Midterm Problem Areas Flashcards
Four types of inflammatory lesions of oral cavity
Irritation Fibroma
Pyogenic Granuloma
Peripheral Ossifying Fibroma
Peripheral Giant Cell Granuloma
Most common inflammatory lesion of oral cavity
Irritation fibroma
Aphthous ulcer cause (2)
Stress
Lack of sleep
Most common fungal infection of mouth
Oral thrush
Cause of scarlet fever
Group A strep
Result in oral cavity of phenytoin/dilantin ingestion
Gingival hyperplasia
3 mutations in squamous cell carcinoma in chronological order
Inactivation of P16 –> Hyperplasia
Mutation of p53 –> Dysplasia
Activation of cyclin D1 –> Malignancy
3 Odontogenic cysts
Dentigerous
Periapical
Keratocyst
Keratocyst location
2 features of the cyst
Posterior mandible
Prominent basal layer palisading + corrugated epithelial surface
DM patients get what sinusitis
Mucormycosis
If someone is an adolescent male with a tumor of BV’s and fibrous tissue what is it?
What to be careful of
Nasopharyngeal angiofibroma
Bleed out during resection
A malignant tumor arising in the cribiform plate with lobular growth pattern
Olfactory neuroblastoma
A tumor with HPV 6 and 11 found in the septum of the nose with inverted growth pattern and mucin microcysts.
Sinonasal/Schneiderian Papilloma
A singer who smokes presents with progressive hoarseness and has bilateral nodules.
Reactive nodules
A child comes in with obstructive symptoms and has a neoplasm on the vocal cord that tests positive for HPV 6 and 11
Squamous papilloma
A smoker with persistent hoarseness comes in
Carcinoma of larynx
Patient comes in with cyst on anterolateral aspect of neck
Branchial cleft cyst
patient comes in with cyst in midline of neck
Thyroglossal duct cyst
60 year old patient comes in with tumor at birfurcation of common carotid artery and has zell ballen of eosinophilic cells
Paraganglioma
Most common lesion of salivary glands
Most common location
Mucoceles
Lower lip
Patient comes in with what looks like a mucocele on floor of the mouth
Ranula
Most malignant salivary gland
Sublingual
Most common tumor of salivary glands
Pleomorphic adenoma
Second most common tumor of salivary glands
Patient at risk
Warthin tumor
Smoker
Most common malignant salivary gland tumor
Mucoepidermoid carcinoma
Parotid gland tumor with cells with clear or granular cytoplasm
Acinic Cell carcinoma
Patient with tumor of minor salivary glands in the palate. Tumor has small blue cells in cribriform pattern and has hyaline membrane between cells. There is perineural invasion seen.
Adenoid Cystic Carcinoma
Patient with benign enlargement of lacrimal gland and salivary glands with dry eyes and mouth
Mikulicz
Patient with granulomas in the orbit that are negative for fungi and bacteria
Sarcoidosis
Most common primary orbital neoplasm
Vascular: Hemangiomas
Most common malignant neoplasm of lacrimal gland
Adenoid cystic carcinoma
Most common benign neoplasm of lacrimal gland
Pleomorphic adenoma
Patient comes in with neoplasm of lower eyelid and medial canthus
Basal Cell Carcinoma
Elderly patient comes in with tumor of upper eyelid and in Zeis/Meibomian glands and presents with conjunctivitis and blepharitis
Sebaceous carcinoma of eyelids
Most common cause of conjunctival scarring
Chronic dry eyes
Patient presents with an actinic tissue that is moving medially towards the cornea. Reports astigmatism and visual changes.
Ptyerygium
Patient presents with yellowish subconjunctival lesion
Pinguecula
Most common neoplasm of conjunctiva
Associated with what (2)
Squamous Cell
HPV 16 and 18
What is the precursor to conjunctival melanomas
Primary Acuired melanosis with atypia
Baby presents with a blue sclera at birth.
What is diagnosis
What is the problem
Osteogenesis imperfecta
No Type 1 collagen
Membrane where Copper is deposited in Wilson’s disease
Descemet
Patient presents with depositing of calcium in Bowman layer
Calcific band keratopathy
Patient presents with solar damage to the Bowman layer
Actinic band keratopathy
Patient presents with progressive thinning and ectasia of cornea with no inflammation. Now has irregular astigmatism. Patient also has Marfans and Downs syndrome
Keratoconus
Patient has an autosomal recessive dystrophy of the corneal stroma. Deposits of keratin sulfate are found.
