Mini 4 - Digestive and Repro 2 Flashcards
How do you know when a gastric antral ulcer is benign?
Mucosa surrounding base isn’t swollen, radiating rugal folds extent nearly all the way to the margins of the base.
How is Clostridium difficile disagnosed?
Culture is too slow - gold standard is in vitro cytotoxin assay.
EIA for GHD (glutamade dehydrogenase), or for toxin. PCR.
What is the most common cause of appendicitis?
In young: hyperplasia of lymphatic follicles, in elderly: fecalith
Describe a spermatocytic seminoma.
Rare testicular tumour (only in testis), excellent prognosis - basically benign.
Mixture of small, medium, and large multinucleate cells.
CD117+.
Describe EHEC/STEC/O157:H7. How is it diagnosed?
Gotten through fecally contaminated water.
Has Shiga toxin 1&2 (encoded by phage) that inhibits protein synthesis/ Also has attachment/effacement lesions by the same mechanism of EPEC except without the BFP.
Sever abdominal cramps, watery diarrhea that can progress to bloody (no WBCs though). Can be complicated by HUS - hemolytic anemia, schistocytes, thrombocytopeni, uremia (main cause renal insufficiency in kids). Endothelial cell damage can lead to microvascular thrombosis.
Diagnose with SMAC (beige colonies).
Antibiotics contraindicated (increases release of Shiga) and antimotility drugs contraindicated (increased HUS risk).
What determines if you get inestinal or extraintestinal manifestations of E.coli disease?
Intestinal comes from exogenous source, extraintestinal from endogenous OR exogenous.
What is the incubation period of Hep A?
~28 days.
Is a hamartomatous polyp benign or malignant?
Usually benign - made of mature tissue normally present at the site.
What does orthostatis hypotension indicate?
A >20% reduction of blood.
What is true about Hep B and C coinfection?
It’s common, more severe, progresses to HCC more often, more rapid fibrosis, more likely to resist interferon treatment.
Can make HBV hard to detect in serology.
What is a uterus didelphys non communicating horn associated with? What investigation should be done?
Severe dysmenorrhea, hematosalpinx, often associated with ipsilateral renal abnormalities. Order an IV pyelogram.
Describe an ovarian endometrioid carcinoma.
Histology similar to endometrial endometrioid carcinoma.
Lots of associated mutations - KRAS, beta-catenin, PTEN, p53 (in poorly differentiated), have microsatellite instability.
Describe Toxoplasma gondii infection in utero.
Once infected, converts to cyst in host and may be carried for life. Doesn’t reactivate in pregnancy - risk is only for new infections.
If infected in 1st trimester may cause spontaneous abortion, stillbirth, severe disease.
If infected in later sequelae, may be asymptomatic at birth but later get neuro problems, chorioretinitis (w/ or w/o blindness).
How can the liver be biopsied if it can’t be done through the skin?
Transjugular. TIPSS - transjugular intrahepatic portosystemic stent system
Where does esophageal squamous cell carcinoma metastasize to?
Regional LNs.
What is indicated for a patient suspected or known to have esophageal varices?
Early octreoride or terlipressin.
Describe prostate intraepithelial neoplasia (PIN).
Can be precursor lesion to prostate cancer. Intraglandular atypical proliferation with stratification, nuclear atypia, prominent nucleoli.
Only high grade is now diagnosed.
What is the endemicity and genotype spread of HepE?
High endemicity areas have HEV1 and HEV2 - human, fecal-oral spread.
Low endemicity areas have HEV3 and HEV4 - zoonotic genotypes. Tend to be asymptomatic, but case fatality rate is high in underlying liver disease and pregnant women, and can cause stillbirth.
What are the histological signs of chronic ischemic bowel disease?
Mucosal atrophy, lamina propria fibrosis.
What is duct euctasia?
When the lactiferous duct is blocked or clogged. Can be simple or squamous metaplasia of the lactiferous duct. Can result to chronic inflammation - periductal mastitis.
Risk increases with reproductive age, smoking, vitamin A deficiency.
What is a cystocele?
Bladder prolapse.
What is the fibrolamellar variant of HCC?
5% of cases, mainly young adults, usually no underlying liver disease.
Large eosinophilic hepatocytes within bands of collagen. Better prognosis than conventional HCC.
What is phlegmon?
A spreading diffuse inflammatory process with formation of purulent exudate.
What are the stages of nonalcoholic fatty liver disease?
Fatty liver/steatosis, Nonalcoholic steatohepatitis, Cirrhosis
Compare Chorion villus sampling and amniocentesis.
CVS in week 11-13, 1% associated abortions, result same week.
Amniocentesis week 1-18, 0.6-0.86% associated abortions, results 1-2 weeks later.
