Mini 4 - Digestive and Repro 2 Flashcards
1
Q
How do you know when a gastric antral ulcer is benign?
A
Mucosa surrounding base isn’t swollen, radiating rugal folds extent nearly all the way to the margins of the base.
2
Q
How is Clostridium difficile disagnosed?
A
Culture is too slow - gold standard is in vitro cytotoxin assay.
EIA for GHD (glutamade dehydrogenase), or for toxin. PCR.
3
Q
What is the most common cause of appendicitis?
A
In young: hyperplasia of lymphatic follicles, in elderly: fecalith
4
Q
Describe a spermatocytic seminoma.
A
Rare testicular tumour (only in testis), excellent prognosis - basically benign.
Mixture of small, medium, and large multinucleate cells.
CD117+.
5
Q
Describe EHEC/STEC/O157:H7. How is it diagnosed?
A
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).
6
Q
What determines if you get inestinal or extraintestinal manifestations of E.coli disease?
A
Intestinal comes from exogenous source, extraintestinal from endogenous OR exogenous.
7
Q
What is the incubation period of Hep A?
A
~28 days.
8
Q
Is a hamartomatous polyp benign or malignant?
A
Usually benign - made of mature tissue normally present at the site.
9
Q
What does orthostatis hypotension indicate?
A
A >20% reduction of blood.
10
Q
What is true about Hep B and C coinfection?
A
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.
11
Q
What is a uterus didelphys non communicating horn associated with? What investigation should be done?
A
Severe dysmenorrhea, hematosalpinx, often associated with ipsilateral renal abnormalities. Order an IV pyelogram.
12
Q
Describe an ovarian endometrioid carcinoma.
A
Histology similar to endometrial endometrioid carcinoma.
Lots of associated mutations - KRAS, beta-catenin, PTEN, p53 (in poorly differentiated), have microsatellite instability.
13
Q
Describe Toxoplasma gondii infection in utero.
A
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).
14
Q
How can the liver be biopsied if it can’t be done through the skin?
A
Transjugular. TIPSS - transjugular intrahepatic portosystemic stent system
15
Q
Where does esophageal squamous cell carcinoma metastasize to?
A
Regional LNs.
16
Q
What is indicated for a patient suspected or known to have esophageal varices?
A
Early octreoride or terlipressin.
17
Q
Describe prostate intraepithelial neoplasia (PIN).
A
Can be precursor lesion to prostate cancer. Intraglandular atypical proliferation with stratification, nuclear atypia, prominent nucleoli.
Only high grade is now diagnosed.
18
Q
What is the endemicity and genotype spread of HepE?
A
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.
19
Q
What are the histological signs of chronic ischemic bowel disease?
A
Mucosal atrophy, lamina propria fibrosis.
20
Q
What is duct euctasia?
A
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.
21
Q
What is a cystocele?
A
Bladder prolapse.
22
Q
What is the fibrolamellar variant of HCC?
A
5% of cases, mainly young adults, usually no underlying liver disease.
Large eosinophilic hepatocytes within bands of collagen. Better prognosis than conventional HCC.
23
Q
What is phlegmon?
A
A spreading diffuse inflammatory process with formation of purulent exudate.
24
Q
What are the stages of nonalcoholic fatty liver disease?
A
Fatty liver/steatosis, Nonalcoholic steatohepatitis, Cirrhosis
25
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.
26
In what zone of the prostate is prostate carcinoma most common?
Peripheral.
27
What is steatohepatitis?
Hepatocyte swelling/necrosis, Mallory bodies, fibrosis (starts in central zone), neutrophilic infiltrates.
28
What is needed for appendicitis Dx?
Mucosal neutrophils.
29
How is H. pylori-induced PUD treated?
PPI + amoxicillin + metronidazole.
BUT GERD incidence increases afterward.
30
How do humans get infected by helminths?
Egg ingestion, larvae ingestion, larvae penetration of skin.
31
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.
32
What are some symptoms of ovarian neoplasias?
Bloating/pressure in belly, pain in abdomen/pelvis, frequent urination, feeling full too quickly.
33
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.
34
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.
35
How does smoking affect ulcerative colitis?
It may worsen if a smoker stops smoking.
36
Will chlorine kill Giardia cystss?
Generally yes but not alwyas.
37
What is primary ovarian insufficiency?
Failure before age 40. High FSH and LH. *check for fragile X.
38
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.
39
What kind of antibodies do you see in HepA?
Anti-HAV IgMs in acute infection. Cannot cause chronic infection.
40
What is Mallory-Weiss syndrome?
Mucosal tears at the gastro esophageal junction.
41
What is hemosiderosis?
Acquired iron overload.
42
What is a contributing gene of acute pancreatitis?
PRSS1
43
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).
44
What are some reactivation triggers for HSV?
UV radiation, fever, emotional/physical stress, menstruation, mild trauma.
45
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.
46
How should Burkitt's Lymphoma be treated?
High dose cyclophosphamide recommended.
47
Describe acute endometritis.
Usually bacterial infection after delivery or miscarriage.
Stromal plasma cells are characteristic.
48
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).
49
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.
50
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.
51
What phases of absorption does Crohn's affect?
Intraluminal digestion, terminal digestion at brush border, transepithelial transport.
52
How do you diagnose gonorrhea?
Men: gram- diplococci in PMNs in urethral exudate.
Women: Culture on Thayer-Martin media, nucleic acid amplification tests.
53
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.
54
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.
55
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.
56
Describe a pancreatic pseudocyst.
No epithelium, fibrous lining. Secondary to necrosis from pancreatitis/trauma.
57
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.
58
Describe a stomach with limitis plastica gastric adenocarcinoma.
Small, shrunken stomach with no discrete mass and thick wall.
59
What causes black pigment gallstones?
Elevated unconjugated bilirubin.
60
Do you need acute pancreatitis/cholecystitis to have chronic?
Yes for pancreatitis - but chronic cholecystitis can occur without evidence of previous disease.
61
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).
62
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.
63
Where does gastric adenocarcinoma typically metastasize?
Virchow's node, Krukenberg tumor, Sister Mary Joseph Nodule (periumbilical).
*these can come from other primaries too
64
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).
65
What does exophytic gastric adenocarcinoma usually look like on histology?
Like intestine.
66
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.
67
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.
68
What is the incubation of HepB?
60-110 days.
69
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.
70
What kind of liver damage does RHF failure make?