Macular Corneal Dystrophy
Most common cause of cataract
Age-related opacification of lens
Patient presents with loss of vision and no pain. Damage is irreversible
Open angle glaucoma
Far-sighted Asian patient comes in. What should you be concerned with
Angle closure glaucoma
Most common primary intraocular malignancy in adults
Where does it spread
Which form is the worst
Melanoma of Uveal Tract
Liver
Epitheloid pattern
Near sighted people with cotton wool spots are at risk for what
Retinal detachment
Number one cause of blindness in US?
Diabetes Mellitus or ARMD
Premature infant treated with oxygen has delayed angiogenesis in lateral retina
Retionopathy of Prematurity
Patient presents with blindness due to deposits in Bruch membrane and loss of retinal pigmented epithelium
Atrophic Dry ARMD
Patient presents with hemorrhage of choroid blood vessels.
Exudative Wet ARMD
Most common intraocular tumor of kids
Retinoblastoma
Most common tumor of retina
Retinoblastoma
Patient presents with leukocoria, dilated fixed pupil heterochromia and strabismus
Retinoblastoma
Most common tumor of the optic nerve
Gliomas
Teenager patient with benign optic nerve tumor comes in. Patient has neurofibromatosis type 1
Pilocytic astrocytoma
3 diseases of optic nerve and cause of each
AION: Vascular injury
Papilledema: Intracranial pressure incrase
Optic neuritic: Demyelination
End stage Eye
Phthisis Bulbi
Newborn has regurgitation of food with first feeding. Aspiration and suffocates.
What is diagnosis
What is it seen with
What form is most common
Esophageal atresia
Tracheoesophageal fistula
Type C
Newborn presents with loops of small bowel outside his abdomen but covered by amniotic membrane.
Ompholocele
Newborn presents with a defect to right of umbilicus and has free floating small bowel outside of abdomen
Gastroschisis
Patient presents with large defect in which bowel is floating in placental membrane
Body stalk defect
Newborn presents with respiratory embarassment and hypoplasia of the lung.
Diaphragmatic hernia or Bochdalek hernia
Meckel diverticulum
True or acquired
Rule of 2’s
True congenital: all 3 walls
First born male presents with muscular vomiting and has a palpable muscular hypertrophy that feels like an olive.
Pyloric stenosis
Newborn Male patient fails to pass meconium. He has Down syndrome. There is a colonic dilatation proximally to the rectum. It ruptures and stercoral ulcers are found.
Hirschsprung disease
Patient presents with episodic food regurgitation at night.
Esophageal Diverticuli
Location of each diverticuli in esophagus
Zenker: Proximal
Traction: Mid
Epiphrenic: Distal
Patient has solid food dysphagia. History of GERD and was drinking lye.
Stenosis
Women presents with iron deficiency anemia, glossitis, and dysphagia.
Plummer-Vinson syndrome with esophageal webs
Young patient presents with dilation of proximal esophagus and constriction in lower esophagus. Birds beak appearance on barium swallow
What are they also at risk for.
Achalasia
Squamous Cell Carcinoma
Patient has a hernia with reflux esophagitis
Sliding axial (most common)
Patient has a hernia with a volvulus
Paraesophageal rolling hernia
Chronic alcoholic presents with severe retching and has longitudinal lacerations of esophagus at GE junction. They are only superficial.
Mallory-Weiss tears
A patient with severe bloody vomit presents with deep tears in the distal esophagus.
Boerhaave Syndrome
Patient with liver cirrhosis presents with massive hematemesis and bleeds out.
Esophageal varices
Patient presents with tiny punched out ulcers and has intranuclear inclusion cells on histo slide.
Herpes simplex esophagitis
Patient presents with shallow ulcerations and intranuclear inclusions
CMV
40 year old adult presents with heartburn, regurgitation and chest pain. You see eosinophils on histo slide of distal esophagus.
GERD
Male Patient has a histo slide prepared of upper/mid esophagus showing corrugated epithelium and many eosinophils after an allergic reaction to a meal.
Eosinophilic Esophagitis
Barrett esophagus associated with what cancer
Achalasia associated with what cancer
Adenocarcinoma
Squamous cell carcinoma
A patient on NSAID’s and Alcohol presents with pinpoint bleeding and hemorrhage and erosions. Curling and Cushing ulcers are also found.