CVS is also at risk of getting inaccurate result if it catches placental mosaicism.
In what zone of the prostate is prostate carcinoma most common?
Peripheral.
What is steatohepatitis?
Hepatocyte swelling/necrosis, Mallory bodies, fibrosis (starts in central zone), neutrophilic infiltrates.
What is needed for appendicitis Dx?
Mucosal neutrophils.
How is H. pylori-induced PUD treated?
PPI + amoxicillin + metronidazole.
BUT GERD incidence increases afterward.
How do humans get infected by helminths?
Egg ingestion, larvae ingestion, larvae penetration of skin.
Describe Hookworm.
Nematode. 2 species - Ancylostoma duodenale and Necator americanus.
Eggs become infective in stool like Ascaris.
Larvae penetrate the skin and migrate to lung, are swallowed.
Most people asymptomatic, some have ground itch. Most important disease is iron-deficiency anemia. Some people have lung issues/eosinophilia.
What are some symptoms of ovarian neoplasias?
Bloating/pressure in belly, pain in abdomen/pelvis, frequent urination, feeling full too quickly.
Describe vaginal embryonal rhabdomyosarcoma.
Multinodulated grape-like mass, most common <5 years of age.
Small blue cell tumour with rhabdomyoblasts (big pink cells) - may show cross-striations.
Describe cryptoorchidism and everything associated with it and how it’s treated.
Common locatoins = abdominal, inguinal, upper scrotal.
Atrophy of Leydig cells, seminiferous tubules lined only by Sertoli cells.
Increased risk of oligo/azoospermia and germ cell tumours in BOTH testes.
Orchiopexy usually done between 6-12 months.
How does smoking affect ulcerative colitis?
It may worsen if a smoker stops smoking.
Will chlorine kill Giardia cystss?
Generally yes but not alwyas.
What is primary ovarian insufficiency?
Failure before age 40. High FSH and LH. *check for fragile X.
What is Kallmann’s syndrome?
Hypogonadotrophic hypogonadism secondary to absence of GnRH. Anosmia/hyposmia - absence of olfactory bulbs, straight gyrus, medial orbital gyrus. Treatment is HRT.
What kind of antibodies do you see in HepA?
Anti-HAV IgMs in acute infection. Cannot cause chronic infection.
What is Mallory-Weiss syndrome?
Mucosal tears at the gastro esophageal junction.
What is hemosiderosis?
Acquired iron overload.
What is a contributing gene of acute pancreatitis?
PRSS1
Describe the Gleason prostate adenocarcinoma score.
Add 2 morst prevalent patterns: Score <6 = PGGI
7 (4+3) = PGGII,
7 (3+4) = PGGIII,
8 (4+4) = PGGIV
9-10 = PGGV
Patterns: 1 (closely packed small glands), 2 (loosely packed small glands), 3 (infiltrative small glands), 4 (infiltrative fused glands), 5 (nearly solid with minimal glands).
What are some reactivation triggers for HSV?
UV radiation, fever, emotional/physical stress, menstruation, mild trauma.
What are the diagnostic criteria for IBS?
More than 3 days/month for the past 3 months with 2 or more of: pain/discomfort improved with defecation, onset associated with change in frequency of stool, onset associated with change in appearance of stool.
How should Burkitt’s Lymphoma be treated?
High dose cyclophosphamide recommended.
Describe acute endometritis.
Usually bacterial infection after delivery or miscarriage.
Stromal plasma cells are characteristic.
Describe DiGeorge Syndrome.
Deletion in c22 - hypocalcemia, reduced/absent immune function, increased risk of psych disorders from puberty.
Deletion mostly 22q11.2 - some only have 10p13-p14 deleted.
Must diagnose by FISH of c22 region (only sees large deletions).
What are the symptoms of a perforated peptic ulcer?
What do you see on scans?
Acute sudden abdominal pain, no movement of abdominal wall with respiration, no bowel sound, guarding and rigidity.
On CXR you see free gas under the diaphragm, CT is most sensitive though.
What are some GI complications of CF? How should they be treated?
Meconium ileus, malabsorption.
Treat with hyperosmolar gastrografin enema (if case is complicated, surgery). If malabsorption, supplement fat soluble vitamins and feed by NG/gastrotomy tube.
What phases of absorption does Crohn’s affect?
Intraluminal digestion, terminal digestion at brush border, transepithelial transport.
How do you diagnose gonorrhea?
Men: gram- diplococci in PMNs in urethral exudate.
Women: Culture on Thayer-Martin media, nucleic acid amplification tests.
How do patients prepare for bariatric surgery?
Must quit smoking at least 30 days prior, quit caffeine, struct calorie controlled high fiber diet including multivitamins, in some pt.s liquid bowel prep diet is given.
