SCC?
p16
what is over expressed in oral cancer caused by alcohol/tobacco?
Cyclin D1
what is the most frequent cause of xerostomia?
medications: anticholinergic, antidepressant/antipsychotic, diuretic, antihypertensive, sedative, muscle relaxant, analgesic, and antihistamine drugs
bacterial cause of sialadenitis?
staph aureus/ strep viridans (secondary to stone)
What is the most common lesion of the salivary glands?
mucocele
how do mucocele’s appear?
blue translucent hue
how can nonspecific sialadenitis be characterized?
unilateral involvement of a single gland
what are the genetic aberrations associated with pleomorphism adenoma?
PLAG1 overexpression
histologic feature of pleomorphism adenoma?
epithelial elements and mesenchymal elements
what’s important to remember about mucoepidermoid carcinomas?
prognosis is dependent on grade
what is an omphalacele?
when the abdominal musculature is incomplete and viscera herniate into the ventral membranous sac
what is gastroschisis?
when all the layers of the abdominal wall fail to develop- from the peritoneum to the skin
what are the complications associated to meckel diverticulum?
complications related to ectopic gastric or pancreatic tissue
What is pyloric stenosis associated with?
turner syndrome and trisomy 18; or erythromycin or azithromycin within first 2 weeks of life
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?
- 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)