Can cause congestion/later necrosis/fibrosis of zone 3 (centrilobular). Results in nutmeg liver.
71
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.
72
What is the histology of autoimmune Hepatitis?
Chronic hepatitis with increased plasma cells.
73
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.
74
What's a sign of toxic megacolon that can be determined on percussion?
Hepatic tympany.
75
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).
76
When does FAP give retinal signs?
If the mutation is past exon 9.
77
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.
78
How do you treat uterine leiomyomata/myomas/fibroids.
Uterine artery embolization, hormonal options.
79
Describe a congenital pancreatic cyst.
Anomalous duct develope lined by cuboidal epithelium. Sporadic or associated with polycystic kidney disease or von Hippel-Lindau disease.
80
How does breast milk stain on microscopy?
Red in Sudan Red.
81
How do you differentiate 'intestinal type' and 'diffuse type' gastric adenocarcinoma?
Diffuse type has 'signet ring' pattern, intestinal type has glandular growth pattern.
82
What kind of nodule is more common in BPH?
Glandular more common than stromal.
83
What is the Arias-Stella phenomenon?
Infolding and vacuolization of glandular epithelium in pregnancy. Become abnormal/atypical but is normal.
84
Describe some symptoms of head of pancreas cancer.
Weight loss, progressive jaundice, dark urine, pale stool, may have hard nodular liver, ascites.
85
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.
86
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.
87
How is invasive ductal carcinoma (breast) NST categorized?
ER+/HER2- (low proliferation and high proliferation types)
HER2+ (ER+/-)
Triple negative (ER-, HER2-, PR-)
88
What is mixed incontinence?
Stress+urge incontinence symptoms.
89
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.
90
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.
91
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.
92
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.
93
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".
94
How is HPV transmitted?
Sexual content, perinatal.
95
Which are more commonly bilateral, serous or mucinous ovarian tumours?
Serous - mucinous are only bilateral 5-10% of the time.
96
What is the normal reproductive age vaginal pH?
3.8-4.2
97
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.
98
What is Gardener syndrome?
FAP + osteomas, epidermal cysts, fibromatosis, thyroid tumours, dental abnormalities.
99
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.
100
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%.
101
What is hemachromatosis?
AR condition - hepcidin mutation resulting in decreased absorption of dietary iron. Iron accumulates in liver, skin, pancreas.
Treat with phlebotomy.
102
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.
103
Describe focal nodular hyperplasia.
Presents as liver mass, often has central scar. Has intact liver architecture with all the components of the liver present.
104
What are the urogenital infecting serovariants of Chlamydia trachomatis?
D through K.
105
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.
106
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.
107
What is hepatoblastoma?
Mainly in infants - epithelial cells resembling fetal hepatocytes - sometimes with immature small blue (embryonal) cells or mesenchymal differentiation.
108
How much weight per week should you put on depending on your BMI?
Underweight and normal: 1lb, Overweight: 0.6lb, Obese: 0.5lb
109
How does IDC NST metastasize?
Axillary LN, hematogenously to viscera, bones, brain, rarely perineurally.
110
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.
111
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.
112
What marker is commonly found in the serum of ovarian cancer?
CA125
113
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.
114
What are some absolute contraindications for liver transplant?
Drug/alcohol use, active septic infection.
115
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.
116
Which HPV strains are generally benign and which are significantly cancer causing?
6&11 (cause condyloma) and 16&18 respectively.
117
Describe intestinal adenocarcinomas.
Vast majority in colon/rectum. AP mutation most common.
Mucinous and poorly differentiated ones have poorer prognosis. CEA is important.
118
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.
119
How ong is breastfeeding recommended for?
Through the first year of life.
120
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.
121
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.
122
Describe eosinophilic esophagitis.
Caused mostly by food allergies. Often see mucosal rings.
Usually >20 from a 400x field.
Diagnosis of exclusion.
123
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.
124
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.
125
What is a neurogenic bladder?
Incontinence due to lesions of the spinal cord.
126
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/
127
What alleles are associated with Crohn's?
HLA-DQ2 and HLA-DQ8
128
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.
129
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.
130
What phases of absorption does pancreatic insufficiency affect?
Intraluminal digestion.
131
How is Schistosomiasis diagnosed?
Stool ova with characteristic spine.
132
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.
133
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.
134
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.
135
What is a favourable allele for clearing HepC infection?
IL-28B C/C allele (vs T/T allele.
136
What are some causes of secondary achalasia?
Chagas disease (T. cruzi), lesios of vagal motor nucleus, diabetic autonomic neuropathy, infiltrative disorders.
137
What is a general marker for testicular germ cell tumours?
Placental Alkaline Phosphatase - PLAP
138
Describe the morphology and virulence factors of H. pylori.
Gram - rod, motile flagella, microaerophile, catalase +, oxidase +.
VFs: Urease, cytotoxin (VacA), CagA.
139
What are the symptoms of 47XYY?
Tall, 10-15 decreased IQ. *Increased incidence in prisons.
140
How do you treat C. difficile?
Discontinue broad spectrum antibiotics if possible - begin specific ones. Fecal transplant is antibiotis fail.
141
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).
142
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.
143
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.
144
What is Zollinger-Eliison syndrome?
A gastrin producing tumour - usually in the small bowel or pancreas, can cause multiple peptic ulcers.
145
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.
146
What are the morphologic changes in lactase deficiency?
None!
147
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.
148
What are the possible effects of congenital rubella?
Cataracts, heart defects (patent ductus arteriosus), deafness, microcephaly, growth restrictions, 'blueberry muffin lesions'.
149
How big should an abdominal aortic aneurysm be for repair to be considered?
Greater or equal to 5cm.
150
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.
151
Describe Congenital Androgen Insensitivity Syndrome (CAIS).
X-linked recessive condition. Short vagina, high testosterone levels. XY person.
152
How much weight should a patient lose within 2 years of bariatric surgery?
33-50% of their weight.
153
What part of the prostate experiences benign prostatic hyperplasia?
The transitional zone.
154
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.
155
How do you diagnose a baby with congenital rubella?
Fetal IgMs can be seen in cord blood and diagnosed with PCR.
156
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.
157
What is appendiceal mucinous cystadenoma?
Mucous filled benign cystic tumour lined by dysplastic epithelium.
158
What is a testicular teratocarcinoma?
Mixed germ cell tumour - mature teratoma + embryonal carcinoma.
159
Under what % body fat do you get hypothalamic suppression (low FSH/LH)?