What is the sinus tubercle?
Caudal tip of paramesonephric duct contacts the tip of the urogenital sinus and forms the sinus tubercle, which gives rise to 2 swellings (sinovaginal bulbs) that proliferare to form vaginal plate which later hollows.
What is Gilbert’s Syndrome? How should it be treated?
AR reduced expression mutation of promoter of UGT1A1 (bilirubin glucuronyl transferase) - results in unconjugated hyperbilirubinemia. Urine colour doesn’t change (serum bilirubin not >6mg/dL).
Jaundice precipitated by diet restriction, exercise, menstruation, other illnesses.
Usually no treatment indicated, but phenobarbital can improve condition.
Describe a pancreatic pseudocyst.
No epithelium, fibrous lining. Secondary to necrosis from pancreatitis/trauma.
How does intussusception present?
Colicky abdominal pain followed by bilious vomiting. “Red currant” jelly stool.
Abdomen soft and distended, may feel sausage shaped mass below right costal margin with concavity directed toward umbilicus. Empty right iliac fossa, blood and mucus in rectum.
Describe a stomach with limitis plastica gastric adenocarcinoma.
Small, shrunken stomach with no discrete mass and thick wall.
What causes black pigment gallstones?
Elevated unconjugated bilirubin.
Do you need acute pancreatitis/cholecystitis to have chronic?
Yes for pancreatitis - but chronic cholecystitis can occur without evidence of previous disease.
What is a dysgerminoma?
Female germ cell tumour. Multinodular, solid, soft. Nests of large cells, large nuclei, prominent nucleoli - fibrous stroma infiltrated with lymphocytes. Radio/chemo sensitive.
Positive for c-KIT mutations (CD117), usually no AFP, may make hCG (scattered syncytiotrophoblastic cells).
What’s the most common histo for hepatocellular carcinoma?
Atypical hepatocytes in trabecular or pseudoglandular pattern. Large round pink cell tumour. Can show bile production.
*Can be single mass, multiple nodules, or diffuse infiltration.
Where does gastric adenocarcinoma typically metastasize?
Virchow’s node, Krukenberg tumor, Sister Mary Joseph Nodule (periumbilical).
*these can come from other primaries too
What is Cyclospora cayetanensis? How is it diagnosed?
Protozoan. Humans only source - eat sporulated oocysts which break open and invade epithelial cells.
Incubation 1 week, watery diarrhea up to 6 weeks. Can also get nausea, vomiting, low-grade fever.
Diagnosed with stool oocysts (UV light).
What does exophytic gastric adenocarcinoma usually look like on histology?
Like intestine.
Describe Taenia solium. How is it diagnosed?
Cestode. Pork tapeworm. Pig is intermediate host (larval cysts develop in it).
Adult tapeworm in human have no symptoms, Cysticercosis can come from larval stage (focal seizures, mental impairment, meningitis, psychiatric illness).
Diagnosed by serology.
What serology do you see in HepB?
Acute: HBsAg and anti-HBc IgM.
Chronic: HBsAg and anti-HBc IgG.
anti-HBsAg IgGs shows long lasting immunity (vax), anti-HBc IgGs also means resolved infection.
What is the incubation of HepB?
60-110 days.
What are fibromas, thecomas, and fibrothecomas?
Benign ovarian stromal tumours.
Fibroma is solid, hard, grey-white (collagen).
Thecomas and fibrothecomas are yellow (theca cells have lipid) - spindle cells with pale cytoplasm, often produce estrogen.
What kind of liver damage does RHF failure make?
Can cause congestion/later necrosis/fibrosis of zone 3 (centrilobular). Results in nutmeg liver.
What can cause a false positive occult blood test?
Gum bleeding, horseradish, red meat, turnips within 3 days of test - also ingestion of colchium, iron, oxidizing drugs.
What is the histology of autoimmune Hepatitis?
Chronic hepatitis with increased plasma cells.
Describe EPEC.
Usually in children and acquired from direct contact not food. No cells in stool.
BFP (bundle-forming pilus) causes aggregation. Type III secretion system injects Tie protein that migrates to the host cell and acts as a receptor for intimin - recruits enzymes that efface microvili/rearrange actin to form pedestal. Attachement/effacement lesions.
Tight junctions are loosened leading to diarrhea, disruption of microvilli leads to malabsorption.
What’s a sign of toxic megacolon that can be determined on percussion?
Hepatic tympany.
What is a serous cystadenoma?
Surface epithelial tumour of the ovary - one layer of cuboidal/columnar cells. May have solid areas of stroma (cystadenofibroma) or papillary formations (serous papillary cystadenoma).
When does FAP give retinal signs?
If the mutation is past exon 9.