Acute Gastritis
Patient presents with H. pylori infection with mucosal atrophy and metaplasia. Lymphocytes have infiltrated the lamina propria and glands.
Chronic active gastritis
Cancer associated with chronic gastritis caused by H. pylori? (2)
- Gastric adenocarinoma
2. MALToma
60 year old Scandinavian presents with pernicious anemia and atrophy of mucosa.
Auto-immune gastritis
Patient who has been using NSAID’s and alcohol presents with little to no inflammation but there is foveolar hyperchromasia and hyperplasia.
Reactive gastropathy
Patient presents with epigastric burning pain. A solitary punched out lesion is found in duodenum. Patient has H. pylori infection and uses NSAID’s.
Peptic Ulcer disease
Patient has a gastrinoma and multiple peptic ulcers. What is cause
Zollinger-Ellison
Male patient with hyperplasia of mucosa and thickened gastric folds presents.
Menetrier Disease
Patient has cystic dilation of fundic glands.
Fundic polyp
Older Patient has pedunculated and sessile polyps. Patient also has Familial adenomatous polyposis.
Adenoma
Patient has round polyp that looks to be part of repair process
Inflammatory/Fibroid polyp
Male patient who eats nitrites, smoked foods, and not enough fruits and veggies presents with chronic gastritis. What is he at risk for
Intestinal type Adenocarcinoma
Patient with poorly differentiated cancer of stomach.
Diffuse Adenocarcinoma
Patient has a tumor develop from enterchromaffin like cells and is in a hypergastrinemic state. He has the CD markers of CD56, synaptophysin, and chromogranin
Carcinoid Tumor
Patient has a tumor develop from interstitial cells of Cajal and is CKIT/CD117 and CD34 positive. Tumor responds to Gleevec.
GIST
Elderly female presents with herniation of jejunum through only two layers.
Jejunal Diverticuli
Most common cause of bowel obstruction
Adhesion
Patient presents with cyclic bowel obstruction symptoms.
Endometriosis - bowel obstruction
Patient presents with pain out of proportion to physical exam. Displays rigid rebound tenderness. Blood levels show lactic acidosis. Patient dies from peritonitis and sepsis.
Ischemic bowel disease at splenic flexure or rectum
Patient with lower GI bleed and CREST & Osler-Weber-Rendu presents. Venous dilations are seen in right colon and cecum.
Angiodysplasia
Patient with lower GI bleed has one large solitary venous dilation.
Arteriovenous Malformation
A pregnant patient who complains of chronic constipation and history of cirrhosis presents with painful bowel movements.
External Hemorrhoid
Premature newborn started on formula presents with problem with first oral feeding. Radiograph shows pneumatosis intestinalis (gas in bowel).
Necrotizing Enterocolitis
Scandinavian patient presents with inflammation of small intestine. Histology shows a blunting of villi with lengthening of glands. Patient tests positive for IgA transglutaminase and IgA Endomysial Ab. Also has dermatitis herpetiformis.
What is diagnosis
What are two associated cancers.
HLA-DQ2 Celiac disease/Sprue
T cell lymphoma and adenocarcinoma
How to test igA tTG in sprue?
How to test IgA EMA in sprue?
What should you do first
tTG: Elisa
EMA: Immunofluoresence
IgA serum test
Person visits the tropics and comes back with macrophages in their distal small bowel. Treatment with Antibiotics gives full recovery
Tropical Sprue
Patient with luminal stasis, hypochlorhydria and immunocompromised has diarrhea.
Bacterial Overgrowth syndrome
Hospitalized Patient comes in with a membrane of neutrophils, fibrin, and necrosis in his colon. He reports using broad-spectrum antibiotics. Patient dies of toxic megacolon.
How to treat
Pseudomembranous colitis caused by C. dif
Oral vancomycin
Female patient presents with cramping and diarrhea. No inflammation is seen and physical exam is normal. Patient reports diet of fatty foods and sugary foods. Patient reports stress.
Irritable bowel syndrome
Twenty year old Jewish patient presents with full thickness inflammation, luminal narrowing, skip lesions, and aphthous ulcers. Fistulas and sinus tract formation occurs as well as fat wrapping. Noncaseating granulomas are in bowel wall lymph nodes. Serology shows P-ANCA positive
Crohn’s disease
Patient presents with ulceration of mucosa and submucosa only. Continuous inflammatory process involving the rectum. Pseudopolyp formation is seen. No granulomas present. Primary sclerosing cholangitis is seen. Serology shows antibodies to Yeast
Ulcerative colitis
Elderly female with chronic watery diarrhea and thickened subepithelial collagen
Collagenous colitis
Patient presents with lymphocytosis of mucosa and inflammation. No thickened subepithelial collagen
Lymphocytic colitis
Patient presents with heavy pigmentation of colon during cholonoscopy. Reports heavy laxative use.