22%.
160
How is Hep B transmitted?
Through all bodily fluids and perinatally. In low endemicity areas mainly by sex, in high prevalence countries perinatally.
161
What drugs were found to help bulimia?
Antidepressants (SSRIs, MAOIs), also Aripiprazole (atypical antipsychotic).
162
Is Turner Syndrome generally a maternal or paternal error?
Paternal 80% of the time.
163
In what people do yeast infections often recur?
Diabetics, HIV+, people on OCs, diaphragm users, people on tetracyclines.
164
Where in the cervix does HPV proliferate?
At the squamo-columnar junction "transition zone".
165
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.
166
How can you determined the parental origin of a trisomy?
Quantitative marker analysis.
167
What happens when intestinal carcinoid tumours are fixed with formalin?
Turn yellow.
168
How much calcium do women need per day?
9-18: 1300mg, 19-50: 1000mg, >50: 1200mg
169
What is a juvenile polyp?
Most are solitary, sporadic, comes with rectal bleeding - dilated glands in expanded inflamed lamina propria, increased risk of adenocarcinoma.
170
Where are GI stromal tumours most common?
SI. *morphology and prognosis similar to gastric.
171
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.
172
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
173
What is hepatic angiosarcoma associated with?
Exposure to vinyl chloride, arsenic, or thorotrast. Often has latent period of decades, most dead <1yr.
174
How do you diagnose HSV?
Tzanck smear, immunofluorescence, PCR, in situ hybridization.
175
What does necrotizing enterocolitis look like on xray?
Fixed/distended loops, penumatosis intestinalis, pneumoperitoneum.
176
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.
177
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.
178
Describe the family and structure of Hepatitis A. How many genotypes/serotypes?
Picornaviridae, nonenveloped, +ssRNA.
4 genotypes but only one serotype.
179
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.
180
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.
181
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).
182
What is acholuric jaundice?
Jaundice without bile pigments in the urine.
183
Describe alpha1AT deficiency.
AR of genes. Accumulates in liver ER - liver shows eosinophilic, PAS+ cytoplasmic granules.
184
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.
185
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
186
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.
187
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).
188
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
189
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).
190
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.
191
What is the endemicity of HepA?
Linked to poor SES, in high endemicity regions is basically universal in kids <10.
192
What is a leiomyoma?
A benign smooth muscle tumour - discrete, firm, circumscribed, grey-white. Can be submucosal, intramural, subserosal.
Hormone sensitive.
193
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.
194
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.
195
What are the possible benign proliferative epithelial breast lesions with atypia?
ADH (atypical ductal hyperplasi) and ALH (atypical lobular hyperplasia).
196
How many polyps are needed for a Familial Adenomatous Polyposis diagnosis?
100.
197
What does ALP >10x elevated point towards?
Extrahepatic biliary tract obstruction.
198
What is the intelligence in Turner Syndrome?
Normal.
199
What are condylomata acuminata?
HPV anogenital warts, flesh-dark grey in colour, sessile or pedunculated.
200
How do you differentiate between gastric and duodenal peptic ulcers?
Pain happens shortly after eating in gastric, 2-3hours after eating in duodenal.
201
What are some normal vaginal flora besides lactobacillus?
coagulase - Staph, Strep, Enterobacteraceae, Gardnerella, other anaerobes.
202
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.
203
What are surface epithelium inclusion cysts?
Ovarian epithelium cysts - benign, common in older women, usually small and multiple.
204
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.
205
What is vaginal adenosis?
Remnant of columnar endocervical type tissue - red granular areas with columnar mucinous epithelium.
Seen in many women who were exposed to DES (diethylstilbestrol) in utero.
Rarely progresses to clear cell adenocarcinoma.
206
Describe Clostridium difficile morphology and pathogenesis of infection.
Anaerobic, gram+, spore forming bacillus - the spores are acquired from contact, people get overgrowth after antibiotic therapy.
Diarrhea (watery, 10-15 days, low fever) that can cause pseudomembranous colitis that can lead to fulminant colitis.
Not all strains have toxins - but toxins are Toxin A and B - both are endocytosed and glycosylate the Rho protein (regulates cytoskeleton structure) to make rounded cells, disrupt tight junctions.
Hypervirulent strain (resistant to fluoroquinones) makes much more toxin and also makes CDT/Binary toxin - ADP ribosylates A:B.
207
How is acute diverticulitis treated?
NPO, IV antibiotics, IV fluids. If abscess, do CT-guided drainage.
208
What is the most common testicular tumour in the elderly and what are helpful markers?
Testicular Lymphoma. Most common is diffuse large B-cell lymphoma. Frequently bilateral.
LCA, CD20 helpful.
209
Describe immature and mature testicular teratomas.
Immature is malignant, mature is benign in kids but considered malignany after puberty.
Mature cystic teratoma of the testicle is severely malignant and chemo resisting.
210
What are the types of cervicitis?
Acute (Staph, Strep, postpartum), Chronic (epithelial reaction/regeneration, hyperplasia, squamous metaplasia), Infectious (C. trachomalis, T. vaginalis, Candida spp, N/ gonorrhoeae, HSV2, HPV).
211
Describe a choriocarcinoma.
Similar to a placental tumour but more resistant to chemo. High hCG, has syncytiotrophoblast (multinucleate, dark) and cytotrophoblast (dark) epithelium.
Aggressive, metastasizes early, primary tumour may regress.
Often small hemorrhagic focus in a mixed germ cell tumour.
212
What are the 3 main illnesses caused by H. pylori?
Noncardia gastric adenoma, duodenal unceration, B cell lymphoma.
213
Describe Edwards Syndrome.
Trisomy 18 (trisomy 90%), rarely mosaicism/translocation.
80% females. Most die within a year.
Hypertonicity (clenched fingers), prominent occiput, low-set malformed ears, small chin, rocker-bottom feet, heart defects, failure to thrive, profound mental retardation.
214
What is chronic hepatitits? What causes it?
Hepatitis >6 weeks. Will see fibrosis. Hep C is most common cause, Hep B will have 'ground glass hepatocytes'.
215
How are Giardia diagnosed?
Ova and parasites in stool (3 parasites needed), ELISA or immunoflouorescence of antibodies.
216
Describe a mucinous cystadenoma.
Surface epithelial tumour of the ovary - multilocular, smooth, one layer of mucin producing cells.
217
What is a pseudomyxoma peritonei of the ovary?