Describe gastric marginal zone lymphoma on histology.
Small mature lymphocytes sometimes mixed with reactive germinal centers (can look like gastritis).
May show plasma cell differentiation or increaed pale cytoplasm. Stains diffusely for B cells.
How do you treat uterine leiomyomata/myomas/fibroids.
Uterine artery embolization, hormonal options.
Describe a congenital pancreatic cyst.
Anomalous duct develope lined by cuboidal epithelium. Sporadic or associated with polycystic kidney disease or von Hippel-Lindau disease.
How does breast milk stain on microscopy?
Red in Sudan Red.
How do you differentiate ‘intestinal type’ and ‘diffuse type’ gastric adenocarcinoma?
Diffuse type has ‘signet ring’ pattern, intestinal type has glandular growth pattern.
What kind of nodule is more common in BPH?
Glandular more common than stromal.
What is the Arias-Stella phenomenon?
Infolding and vacuolization of glandular epithelium in pregnancy. Become abnormal/atypical but is normal.
Describe some symptoms of head of pancreas cancer.
Weight loss, progressive jaundice, dark urine, pale stool, may have hard nodular liver, ascites.
Describe a mucinous cystadenocarcinoma.
Surface epithelial tumour of the ovary - invasive glands, papillae, solid areas with obvious atypia.
Spread beyond the ovary is usually lethal.
Describe a seminoma.
Most common testicular germ cell tumour, solid mass with hemogenous yellow-grey cut surface.
Radio and chemo sensitive.
Lobules of large uniform cells with clear cytoplasm, large central nucleus, prominent nucleoli, fibrous stroma with lymphocytes.
How is invasive ductal carcinoma (breast) NST categorized?
ER+/HER2- (low proliferation and high proliferation types)
HER2+ (ER+/-)
Triple negative (ER-, HER2-, PR-)
What is mixed incontinence?
Stress+urge incontinence symptoms.
Describe inflammatory breast carcinoma.
Clinical features of mastitis - 50% don’t have palpable mass.
Invasive cancer with blockage of dermal lymphatics - erythema, peau d’orange. Early distant metastases, poor prognosis.
Descrbibe a granulosa cell tumour.
Sheets/cords of small polygonal cells. Follicular structures - Call-Exner Bodies ‘coffee-bean nuclei’.
Often yellow, low-grade malignant. Produce inhibin. Adult type have FOXL2.
How is Shigella spp dianosed and treated?
Generally a Methylene blue stool stain, though can maybe use culture in later stages.
Antibiotics given for severe cases, Antimotility agents contraindicated.
What is the vitamin, protein, and fluids recommendation for post-bariatric surgery?
100-200% RDA of vitamins, 1-1.5g/kg protein of ideal body weight, fluids 1/4 cup water every 15 mins.
*avoid water during meals - wait 30 min after a meal to drink fluids.
Desribe Vibrio cholerae and its food poisoning.
Gram - comma shaped bacterium. >200 serogroups based on O-antigen. Groups that produce the toxin are ones infected with the CTXphi phage.
Heat-labile A:5B enterotoxin that ADP-ribosylates the GalphaS protein on the GM1 receptor. Pilus is toxin co-regulated.
Ingested via fecally contaminated water (reservoir is human colon). Incubation is 16-72hrs. May progress to hypovolemic shock in 4-12 h - abrupt onset of high-volume watery diarrhea and vomiting up to 1L/hour “rice-water stool”.
How is HPV transmitted?
Sexual content, perinatal.
Which are more commonly bilateral, serous or mucinous ovarian tumours?
Serous - mucinous are only bilateral 5-10% of the time.
What is the normal reproductive age vaginal pH?
3.8-4.2
What is Budd-Chiari syndrome?
Acute liver enlargement, RUQ pain and ascites due to ostruction of 2 or more major hepatic veins.
Needs quick surgical correction.
Has marked centrilobular congestion and necrosis. Associated with myeloproliferative states, hypercoagulable states, carcinomas.
What is Gardener syndrome?
FAP + osteomas, epidermal cysts, fibromatosis, thyroid tumours, dental abnormalities.
What are the symptoms of ulcerative colitis?
Lower abdominal cramping, fecal urgency, tenesmus, anemia, low serum albumin, weight loss, negative stool cultures.
In severe disease: Increaed bowel frequency, dilated intestinal loops, increased ESR and CRP, decreased Hb.
Describe diverticular-induced bleeding.
Right sice is uncommon, if present may cause massive bleeding.
Usually only moderate blood loss and spontaneous cessation. Recurrent bleed common in ~40%.
What is hemachromatosis?
AR condition - hepcidin mutation resulting in decreased absorption of dietary iron. Iron accumulates in liver, skin, pancreas.
Treat with phlebotomy.