Melanosis Coli
Patient has a mass in colon from straining during bowel movements
Mucosal prolapse
Patient presents with a GI tumor of spindle and stellate cells with inflammation. Cells are CD34 positive. inflammation only through submucosa, not transmural.
Inflammatory fibroid polyp
Toddler presents with rectal bleeding
Juvenile polyposis
Young kid presents with tree like polyps and pigmentation on lips and oral cavity. Mutation at STK11/LKB1 on choromosome 19
Peutz-Jegher syndrome
Patient presents with macrocephaly, benign skin and mucosal tumors and dysplastic gangliocytoma of cerebellum. Loss of PTEN gene function and activation of MTOR
Cowden
Most common polyps of bowel
Location
Size
Hyperplastic
Left colon
Less than 5 mm
Polyps are found in the right colon. Associated with defective mismatch repair genes
Sessile serrated adenoma
3 mutations for colorectal carcinoma
Loss of APC gene
Turn on KRAS
Lose DCC
Most common primary malignancy of Small intestine
Carcinoids
Most common type of GI lymphoma
Large B-cell
Patient presents with apple core apearing tumor in the duodenum
Small intestine adenocarcinoma
Most common neoplasm of appendix
Carcinoid
Appendix tumor that makes mucin
Pseudomyxoma peritonei
Most common thing we see in peritoneum
Secondary neoplasms
Two genetic causes of acute pancreatitis
PRSSI: AD
SPINK1: AR
Two lab tests for pancreatitis
Which is better
Lipase and amylase
Lipase is more specific and sensitive
Main thing confused with acute pancreatitis?
How to differentiate
Occlusion of mesenteric vessels –> Ischemic bowel
Do blood gases and look for lactic acidosis
Primary progression of chronic pancreatitis
Secondary diabetes mellitus due to eventual destruction of islet cells
Most common cyst in pancreas
Pseudocysts
Tumor of pancreas in adolescent girls and young women with mild abdominal discomfort.
Solid pseudopapillary tumor
Female patient with cystic neoplasm. Ovarian-like stroma in cyst wall
Mucinous Cystic neoplasm
Male patient with cystic neoplasm in pancreatic head
Intraductal papillary mucinous neoplasm
Most common type of pancreatic malignancy
Pancreatic adenocarcinoma
Two mutations in pancreatic adenocarcinoma
KRAS activated
p16 inactivated
Patient presents with obstructive jaundice, weight loss, and migratory thrombophlebitis. Patient dies within a year.
Pancreatic adenocarcinoma
Best tumor marker for pancreatic cancer
CA19-9
Young female Northern European presents with hepatitis. Plasma cells are found at portal tract lobule interface. There is an absence of viral markers and it is negative for anti-mitochondrial antibodies. There is an elevation in autoantibodies.
Type 1 of this has what genetic association?
Autoimmune Hepatitis
HLA-DR3
Child presents with liver disease after taking aspirin during a viral infection.
Reye’s syndrome
African american woman presents with hepatitis. There are mallory bodies, hepatocyte swelling and necrosis, neutrophilic infiltrates, fibrosis, and steatosis. Elevated liver enzymes and neutrophils are found.
Alcoholic hepatitis
An obese patient with diabetes mellitus type 2 presents with elevated liver functions and hepatitis.
Metabolic liver disease such as NASH
Older male patient presents with hepatomegaly, pancreatic pigementation, diabetes mellitus, and skin pigmentation of a bronze color. Cardiomegaly is also present.
What is diagnosis
What is the mutation
What is the chromosome
Hereditary hemochromatosis
HFE gene
Chromosome 6
Patient presents with liver disease. There is also basal gnaglia atrophy, kayser-fleischer rings.
How to diagnose? (2)
What is diagnosis
Check serum ceruloplasmin and urine copper levels
Wilson’s Disease
Middle aged woman with celiac disease had her first symptom as pruritis. She developed jaundice, xanthomas, dark urine and light colored stools later. Blood levels show elevated alkaline phosphatase and cholesterol. Antimitochondrial antibodies are found. Duct injury and plasma cells are found on histo slide.