Usually a metastasis from the appendix.
218
What organism causes yeast infections?
Candida albicans - in immunocompromised patients can be other Candida species.
219
How are yeast infections treated?
With oral or vaginal imidazoles.
220
Describe HepB disease.
Generally no cytopathic effect - damage done by immune mediated.
Liver function returns to normal in 8-12 weeks.
Can cause chronic and also fulminant disease - is most common form of viral fulminant hepatitis.
221
Describe the family and structure of Hepatitis D. How many genotypes/serotypes?
Deltaviridae, enveloped, defective circular -ssRNA. Only one serotype - relies on HBV for it's replication.
222
Describe Cryptosporidium and its infection.
ProWhat is Isospora beli?tozoan. Cysts/oocytes ingested (cattle infected) - excysts in stomach and enters cells (some form sexual gametocytes that fuse to become oocytes).
Incubation 1 week then watery diarrhea, malabsorption - lasts 5-10 days. In AIDS pts can disseminate to cause lung infiltrates or cholangitis or pancreatitis. Can be chronic.
223
What is Whipple's disease?
Rare systemic disease caused by Trophyrema whippelli (gram + actinomycete).
Macrophages stuffed with organisms obstruct lymphatics and cause malabsorptive diarrhea.
SI intestinal lamina propria distended by foamy PAS+ macrophages.
224
What is the most common cervical cancer?
Squamous cell carcinoma.
225
What is the Courvoisier Law?
Distended cystic gallbladder in jaundice patients may be due to cancer of the head of the pancreas.
226
How is invasive breast carcinoma staged?
I: <2cm
II: <5cm and 3 or less LNs.
III: >5cm or any size and 4 or more LNs OR skin/chest wall incasion OR inflammatory carcinoma
IV: distant metastases present
227
What are some risk factors for pancreatic adenocarcinoma?
Smoking, high fat diet, BEING ELDERLY, alcohol, Fx, Peutz-jeghers, hereditary pancreatitis.
228
What is primary and secondary amenorrhea?
Primary - no menses at 13 with absence of secondary sexual characteristics or at 15 with presence of secondary sexual characteristics.
Secondary - Cessation of menses over either 3 cycles or 6 months.
229
Describe invasive lobular carcinoma.
Firm (less than IDC), ill-defined margins. Infiltrating growth of signet-ring cells with no ductal/glandular pattern. Discretely distributed cells 'indian files' lines, trabeculus,
230
What trimester are infections most damaging in?
First.
231
What are mucinous borderline tumours?
Surface epithelial tumour of the ovary - stratified mucinous epithelium with variable atypia.
85% intestinal type (has goblet cells), 15% endocervical type.
232
Describe PCOD.
Increased estrone and androgens.
Scant corpora lutea and albicans.
233
What does a nodule and blue dot sign indicate in acute scrotum?
Testicular appendix torsion.
234
What is Meckel's diverticulum? How is it identified and what should be done?
The unobliterated part of the vitello-intestinal tract, most prevalent congenital anomaly.
Usually 3 feet proximal from ileocecal junction. Usually asymptomatic.
Tc-99 scan can be good for identifying ectopic gastric mucosa. If asymptomatic, leave it alone, if symptomatic, resection required.
235
What are the nutritional requirements of a breastfeeding woman?
Extra 500cal/day, increased amounts of protein, Zn, B1, A, C, E.
236
Describe cffDNA.
Next gen sequencing is done - each fragment is mapped to a a chromosome and the # of fragments /chrom are counted.
Specificity for Down's is >99%, FP rate <0.1%.
237
What vessels provide the inflow of blood for the liver?
Portal vein and hepatic artery.
238
What are the symptoms of epididymitis?
Dysuria, fever, scrotal erythema.
239
What is Fragile X?
>200CGG repeats in FMR1 (55-200 is premutation, <44 is normal).
Shows anticipation but only when passed from mother - even if father has full mutation, only premutation will be passed on.
AGG interruptions in CGG repeats reduce likelihood of transmission.
240
What are the genetic ways people can get Down's Syndrome?
95% classical trisomy, 14;21 robertsonian translocation is common (3-4%), <1% is mosaicism (mitotic nondisjunction).
241
Describe S. aureus food poisoning.
Most common food poisoning. Gotten from salty, high-fat food, hard boiled eggs. Produces enterotoxins (SEA but also B and C) which acts fast (1-3hrs). Toxin is heat-stable and causes intestinal serotonin release.
Incubation is 1-6 h, duration is less than 24 hours.
242
How do you treat gonorrhea?
Ceftriaxone. Has plasmid-encoded beta-lactamase.
243
Which hepatitides can cause chronic infections?
B, C, D.
244
What differentiates early form and late form gastric adenocarcinoma?
Whether or not it extends past the submucosa.
245
What are the symptoms of Yeast vulvovaginitis?
Thick, cottage cheese-like discharge. pH 4.3-4.5. Inflammation and erythema with satellite lsions on sides - possible pain on urination.
246
What is the female athlete triad?
Eating disorder + menstrual dysfunctoin + low bone mineral density.
247
What is Lymphogranuloma venereum?
Chlamydia serotypes L1, L2, L3.
1st stage - Lesion at site of infection then incubation, might have headache, fever, myalgia when lesion present.
2nd stage - lymphadenopathy of LNs (mostly inguinal) - nodes become painful buboes that can enlarge and rupture. - Fever, chills, anorexia, headache, meningismus, myalgias, arthralgia, may develop proctitis.
Untreated may progress to chronic ulcerative phase.
248
Describe fulminant hepatitis.
Progression to hepatic failure in 2-3 weeks. Small shrunken liver with extensive necrosis, mortality is high without a transplant.
249
What is the incubation and duration time of E.coli?
Incubation 24-48h, duration 3-4days of watery diarrhea (n cells), mild fever.
250
What are the Bulimia diagnostic criteria?
Inappropriate compensatory behaviour at least once weekly for 3 months.
251
Describe HepC serology.
Acute: anti-HCV IgMs.
Chronic: anti-HCV IgGs.
252
How much iron is needed in pregnancy? What is it found in?
Almost doubles from ~18mg to 27mg per day.
Lean meat, poultry, fish, beans, peas.
253
Describe Cri-Du-Chat.
Deletion on c5 - deletions vary (size is proportionate to extent of disability). Severe intellectual disability. In very few cases the cry occurs isolated.