What is Chancroid? How do you treat it?
Haemophilus ducreyi - gram -.
~5-7 days after exposure, develop tender papule with erythematous base. In 2 days lesion ulcerates and becomes painful (soft chancre).
Give erythromycin.
Describe focal nodular hyperplasia.
Presents as liver mass, often has central scar. Has intact liver architecture with all the components of the liver present.
What are the urogenital infecting serovariants of Chlamydia trachomatis?
D through K.
What is a radial scar of the breast?
Benign proliferative epithelial lesion with no atypia. Pseudo-infiltrative with central sclerotic zone and radiating tubules. Closely mimics breast cancer.
Describe necrotizing enterocolitis.
Median onset 10 days after birth, common in premature infants and associated with patent ductus arteriosus.
Infection in intestine with the potential to form extensive ulceration, necrosis, and perforation.
Poor feeding, bilious vomiting, distended abdomen, blood in stools. May have abdominal tenderness, sepsis, periumbilical darkening/erythema, possible diarrhea after milk ingestion.
What is hepatoblastoma?
Mainly in infants - epithelial cells resembling fetal hepatocytes - sometimes with immature small blue (embryonal) cells or mesenchymal differentiation.
How much weight per week should you put on depending on your BMI?
Underweight and normal: 1lb, Overweight: 0.6lb, Obese: 0.5lb
How does IDC NST metastasize?
Axillary LN, hematogenously to viscera, bones, brain, rarely perineurally.
Describe Patau Syndrome.
Trisomy 13.
Sex equal. Most die within a year. Sloping forehead, forebrain defects, low set malformed ears, polydactyly, deafness, profound mental retardation.
In most: heart defects, eye abnormalities, cleft lip and palate.
Describe the family and structure of Hepatitis C. How many genotypes/serotypes?
Flaviviridae, enveloped, +ssRNA.
Genotypes 1-6 (1-4 most important), subtypes a, b, c.
What marker is commonly found in the serum of ovarian cancer?
CA125
Describe GI stromal tumours.
In stomach wall, show differentiation of interstitial cells of Cajal (usually made of spindle cells).
Most express a TK called c-KIT (stains with CD117).
Advanced disease often response to Imatinib.
What are some absolute contraindications for liver transplant?
Drug/alcohol use, active septic infection.
Describe HSV1 and HSV2 structure and how they look on microscopy.
Linear dsDNA, enveloped icosahedral capsid with tegument.
Cowdry type A on Tzanck smear. Cause syncytia.
Which HPV strains are generally benign and which are significantly cancer causing?
6&11 (cause condyloma) and 16&18 respectively.
Describe intestinal adenocarcinomas.
Vast majority in colon/rectum. AP mutation most common.
Mucinous and poorly differentiated ones have poorer prognosis. CEA is important.
How is ETEC treated?
Antibiotics can maybe shorten duration but some have a more severe effect. Antimotilitics are usually bad!
Bismuth subsalicylate can be a prophylactic.
How ong is breastfeeding recommended for?
Through the first year of life.
Describe Campylobacter infection. How is it diagnosed?
Zoonotic - transmitted fecal-oral or ingestion of undercooked meat/poultry products, unpasteurized milk, pet dogs.
Incubation 2-4 days, invasive/inflammatory diarrhea.
Important cause of Guillain-Barre (Abs to O-antigen recognize some human gangliosides_. PPIs increase susceptibilty.
Diagnosed with stool culture on selective Campy-BAP or Skirrow medium.
Describe autoimmune chronic gastritis.
Typically in the body/fundus. Reaction to parietal cells.
Causes antral endocrine cell hyperplasia, reduced serum pepsinogen (chief cells suffer collateral damage), B12 deficiency.
Diffuse mucosal damage, atrophy in intestinal metaplasia.
Describe eosinophilic esophagitis.
Caused mostly by food allergies. Often see mucosal rings.
Usually >20 from a 400x field.
Diagnosis of exclusion.
What is diversion colitis?
Develops post surgically when there’s a blind area that lacks normal fecal flow.
Looks like IBD (chronic colitis + neuts), can also be due to changes in intraluminal flora - enemas with SCFAs can help.
Describe breast LCIS (lobular carcinoma in situ).
Grows acinar/lobular (cohesiveness of cells is lost due to E-cadherin mutations) with uniform cells with oval-round nuclei and small nucleoli. Nothing will be seen on mammography.
What is a neurogenic bladder?
Incontinence due to lesions of the spinal cord.
Describe HepA disease.
Damage is immune mediated and not directly cytotoxic.
Can cause fulminant hepatitis - survivors recover full liver function, spontaneous recovery in 30-60% cases/
What alleles are associated with Crohn’s?