Primary Biliary Cirrhosis
Middle aged male with ulcerative colitis presents with biliary cirrhosis. Histo shows a segmental fibrous obliteration of bile ducts.
Diagnosis and increased risk of what
Primary Sclerosing Cholangitis
Cholangiocarcinoma
Tan clusters of dilated bile ducts in a fibrous stroma are found. They are free of bile and are remnant of biliary duct micro hamartomas
Von Meyenburg Complex
Female with autosomal dominant polycystic kidney disease presents with diffuse cystic lesions in the liver. These lesions do not communicate with biliary tree.
Polycystic liver disease
Patient presents with irregular fibrous widening of portal tracts. Patient also has autosomal recessive polycystic kidney disease
Congenitla hepatis fibrosis
Patient presents with dilation of large bile ducts. Stones and stasis is seen. Associated with both forms of polycystic disease.
Caroli Disease
Three things that increase risk of cholangiocarcinoma
Primary sclerosing cholangitis
Caroli’s
Congenital hepatic fibrosis
Patient presents with peculiar facies, vertebral anomalies, CV defects. Histo discovers there are no liver bile ducts. Mutation of JAG 1 gene on Chromosome 20
Alagille Syndrome
Patient comes in with liver failure. They admit to steroid, oral contraceptive, and danazol use. They report a Bartonella infection recently.
Peliosis hepatitis
Patient presents with hepatomegaly and ascites. Two or more major hepatic veins are obstructed
Budd-Chiari Syndrome
Jamaican bush tea drinker presents with oblieration of hepatic veins. He recovers spontaneously.
Veno-occlusive disease
First time Pregnant mother presents with hypertension and proteinuria. Also displays signs of HELLP syndrome.
Pre-eclampsia
First time pregnant mother prsents with hypertension and proteinuria. Also displays hyperreflexia and convulsions.
Eclampsia
Pregnant mother in third trimester presents with liver disease. Microvesicular steatosis is seen on the biopsy.
Acute fatty liver of pregnancy
Pregnant mother presents with pruritis, jaundice, dark urine, light colored stools. Cholestasis but no necrosis. Conjugated bilirubin detected.
Intrahepatic cholestasis of pregnancy
Middle aged woman comes in with a nodule on her liver. It is well demarcated, and has a central scar. It is lighter colored and contains large arterial vessels.
Focal nodular hyperplasia
Elderly patient comes in with multiple spherical nodules in absence of fibrosis. Develops portal hypertension after other stressor. Reticular stain used to accentuate the nodules.
Nodular regenerative hyperplasia.
Number one cause of non-cirrhotic portal hypertension in the world
Nodular Regenerative Hyperplasia
You find a benign vascular neoplasm less than 2 cm in size on the liver. Should you biopsy?
No, hemangiomas can bleed out
Young female patient on oral contraceptives presents with a benign proliferation of hepatocytes without portal triads. They are pale and yellow-tan in color. It is 30 cm large.
Hepatic adenoma
Young child comes in with FAP. He has a liver tumor. There is a mutation in beta-catenin.
Hepatoblastoma
Patient comes in after exposure to vinyl chloride with an aggressive tumor
Angiosarcoma
Elderly black patient comes in with cirrhosis after a mass was found. Patient has a history of viral liver infections and alcohol use. Elevated serum alpha-fetoprotein is found. The tumor is paler than surrounding tissue.
Hepatocellular carcinoma
Younger patient comes in with what is believed to be a hepatocellular carcinoma. However it is solitary and very fibrosed and well demaracated. Patient has no history of cirrhosis or chronic liver disease.
Fibrolamellar hepatocellular carcinoma
Hispanic patient comes in with PSC. He has a well differentiated tumor of bile duct with no bile within it. It is found at bifurcation of right and left hepatic ducts. Desmoplastic response is seen.
Cholangiocarcinoma: Specifically a Klatskin tumor based on location
Obese White female presents with biliary colic
Cholelithiasis
Child comes in with acholic stools, symptoms of cholestasis and eventual biliary cirrhosis. There is an obstruction found above the porta hepatis that is uncorrectable.
Biliary atresia
Elderly woman presents with long standing stones and chronic cholecystitis.
Carcinoma of the gall bladder
Elderly man presents with painless jaundice, hepatomegaly and a palpable gall bladder. Bilirubinemia and elevated alkaline phosphatase are also found.
Carcinoma of the extrahepatic ducts