90% spontaneous, 10% is due to one parent having a reciprocal translocation.
254
Describe non-typhoidal Salmonellosis/Gastroenteritis.
Zoonotic - gotten from animal products.
Incubation 6-48h, duration 2-7d. Watery diarrhea, cramping, fever, WBCs in stool, usually no RBCs. S. typhi or paratyphi can cause typhoid fever.
Invades M cells via trigger mechanism (Sip proteins via T3SS) and replicates in endocytic vacuoles. Some serovariants can disseminate - only time you should give antibiotics.
255
Where are intestinal adenocarcinomas most common?
SI.
256
What is Cirrhosis?
Hepatic stellate/Ito cells transform into myofibroblasts and lay down fibrosis through type I and III collagen in the space of Disse. Hepatocytes stimulated to regenerate as spherical nodules.
Need diffuse fibrosis and 2 regenerative nodules for diagnosis.
257
Describe a monodermal/specialized teratoma.
Only one type tissue present. Generally benign. Can cause hyperthyroidism if it's thyroid tissue.
Carcinoid will be unilateral *usually bilateral in metastasis.
258
What is the primary enzyme indicating excessive alcohol use?
GGT
259
Describe Stepwise Sequential fetal screening.
1st trimester screen but recommend CVS to high risk couples, for others continue quad test, offer amniocentesis to elevated risk.
95% Se with 5% FP rate for DS.
260
Describe Leydig cell tumours. What features are associated with malignancy?
Small golden-brown nodule. May produce androgens, estrogens, even cortisol (can cause gynecomastia, precocious puberty).
Features associated with malignancy: >5cm, invasive growth, necrosis, high mitotic rate, atypical mitoses.
261
Describe breast mucinous carcinoma.
Well-circumscribed, soft/rubbery, pale grey-blue genatinous. Lakes of mucin.
262
What is the normal testis length and prostate length?
3.5cm and 2.5cm.
263
What is verrucous carcinoma?
A well-differentiated variant of penile squamous cell carcinoma (has favourable prognosis, doesn't usually metastasize).
264
What are common complications of Down's syndrome?
Hypothyroidism, heart malformations, Alzheimer's (APP gene and cholesterol transporter ABCG1 on C21).
265
What is the most important risk factor for esophageal adenocarcinoma?
GERD.
266
What tests are done in first trimester screening and in what weeks?
Weeks 11-13. Mainly for Down's.
betahCG (higher = higher risk), PAPP-A (lower = higher risk), Inhibin A (increases with decreasing PAPP-A but is rarely used).
Nuchal Translucency strongly enlarged has bad prognosis. Finds trisomies, XO, other abnormalities.
267
Describe right side vs left side colonic adenocarcinoma.
Right side usually polypoid and late to obstruct (presents with fatigue, immuno-deficiency anemia).
Left side usually annular and stenosing (presents with bleeding, changed bowel habits, cramping, discomfort). Has suprapubic colicky pain, palpable lump. Liver metastasis common.
268
How much of a loss of blood indicates transfusion?
>30% volume or Hct <20%.
269
What is AST and ALT in alcoholic liver disease?
AST never >500 and ALT >300.
270
Describe an embryonal carcinoma. What does it stain for?
Solid with areas of hemorrhage/necrosis, sheets/gland-like structures of large pleiomorphic cells. Can make hCG
CD30+,OCT3/4+, PLAP+, AFP often +, CD17-
271
How is HepD transmitted?
Parenterally, sexually, through occult parenteral route.
272
What is Lichen sclerosis?
White placques around the female genitals which coalesce and may extend around the anus. Thin, flat epidermis, superficial dermal fibrosis, degeneration of basal epidermal cells.
Affects mainly postmenopausal women.
273
Describe Enterobius vermicularis.
Nematode. Pinworm. Has no intermediate host. Transmitted by ingestion of eggs (NOT fecal-oral), adults migrate at night through the anus, lay eggs, die. Perianal itching.
Diagnosed with scotch tape (eggs rarely seen).
274
Describe breast DCIS (ductal carcinoma in situ).
Proliferation of pleiomorphic luminal cells limited by the BM. Grows tubular, clustered microcalcifications. Probably will have a palpable mass and nipple discharge.
Comedo DCIS is the most aggressive type (extreme central necrosis and calcifications). Noncomedo means no necrosis.
Paget Disease is persistent erythematous, crusted, pruritic skin lesion of the nipple and areola (looks like dermatitis). Malignant cells spread through the ducts to the nipple. Paget cells within the nipple epidermis - large, pale cells with granular cytoplasm. Has 50% chance of being invasive ductal carcinoma.
275
What do the Mesonephric/Wolffian ducts differentiate into?
Epididymis, vas deference, seminal vesicle.
276
What are some risk factors of gastric adenocarcinoma?
Nitrites, diet low in fresh fruit/veg, atrophic gastritis with intermediate metaplasia, gastric adenoma, H. pylori.
277
Right after bariatric surgery, how is the person's diet?
0-6hrs nothing (just IV)
6hrs-2-3weeks liquid diet
4-8 weeks soft solid foods (2L/day water, can start having a little sugar), liquid vitamins
>8 weeks regular food with specific descriptions, chewable vitamins.
278
What kind of patients can CMV cause upper GI lesions in?
Immunocompromised ones.
279
What happens in a helminth intermediate host?
Eggs develop into larvae but larvae don't develop into adults.
280
What is the most sensitive and specific lab abnormality associated with cirrhosis?
Thrombocytopenia.
281
What is fibrocytic change of the breast?
Benign bilateral breast mass (epithelial lesion), pain often before menstruation. "Lumpy" cysts/blue domes around 1-2cm, apocrine metaplasia - secretory cells with granular eosinophilic cytoplasm. Fibrosis, adenoma (increased acini perlobule).
282
What are the enzymes like in cholestasis?
Significant ALP and GGT increase, slight AST and ALT increase.
283
What are some normal urethral flora?
S. aureus, S. epidermidis, Strep (alpha and gamma hemolytic), diptheroids (gram +), gram - rods (E. coli, enterobacter).
284
What is colonic angiodysplasia?
Dilated and malformed mucosal/submucosal BVs. Mainly in people >60, most common in right colon.
285
What tests should be done when detecting primary ovarian insufficiency?
Anti-adrenal and ant-21 hydroxylase antibodies, thyroid panel, anti-thyroid peroxidase Abs, DEXA scan for bone mineral density.