HLA-DQ2 and HLA-DQ8
Describe the effect of Kallmann SYndrome on male fertility.
AR gene deficient, degeneration of both seminiferous tubules/germcells and Leydig cells shortly after puberty.
Severely reduced sperm count.
Describe appendiceal mucinous cystadenoma.
Mucous filled cystic tumour lined by dysplastic epithelium but either wall is invaded or epithelial cells are in peritoneal mucinous deposits.
Most common origin ofpseudomyxoma peritonei.
*also can cause cystic ovarian mets resembling a primary ovarian tumour.
What phases of absorption does pancreatic insufficiency affect?
Intraluminal digestion.
How is Schistosomiasis diagnosed?
Stool ova with characteristic spine.
Describe typhoid fever.
S. typhi fecal-oral (not zoonotic, humans). Incubation 10-14d, duration 1-3 weeks.
Diarrhea followed by constipation, then high fever and nonspecific symptoms. 1/3 pts have maculopapular rash on the trunk. Complications involve GI bleeding and perforation.
Gallbladder colonization is asymptomatic.
TYpe III secretion system is important - can live in phagocytes, can circulate in blood to infect BM, liver, spleen, GB, Peyer’s patches.
Diagnosed with culture of stool, urine, rose spots, BM. ANtibiotics given based on susceptibility testing.
There is a live oral vaccine - infection doesn’t provide immunity.
What is cholangiocarcinoma?
Cancer of the bile ducts. Extrahepatic 85%, intrahepatic 15%.
Cause in SE asia by biliary infection of Opithorcis sinensis (liver fluke).
Most common is extrahepatic ducts of liver hilum (Klatskin tumour).
Median survival 6 months.
What are the symptoms of 47XXX (or even more Xs)?
Tall, some reduction in IQ, 62% have no physical abnormalities.
Increased risk of intellectual disbility, psychiatric disorders, primary ovarian failure.
What is a favourable allele for clearing HepC infection?
IL-28B C/C allele (vs T/T allele.
What are some causes of secondary achalasia?
Chagas disease (T. cruzi), lesios of vagal motor nucleus, diabetic autonomic neuropathy, infiltrative disorders.
What is a general marker for testicular germ cell tumours?
Placental Alkaline Phosphatase - PLAP
Describe the morphology and virulence factors of H. pylori.
Gram - rod, motile flagella, microaerophile, catalase +, oxidase +.
VFs: Urease, cytotoxin (VacA), CagA.
What are the symptoms of 47XYY?
Tall, 10-15 decreased IQ. *Increased incidence in prisons.
How do you treat C. difficile?
Discontinue broad spectrum antibiotics if possible - begin specific ones. Fecal transplant is antibiotis fail.
What is Dubin Johnson syndrome?
Faulty excretory mechanism of hepatocytes (point mutation in gene for organis anion transporter/ATP pump).
Increased conjugated bilirubin (centrilobular brown/black pigmentation).
How does alcohol contribute to pancreatitis?
Leads to protein-rich secretions that can block small ducts, increase pancreatic secretions, may cause transient contractrions of the Sphincter of Oddi, may have direct effects on acinar cells.
Differentiate between Crohn’s and Ulcerative Colitis.
Crohn’s: Any part of GI tract, typically transmural, skip lesions, can see granulomas. Often extraintestinal manifestations. Any age, nonwhites > whites.
UC: Rectum involves and extends proximally (no skip lesions). SI only involved in backwash ileitis in severe cases. Typically only mucosa and submucosa. Often broad ulcers with pseudopolyps. Peak age 20-25, whites and women. *can also have extraintestinal manifestations
UC can cause toxic megacolon.
What is Zollinger-Eliison syndrome?
A gastrin producing tumour - usually in the small bowel or pancreas, can cause multiple peptic ulcers.
How do you differentiate etween acute bacterial, chronic bacterial, and chronic abacterial prostatitis (AKA Chronic Pelvic Pain Syndrome)?
Acute bacterial will hae neutrophils and bacteria in secretions.
Chronic bacterial will have mononuclear cells and bacteria in secretions.
Chronic abacterial will have no bacteria in culture but may see neutrophils. Also has perineal/suprapubic discomfort and painful ejaculation.
What are the morphologic changes in lactase deficiency?
None!
Describe a corpus luteum cyst.
Cyst on ovary - Looks like corpus luteum, regresses spontaneously most of hte time. Occurs in reproductive years, end of the menstrual cycle, or in pregnancy.
What are the possible effects of congenital rubella?
Cataracts, heart defects (patent ductus arteriosus), deafness, microcephaly, growth restrictions, ‘blueberry muffin lesions’.
How big should an abdominal aortic aneurysm be for repair to be considered?
Greater or equal to 5cm.
