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step 1 - path > GI > Flashcards

GI Flashcards

1
Q

MC salivary gland tumor?

A

pleomorphic adenoma
painless, mobile mass
chondromyxoid stroma and epithelium

** recurs if incompletely excised or ruptured

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2
Q

MC malignant salivary tumor?

A

mucoepidermoid carcinoma
painless, slow growing
mucinous and squamous components

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3
Q

Warthin tumor?

A

benign cystic salivary tumor

has germinal centers

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4
Q

pathophys of achalasia?

A

loss of myenteric (Auerbach) plexus
increased risk of squamous cell ca
2ary: Chagas or malignancies

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5
Q

food allergy with dysphagia, heartburn, strictures?

A

eosinophilic esophagitis

unresponsive to GERD tx

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6
Q

what causes esophageal strictures?

A

acid reflux

lye ingestion

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7
Q

where do esophageal varices occur?

A

lower 1/3 of esoph

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8
Q

white pseudomembrane in esoph?

A

candida

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9
Q

punched out ulcers in esoph?

A

HSV-1

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10
Q

linear ulcers in esoph?

A

CMV

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11
Q

dysphagia, iron deficiency anemia, esophageal webs?

A

Plummer Vinson syndrome
may be assoc with glossitis

** increased risk of squamous cell ca

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12
Q

what are risk factors for squamous cell ca of esoph?

A 
achalasia
alcohol
cigarettes
Zenker's diverticulum
esophageal web/Plummer Vinson
hot liquids
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13
Q

what are risk factors for adenocarcinoma of esoph?

A

Barrett
cigarettes
obesity
GERD

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14
Q

where does squamous cell ca vs adenocarcinoma affect esoph?

A

squamous: upper 2/3
adeno: lower 1/3

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15
Q

epidem of esophageal cancer?

A

worldwide: squamous cell more common
US: adeno

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16
Q

Curling ulcer?

A

burns –> decreased plasma volume –> gastric mucosa sloughing –> acute gastritis

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17
Q

Cushing ulcer?

A

brain injury –> increased vagal tone –> increased ACh stim of parietal cells –> increased H+ production –> acute gastritis

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18
Q

chronic gastritis in fundus?

A

type A gastritis
autoimmune (Abs to parietal cells)
pernicious anemia
achlorhydria

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19
Q

chronic gastritis in antrum?

A

type B gastritis
H pylori!

** increased risk of MALT lymphoma

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20
Q

stomach rugae look like brainnnnzzz?

A

Menetrier disease
gastric mucosal hyperplasia –> hypertrophied rugae, protein loss, parietal cell atrophy and decreased acid production

** pre cancerous

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21
Q

which type of stomach ulcer has risk of ca?

A

gastric

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22
Q

if you rupture gastric ulcer on lesser curvature, what artery is involved?

A

left gastric

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23
Q

if you rupture posterior duodenal ulcer, what artery is involved?

A

gastroduodenal

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24
Q

blunting of villi, lymphocytes in lamina propria?

A

celiac
HLA-DQ2, HLA-DQ8
primarily distal duodenum, prox jejunum

** increased risk of malignancy (T cell lymphoma)

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25
Q

osmotic diarrhea, can occur following viral enteritis, villi look normal?

A 
lactase deficiency
(lactase located at tips of intestinal vill)
lactase tolerance test: admin of lactose --> sx and glucose rises <20 mg/dL
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26
Q

findings in pancreatic insufficiency?

A

increased neutral fat in stool
ADEK and B12 malabsorption
D-xylose absorption: normal urinary excretion if pancreatic insufficiency (decreased in mucosal defects or bacterial overgrowth)

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27
Q

colon biopsy: PAS+ foamy macrophages in lamina propria, mesenteric nodes?

A

Whipple disease
cardiac, arthralgias, neurologic sx
give Abx

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28
Q

colon biopsy: noncaseating granulomas and lymphoid aggregates?

A

Crohn

TH1 mediated

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29
Q

colon biopsy: crypt abscesses and ulcers, no granulomas?

A

UC

TH2 mediated

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30
Q

causes of appendicitis in kids vs adults?

A

kids: lymphoid hyperplasia
adults: fecalith

31
Q

where do Zenker diverticula occur?

A

Killian triangle - b/w thyropharyngeal and cricopharyngeal parts of inferior pharyngeal constrictor

32
Q

dx of Meckel?

A

pertechnetate study

33
Q

five 2s of Meckel?

A 
2 inches long
2 feet from ileocecal valve
2% of population
presents in first 2 years of life
may have 2 types of epithelia (gastric, pancreatic)
34
Q

common location of volvulus in kids vs elderly?

A

kids: midgut
elderly: sigmoid

35
Q

bull’s eye on ultrasound?

A

intussusception

36
Q

mutation assoc with Hirschsprung?

A

RET

failure of neural crest cell migration

37
Q

premie with air in bowel/free air in abdomen?

A

necrotizing enterocolitis

formula fed infants with immature immune system

38
Q

villous vs tubulovillous vs tubular polyps?

A

villous highest malignant potential

tubular lowest potential

39
Q

serrated polyp?

A

premalignant
CpG hypermethylation –> BRAF mutations, microsatellite instability

    • sawtooth crypts on biopsy
    • up to 20% of sporadic CRC
40
Q

thousands of colonic polyps following puberty, rectum involved?