286
Describe the Bethesda system of grading cervical INs.
CIN I = LSIL (lots of cytoplasm), CIN II/III = HSIL (less cytoplasm).
287
What is Peutz-Jeghers syndrome?
Multiple GI hamartomatous polyps + mucocutaneous hyperpigmentation.
Polyps are not precancerous but are associated with an increaed cancer risk.
Most common in SI is AD STK11 gene mutation.
288
When you biopsy an ulcer, when do you admit and when do you discharge?
Clean base - dischage, otherwise admit 3 days.
289
What causes a mucosal prolapse polyp?
Chronic injury.
290
Describe Shigella morphology and infection. Name important species.
Lactose nonfermenter, H2S negative, urease negative, nonmotile, most don't roduce gas from glucose but do ferment it.
Fecal-oral transmission. Invades M cells via trigger mechanism (Sip proteins via T3SS) from basolateral side, lyses phagocytic vacuole, replicates in cytoplasm.
Spreads to adjacent cells via actin 'tails'.
S. sonnei is mostly in developed countries, S. flexneri most often in developing, S. dysenteriae makes Shiga toxin, is most severe.
291
What % of the DNA in cffDNA analysis needs to be fetal?
<4% is problematic.
*if mom is obese there is a higher % of maternal DNA.
292
What is CMMR-D?
Constitutional Mismatch Repair Deficiency Syndrome.
Homozygous for same gene mutations as Lynch but much rarer and more severe.
PMS2 is 60%, of CMMR-D cases but only 5-15% Lynch cases.
293
What's the difference between HSV1 and HSV2?
HSV1 mainly orolabial, HSV2 primarily genital (can also cause neonatal herpes through birth canal).
HSV1 is less severe and less frequent.
294
What are some possible permanent outcomes of a baby born with CMV?
Microcephaly, vision loss, hearing loss, mental retardation.
295
What are caseins vs whey?
Whey remains soluble in acid and is absorbed better, Caseins form curds in acid and contains albumin, lactoferrin, lysozyme, IgA, etc.
296
What are some metabolic benefits after mariatric surgery?
Associated with incretins and others.
297
Describe Ascaris and symptoms.
Nematode. 5-12 inches long, white. Ova have thick shell with wavy, ruffled surface.
Fecal-oral - eggs mature and become infective in soil. Are ingested, hatch in intestine, larvae cross the bowel to enter the blood, then enter the lung, migrate up the trachea, are swallowed. Adults develop in the intestine and lay eggs.
Most pt.s are asymptomatic. WIth heavy burdens can get intestinal obstruction, biliary and pancreatic duct obstruction, rarely lung symptoms/eosinophilia, maybe malnutrition.
298
What is invasive breast carcinoma normally like at discovery?
2-3cm painless, solitary, movable mass - 50% has already metastasized to the axillary LN.
299
What % of vulvar squamous cell carcinomas are associated with HPV?
30%. The non-associated ones have a mean age of 76, differentiated VIN, chronic irritation, often long standing lichen sclerosis.
300
Describe the family and structure of Hepatitis E. How many genotypes/serotypes?
Hepeviridae, non enveloped, icosahedral, +ssRNA.
4 genotypes but only one serotype.
301
How is Hepatitis A transmitted?
Mainly fecal-oral but sexual and blood transfusion is also possible.
Consumption of raw/inadequately cooked foods.
302
How does Chlamydia affect men and women?
Women - mostly asymptomatic but can get complications like PID - in few who are symptomatic will see mucopurulent discharge (cervicitis).
Men - Urethritis/purulent discharge that is clear-white, no leisions. If it goes to blood, it's called Reiter syndrome - urethritis, conjunctivitis, pneumonia.
303
What is STUMB?
Smooth Muscle Tumour of Undetermined Malignant Behaviour.
304
What are the signs and symptoms of mixed rotation of the midgut?
Abdominal signs minimal in early stages.
Later can cause bilious vomiting with irritation, bloody stool with redness and edema in abdominal wall.
305
What is more sensitive for liver, ALT or AST?
ALT. They usually have similar increase except in alcoholic hepatitis where AST:ALT will be >2,
306
Describe the symptoms and treatment of a prolactin-secreting pituitary tumour.
Low FSH/LH, amenorrhea, maybe also galactorrhea.
Give Bromocriptine (DA agonist) and maybe also transphenoidal resection.
307
What are the three types of helminths?
Cestodes (tapeworms), Trematodes (flukes), Nematodes (roundworms).
308
How do you treat chlamydia?
Doxycyxline, azithromycin.
309
Describe male breast carcinoma.
Common in subsaharan africa, risk factors are older age, Klinefelters, BRCA2 mutation, exposure to exogenous estrogens.
Similar to ICD NST - ER+ is good prognosis.
310
What mutation is most commonly associated with pancreatic adenocarcinoma?
KRAS. Found in 95% of cases.
311
Can HepE cause chronic infection?
Yes, in solid-organ transplant recipients and other immunocompromised people. Treat with Ribavirin.
312
Describe prostatic adenocarcinoma and how it spreads.
Smaller than normal glands, single layers of uniform cells - no basal layer.
Large nuclei, one/two large nucleoli. PSA.
Spreads locally/perineurally to seminal vesicles and base of the bladder, also through LNs (obturator, iliac, paraaortic), and blood - commonly to the axial skeleton.
313
Describe hepatic adenoma and its three subtypes.
Benign hepatocyte tumour, benign but can rupture with serious hemorrhage. Most common in women on oral contraceptives.
HFN1alpha mutation: mostly women on the pill, no atypia.
Beta catenin mutation seen in men and women, associated with OCs/anabolic steroids, often shows atypia (high risk of malignant transformation).
Inflammatory is associated with nonalcoholic fatty liver disease.
314
What are the shapes of intestinal adenoma?
Tubular (<20% villous growth) or villous (>80%). In between is tubulovillous.
315
What is Dumping syndrome?
Clinical condition of malabsorption and/or osmotic overload in SI.
Too-large/too-fast meals especially of high sugar/fat dumped into the intestine too fast, metabolized by bacteria - nausea, tachycardia, diarrhea, sweating, intestinal cramps/gas.
316
What is secondary biliary cirrhosis?
Prolonged obstruction of extrahepatic biliary tree causing changes within the liver.
Will see bile stasis, bile ductular proliferation, fibrosis/cirrhosis. Neutrophils in infection.
317
What are colonic hyperplastic polyps?