What are some extraintestinal manifestations of Crohn’s and UC and which are specific to which?
Eye lesions, arthritis, thromboembolism, osteoporosis.
Gallstones (Crohn’s)
TTP (UC), primary sclerosing cholangitis (UC).
Both can have skin lesions, but in Crohn’s it’s erythema nodosum and in UC it’s pyoderma gangrenosum.
Describe Congenital Androgen Insensitivity Syndrome (CAIS).
X-linked recessive condition. Short vagina, high testosterone levels. XY person.
How much weight should a patient lose within 2 years of bariatric surgery?
33-50% of their weight.
What part of the prostate experiences benign prostatic hyperplasia?
The transitional zone.
What is an intraductal papilloma of the breast and what is a common symptom?
Benign proliferative epithelial lesion with no atypia. Often has bloody nipple discharge.
How do you diagnose a baby with congenital rubella?
Fetal IgMs can be seen in cord blood and diagnosed with PCR.
What is a Phyllodes tumour?
Breast stromal tumour - rare, more common in 6th decade. Source is intralobular stroma.
Not encaplsulated. Stromal hypercellularity, cysts with branching ‘leaves’ covered by epithelium.
Has low, intermediate, and high grade - high recurs locally, metastasizes by lymph and blood, and is refractory to chemo and radiotherapy.
What is appendiceal mucinous cystadenoma?
Mucous filled benign cystic tumour lined by dysplastic epithelium.
What is a testicular teratocarcinoma?
Mixed germ cell tumour - mature teratoma + embryonal carcinoma.
Under what % body fat do you get hypothalamic suppression (low FSH/LH)?
22%.
How is Hep B transmitted?
Through all bodily fluids and perinatally. In low endemicity areas mainly by sex, in high prevalence countries perinatally.
What drugs were found to help bulimia?
Antidepressants (SSRIs, MAOIs), also Aripiprazole (atypical antipsychotic).
Is Turner Syndrome generally a maternal or paternal error?
Paternal 80% of the time.
In what people do yeast infections often recur?
Diabetics, HIV+, people on OCs, diaphragm users, people on tetracyclines.
Where in the cervix does HPV proliferate?
At the squamo-columnar junction “transition zone”.
What is Tropical Sprue?
Coeliac-like, seen in people visiting hte tropics.
Usually follows acute diarrheal infection, usually rapidly responds to broad specrum antibiotics. Villous atrophy similar but more pronounced in distal SI.
How can you determined the parental origin of a trisomy?
Quantitative marker analysis.
What happens when intestinal carcinoid tumours are fixed with formalin?
Turn yellow.
How much calcium do women need per day?
9-18: 1300mg, 19-50: 1000mg, >50: 1200mg
What is a juvenile polyp?
Most are solitary, sporadic, comes with rectal bleeding - dilated glands in expanded inflamed lamina propria, increased risk of adenocarcinoma.
Where are GI stromal tumours most common?
SI. *morphology and prognosis similar to gastric.
What is rumination disorder?
Common in kids, is repeated regurgitation of food for more than a month, is not associated with another disorder, and is sufficiently severe to warrant clinical attention.
What are the liver enzymes like in cirrhosis?
AST usually <8x upper limit normal and ALT <5x upper limit normal, GGT about 8-10x upper limit normal
What is hepatic angiosarcoma associated with?
Exposure to vinyl chloride, arsenic, or thorotrast. Often has latent period of decades, most dead <1yr.
How do you diagnose HSV?
Tzanck smear, immunofluorescence, PCR, in situ hybridization.
What does necrotizing enterocolitis look like on xray?
Fixed/distended loops, penumatosis intestinalis, pneumoperitoneum.
What is Wilson’s disease?
AR ATP7B gene - cuases impaired excretion of copper into bile.
Liver shows steatosis, acute/chronic hepatitis, massive necrosis and cirrhosis.
Decreased serum ceruloplasmin.
What is the band of Ladd?
The band connecting the cecum to the abdominal wall when it’s in the epigastrium during incomplete/mixed rotation of the midgut.
Crosses duodenum.
Describe the family and structure of Hepatitis A. How many genotypes/serotypes?
Picornaviridae, nonenveloped, +ssRNA.
4 genotypes but only one serotype.
How do you differentiate between a low-grade and high-grade endometrial stromal sarcoma?
Both invade vasculature. Low grade looks like endometrial stroma while high grade has marked atypia/pleiomorphism and doesn’t look like endometrial stroma on histo.
What are some signs and symptoms of pyloric stenosis?
Dilated stomach, olive shaped lump in upper abdomen, peristalsis aggravated by test feed, dehydration, hypochloremic metabolic alkalosis.
What is the lining of the terminal duct lobular unit of the breast?