A

FAP
AD - APC (5q) mutation
100% CRC progression

41
Q

FAP + osseous and soft tissue tumors?

A

Gardner syndrome
hypertrophy of retinal pigment epithelium
impacted/supernumerary teeth

42
Q

FAP + malignant CNS tumor?

A

Turcot syndrome

43
Q

hamartomas in GI tract, hyperpigmented mouth/lips/hands/genitalia?

A

Peutz-Jeghers
AD

** increased risk of CRC, breast ca, stomach ca, small bowel ca, pancreatic ca

44
Q

child < 5 yo with polyps in colon, stomach, small bowel?

A

juvenile polyposis syndrome
AD
increased CRC risk

45
Q

HNPCC?

A

= Lynch
AD - DNA mismatch repair genes
80% progression to CRC

    • prox colon always involved
    • endometrial, ovarian, skin ca association
46
Q

presentation of L sided CRC vs R sided?

A

L sided: infiltrating, obstruction, colicky pain, hematochezia
R sided: exophytic mass, Fe deficiency anemia, weight loss

(R side bleeds, L side obstructs)

47
Q

gene events leading to CRC?

A

1) APC loss –> decreased intercellular adhesion, increased proliferation
2) KRAS mutation –> unregulated signal transduction –> adenoma
3) loss of p53 and DCC –> increased tumorigenesis –> carcinoma

48
Q

microscopic change in Reye?

A

microvesicular fatty change

49
Q

microscopic change in hepatic steatosis?

A

macrovesicular fatty change

** reversible

50
Q

microscopic change in alcoholic hepatitis?

A

swollen and necrotic hepatocytes
neutrophilic infiltration
Mallory bodies = eosinophilic inclusions of damaged keratin

** reversible

51
Q

microscopic change in alcoholic cirrhosis?

A

micronodular, shrunken, hobnail appearance
sclerosis around central vein (zone III)

** irreversible

52
Q

microscopic change in NASH?

A

fatty infiltration of hepatocytes

cellular ballooning –> eventual necrosis

53
Q

dx of HCC?

A

increased alpha feto protein
CT/MRI
biopsy

54
Q

collection of dilated blood vessels in liver?

A

cavernous hemangioma
common, benign, age 30-50

** NO BIOPSY - risk of hemorrhage

55
Q

liver tumor related to OCP/steroid use?

A

hepatic adenoma
rare, benign
regress or rupture

56
Q

exposure to arsenic, vinyl chloride causes what?

A

angiosarcoma of liver

malignant, endothelial origin

57
Q

MC origins of liver mets?

A

GI
breast
lung

58
Q

cirrhosis with PAS+ globules in liver?

A

alpha 1 antitrypsin

misfolded gene product aggregates in hepatocellular ER

59
Q

what bili level do you need for jaundice?

A

> 2.5 mg/dL

60
Q

physiologic jaundice?

A

newborns: immature UDP-glucuronyl-transferase –> unconjugated hyperbili –> jaundice, kernicterus (affects BG preferentially)

61
Q

Gilbert?

A

unconjugated hyperbili
decreased UDPglucuronosyltransferase and bili uptake
asx - mild
bili increases with fasting or stress

62
Q

Crigler-Najjar?

A

unconjugated hyperbili
ABSENT UPDglucurosyltransferase –> presents early in life, fatal
tx: plasmapheresis, phototherapy

** type II less severe than type I, responds to phenobarb

63
Q

Dubin J vs Rotor?

A

conjugated hyperbili due to defective liver bili excretion
both benign
D-J: black liver
R: no black liver

64
Q

genetics of Wilson?

A

AR

chromosome 13: ATP7B gene - hepatocyte copper transporting ATPase (liver excretion of Cu into bile)

65
Q

cirrhosis, diabetes, skin pigmentation?

A

hemochromatosis

HF, testicular atrophy, increased risk HCC

66
Q

genetics of hemochromatosis?

A

C282Y or H63D mutations on HFE gene

HLA3 association

67
Q

biliary biopsy: lymphocytic infiltration and granulomas?

A

PBC
anti-mitochondrial Abs (including IgM)
assoc with autoimmune conditions - CREST, Sjogren, RA, celiac

68
Q

biliary biopsy: onion skin fibrosis; beading on ERCP?

A 
PSC
hypergammaglobulinemia (IgM)
p-ANCA +
assoc with UC
can lead to cholangiocarcinoma
69
Q

cholesterol stones?

A

radiolucent
80% of gallstones

assoc: obesity, Crohn, older, fibrates, estrogen, multiparity, rapid weight loss, Native American

70
Q

pigment stones?

A 
black = radiopaque, Ca bilirubinate from hemolysis
brown = radiolucent, from infection

assoc: chronic hemolysis, alcoholic cirrhosis, biliary infx, TPN

71
Q

what causes 1ary infection of gallbladder?

A

CMV (rare)

72
Q

porcelain gallbladder?

A

calcified 2/2 chronic cholecystitis

tx: prophylactic chole - risk of GB carcinoma

73
Q

risk factors for pancreatic adenocarcinoma?

A 
smoking
chronic panc
diabetes
age L 50
Jewish, AfAm males
74
Q

Courvoisier sign?

A

obstructive jaundice, palpabile nontender GB

–> pancreatic cancer

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