Benign, <5mm, serrated with goblet cells. May resemble sessile serrated adenomas.
Serrated growth extending to crypt base, dilated crypts, lateral crypt growth.
318
What is a hyperplastic/inflammatory polyp?
Mucosal masse swith enlarged foveolar glands and smooth muscle. Increases risk of dysplasia.
Resect if >1.5cm.
319
Which babies are at the highest risk of contracting HBV?
Babies born to chronically infected mothers. Without prophylaxis, 40% will get HBV and 1/4 will die of liver disease.
320
Where can you take cells from to do a katyotype and how long do you have to culture them?
Blood (2-3 days), BM (no culture), Fibroblasts (2-3 weeks).
321
What is vaginal clear cell adenocarcinoma?
Malignant glands with clear and hobnail cells.67% associated with maternal DES use.
Avg age is 17 but also occurs around age 70.
322
How do you treat HepC?
N53-N54A PIs: Telaprevir, Boceprevir, Simeprevir, Paritaprevir, Ritonavir.
NS5A Serine PIs: Daclatasvir, Ledipasvir, Ombitasvir.
NS5B polymerase inhibitor: Sofosbuvir.
Alternative treatments for chronic HCV is interferon alpha + ribavirin or interferon alpha + DAAS.
323
What is sclerosing adenosis of the breast?
Sclerosis with increased number of acini of the breast. Can mimic cancer. Is a proliferative lesion with no atypia.
324
How does HepE compare to HepA?
Disease more severe, but can also cause fulminant hepatitis (mostly HEV1 and 2).
325
What is phimosis?
Can't retract foreskin.
326
Describe the findings of Turner's Syndrome.
Increased FSH, decreased estradiol. Ovary 'streak' glands.
327
How is PCOD treated?
Clomiphene citrate (SERM). 2nd line is GnRH.
328
How does a seminoma stain?
C-KIT (CD117) +. OCT3/4+, PLAP+
CD30-, AFP-, 15% show hCG
329
For what treatments of a minor is parental consent not necessary?
Contraception, prenatal care, STD treatment.
330
Describe a serous cystadenocarcinoma.
Surface epithelial tumour of the ovary - papillary architecture with Psammona bodies. Often has solid areas.
Often involves peritoneum.
Low grade may arise from borderline tumour and KRAS/BRAF mutations. High grade usually has no ovarian precursor and is often associated with fallopian tube carcinoma in situ, p53 muts, BCA1/BRCA2.
331
What is paraphimosis?
Foreskin trapped back.
332
What is Turcot syndrome?
FAP + CNS tumours.
333
How should you image colon cancers/suspected colon cancers?
Plain and contrast xrays, ultrasound, contrast CT/MRI, endoluminal ultrasound and MRI.
334
Describe vaginal intraepithelial neoplasia (VAIN).
Similar to VIN and cervical IN - rarer than similar lesions of cervix and vulva.
Almost all associated with high risk HPV.
335
What causes tooth rot?
S. mutans - acid production on fermentation.
336
What is hereditary spherocytosis?
A heterogenous RBC membranopathy. Spectrin deficiency most common.
No central pallor, increased hemolysis in hypertonic saline solution.
337
Describe primary biliary cirrhosis/cholangitis.
Destruction of intrahepatic bile ducts.
Often asymptomatic, but may cause diarrhea, steatorrhea, jaundice, weight loss, hepatosplenomegaly. Increased ALP, GGT, IgM, cholesterol, antimitochondrial Abs.
Liver biopsy will show T-lymphocyte mediated attack on small intralobular bile ducts.
Later can present with fatigue, jaundice, cirrhosis features, xanthelasma, xanthomata, steatorrhea.
338
What is an intramucosal intestinal adenocarcinoma?
Means it has reached the lamina propria but not the muscularis mucosa.
339
Describe how IDC NST appears.
Grossly is firm, poorly circumscribed. Cut is stellate/crab like configuration - yellow-grey with small white foci of calcification and chalky streaks of stroma.
On scraping, produces grating sound.
On mammography looks like DCIS - stellate soft tissue mass with clustered linear branching microcalcifications.
340
How does HPV cause cancer?
E5 activages EGFR, E6 binds p53 and targets it for degradation, E7 binds and inactivates RB.
341
What virus family is rubella and is it cytolytic?
Togaviridae and no.
342
Describe a breast fibroadenoma.
Most common breast tumour in women. Monoclonal tumour of intralobular stroma. Epithelial component is always polyclonal. Encapsulated. Doesn't increase breast cancer risk EXCEPT for complex tumour which has areas with benign epithelial lesions thent he cancer risk increases corresponding to the type of lesion.
343
What is Charcot's Triad?
Signs of choledocholithiasis: pain, jaundice, fever/
344
What are the stages of syphillis?
Primary is syphilitic chancre 10-90 days after inoculation - painless ulcer with raised borders. Often get painless regional lymphadenopathy 1-2 weeks after chancre.
Secondary is disseminated flu like symptoms with mucocutanous rash everywhere INCLUDING palms and soles. May resolve over weeks-months.
Tertiary happens in 1/3 untreated patients - years-decades later there is devastating destruction of any tissue "gummas".
345
Describe Norovirus vs Rotavirus gastroenteritis.
Noro has outbreaks in cooler months and many secondary cases, Rota is endemic year-round but south->north, and rarely has outbreaks.
Noroviruses are resistant to chlorine.
Noro has 48h incubation (Rota is less) has vomiting moreso than diarrhea, and lasts 1-3 days. Rota has 1-2 day onset of vomiting and then diarrhea around 5 days.
Noro usually no fever, mild, Rota can kill.
346
What gene is most commonly responsible for FAP? Describe the mutation and its inheritance.
APC (beta catenin suppressor in the Wnt pathway - is a tumour suppressor gene).
AD mutation 99% penetrance, mutation is de novo in 25% cases. Mutation in the middle 4/5 of the gene = classic FAP, at either end is milder. Two-hit hypothesis is required. *Loss of heterozygosity is found in the tumors.
347
What kind of glands predominate in the corpus, greater curve, and antrum of the stomach?
Corpus - oxyntic glands
Greater curve - parietal cells
Antrum - G cells
348
Will chlorine kill Cryptosporidium?
No.
349
What are the common gingivitis microorganisms?
Bacteriodes, Prevotella, Actinobacillus, Treponema denticola
350
How does estrogen affect vaginal pH?