Inner layer of cuboidal/colunar secretory epithelium (luminal cells) and outer layer of myoepithelial cells (hallmark = vacuolated cytoplasm).
What is acholuric jaundice?
Jaundice without bile pigments in the urine.
Describe alpha1AT deficiency.
AR of genes. Accumulates in liver ER - liver shows eosinophilic, PAS+ cytoplasmic granules.
Describe Swyer’s syndrome.
XY female, defective sex determining factor.
No testosterone, internal female organs. Gonads streajed. Endrogen deficient - begin HRT in adolescence to induce puberty/menstruation.
What’s the deal with Ashkenazis and BRCA?
Have 1/40 BRCA mutation carrier risk, have 3 common mutations that should be screened for first.
BRCA1 c.68_69delAG and c.5266dupC
BRCA2 c.5946delT
What is Fanconi anemia?
Early onset BM failure. 30% present with malignancy, often MDS, AML, or squamous cell carcinoma of head and neck or vulva. 70% of patients have short stature, cafe au lait spots, thumb abnormality, hypogonadism, micro/hydrocephaly, developmental delay.
AR or X-linked mutations of FANC genes: FANCA most common, FANCD = BRCA2, BRCA1 interacts with FANCJ.
What is a surface epithelial tumour of the ovary?
Epithelium undergoes inclusion cysting and differentiates like it does embryologically into serous (tubal), endometrioid (endometrial), or mucinous (endocervical) type epithelium.
*Can also develop tubal metaplasia (endosalpingosis) and surface epithelial tumours (primary peritoneal carcinoma).
Describe Sertoli cell tumours.
What features are associated with malignancy?
Small white-grey nodule - columnar cells in tubules/cords separated by fibrous network.
Features associated with malignancy: >5cm, vascular invasion, nuclear pleiomorphism, necrosis, >5-10HPF
Describe type I endometrial carcinoma.
Endometrioid, RFs unopposed E, obesity, HTN, diabetes. In 55-65yr old women.
Indolent, spreads through lymphatics. On histology is confluent/infiltrative glands.
PTEN, PIK3A, KRAS, beta-catenin, MSI, p53 can be involved.
Grade 1 (>95% glands), Grade 2 (5-50% solid areas), Grade 3 (>50% solid areas).
How is H. pylori diagnosed?
Biopsy/culure of gastric mucosa or secretions, serology (but Abs decline after 3-6 months after treatment), urease breath test.
What is the endemicity of HepA?
Linked to poor SES, in high endemicity regions is basically universal in kids <10.
What is a leiomyoma?
A benign smooth muscle tumour - discrete, firm, circumscribed, grey-white. Can be submucosal, intramural, subserosal.
Hormone sensitive.
Describe ovarian hyperstimulation syndrome.
Increased vasoactive substance release, increased capillary permeability. Serum leaks out from IV space leading to hemoconcentration.
Ovaries enlarged, can cause ascites, nause/vomiting, diarrhea, hydrothorax. Life threatening stage can cause tense ascites and ARDS.
Describe pancreatic intraductal papillary mucinous neoplasm.
Dilatation of pancreatic ducts with dysplatic mucinous epithelium (no ovarian type stroma).
Usually in the head.
Is a precursor lesion to adenocarcinoma.
What are the possible benign proliferative epithelial breast lesions with atypia?
ADH (atypical ductal hyperplasi) and ALH (atypical lobular hyperplasia).
How many polyps are needed for a Familial Adenomatous Polyposis diagnosis?
100.
What does ALP >10x elevated point towards?
Extrahepatic biliary tract obstruction.
What is the intelligence in Turner Syndrome?
Normal.
What are condylomata acuminata?
HPV anogenital warts, flesh-dark grey in colour, sessile or pedunculated.
How do you differentiate between gastric and duodenal peptic ulcers?
Pain happens shortly after eating in gastric, 2-3hours after eating in duodenal.
What are some normal vaginal flora besides lactobacillus?
coagulase - Staph, Strep, Enterobacteraceae, Gardnerella, other anaerobes.
What is Paget Disease?
Scattered large pale intraepithelial sweat gland adenocarcinoma in squamous epithelium.
Red crusted lesion on labia majora, often extends beyond visible lesion. May arise from acrosyringium (intraepidermal sweat ducts) or multipotent stem cells of hair follicles.
What are surface epithelium inclusion cysts?
Ovarian epithelium cysts - benign, common in older women, usually small and multiple.
Describe the family and structure of Hepatitis B. How many genotypes/serotypes?
Hepadnaviridae, enveloped, icosahedral, gapped ds circular DNA. Has RT.
10 genotypes A-J, 4 serotypes (adw, ayw, adr, wyr - but immunity to one affords immunity to all.