Estrogen increases glycogen in the epithelium which favours lactobacilli - lower pH via production of lactic acid.
351
What are pancreatic mucinous cystic neoplasms?
95% in females, usually body or tail of pancrease. Single layer of mucinous columnar epithelium, may have cellular ovarian type stroma (ER+).
352
How is Coeliac's treated?
Prolamin (gliadins and glutenins) avoidance. In rare cases, steroids and immunosuppressants.
353
Describe gastric diffuse large B cell lymphoma.
Aggressive rapidly fatal without treatment. Good response to chemo tho.
Grossly looks 'fleshy', on histo has sheets of large lymphocytes - can be confused with diffuse adenocardinoma. Must do stains.
LCA+, keratin-
354
Describe how ulcerative colitis is named based on how proximally it extends.
Procritis (rectum), proctosigmoiditis (rectum+sigmoid), left-sided colitis (extends to splenic flexure), pancolitis (past splenic flexure).
355
What are the types of esophageal diverticula?
Zenkers/Pharyngeal (above UES), Traction (mid esophagus), Epiphrenic (above LES).
356
What is Pica?
Eating nonfood substances - in a way thats inappropriate for developmental level, not part of culturally supported/normative practice, is sufficiently severe to warrant intervention.
357
How do you diagnose cryptospodirium?
Stool oocytes shown by modified acid-fast stain, auramine, Ag detection, immunofluorescence.
358
How do you distinguish between a bicornuate and a septate uterus?
3D ultrasounds and MRI - NOT hysteroscopy and HSG.
359
What is the gold standard test for Coeliac Disease?
What will other investigations show?
Endoscopic SI biopsy (should see villous atrophy, migration of activated lymphocytes from the base to the tip, intraepithelial lymphocytes).
CBC will show macrocytic anemia with hypersegmented neutrophils. Will also see serum antigliadin and anti-endomysial Abs.
360
What is a lactating adenoma?
A nodule of lactating lobules - not a tumour!
361
How does viral gastroenteritis differ from bacterial?
Usually no blood/mucus in stool, diagnosis usually not confirmed.
362
What cells does HPV infect?
Surface epithelia (early gene expression is in basal layer) - infects mucous membranes.
363
What are some HepB treatments?
Lamivudine, Telbivudine, Entecavir, Tenofovir, Adefovir.
364
How do you treat urge incontinence?
Beta agonist, antimuscarinics, botox.
365
What are the phases of food absorption?
Intraluminal digestion, terminal digestion at brush border, transepithelial transport, lymphatic transport.
366
Describe adenocarcinoma of the gallbladder.
Most found in fundus/neck/ Can be infiltrative or exophytic.
Most in 7th decade. Gallstones in 95% of cases. Metastasizes to regional nodes, peritoneum, lungs, GI.
367
What are Crohn's apthous ulcers?
May have association with HHV-6. Found on freely moving nonkeratinized mucosa.
Yellow-grey fibrinoid centers surrounded by red halos - stress seems to be a major predisposing factor.
368
What does chronic pancreatitis cause?
Leads to continued loss of parenchymal cells ending in fibrosis, chronic inflammation, acinar loss, proliferation of ductules and islets.
369
Describe a gonadoblastoma.
Tumour from undifferentited gonadal stroma. Rarer in testis than ovaries.
Rare tumour, most commonly found in pts with abnormal sexual development or cryptoorchidism.
Nests of primitive germ cells and sex cord stroma cells resembling sertoli or granulosa cells. Frequent calcifications.
370
When should babies be weaned onto real food?
6 mo recommended, can begin at 4 months. Mashed food at 8 months then chopped at 1 year.
371
What is Vulvar Intraepithelial Neoplasia (VIN) and describe the 2 types.
Premalignant proliferation/dysplasia of squamous epithelium. Precursor to squamous cell carcinoma.
Classic - shows architectural disorder and enlarged dark nuclei. HPV-associated.
Differentiated - not HPV-associated, basilar atypia with prominent superficial maturation. Usually noted adjacent to squamous cell carcinoma, rarely diagnosed in pure form.
372
What are the forms of neonatal Listeria monocytogenes disease?
Early onset (cquired transplacentally) - abortion, stillbirth, premature birth, granulomatosis infantiseptica.
Late onset (acquired soon after birth) - noticed 2-3 weeks after birth as meningitis of meningoencephalitis with septicemia.
373
How should pregnant women be screened for S. agalacticeae?
Vaginal swab culture in 3rd trimester.
374
What are the indications for karyotyping?
Suspicion of a recognized disorder, unexplained mental retardation, unexplained congenital malformations, pregnancy loss/infertility, abnormal sexual development, malignancies.
375
What can Neonatal group B strep cause?
Neonatal sepsis, meningitis, pneumonia.
376
Describe the two types of miscrocropic colitis.
Lymphocytic (increased surface intraepithelial lymphocytes (>1/5 epithelial cells)) and Collagenous (same as lymphocytic but also has thickened subepithelial collagen).
377
What is Isospora belli? How is it diagnosed?
Protozoan. Incubation 1 week, lasts 2-3 weeks, sporulated oocysts ingested. Epithelial cells penetrated. Nonbloody watery diarrhea.
Diagnosed with oocysts in stool (acid-fast).
378
What is the 5yr survival of HCC?
3%. *most dead in <2 years.
379
What cells is preimplantation genetic diagnosis done?
1-2 blastomeres removed from 3 day embryo or some trophectoderm cells from 5-6 day blastocyst.
380
Describe Sertoli-Leydig cell tumours.
Tumours of ovary! Rare, usually unilateral and solid. Variable proportion of sertoli and leydig cells (can identify Leydig cells with Reinke's crystals).
Inhibin+, can secrete androgens.
Low grade malignant.
381
How is bcterial vaginosis diagnosed?
Gram stain to determine [lactobacilli].
3 of: homogenous thin white discharge, Clue cells, pH>4.5, fishy odour before or after KOH "whiff test".
382
What are the indications for intracytoplasmic sperm injection?
<2M motile sperm/ejaculate, antisperm Abs, prior/repeated failed IVF, limited frozen sperm, abnormal sperm morphology >95%, obstruction of male reproductive tract.
383
What is the structure of HPV?
Circular dsDNA, naked, icosahedral capsid (L1 and L2 proteins).
384
What kind of manifestations of IBS are more common in what sex?
Diarrhea more common in men, constipation in women.
385
How is syphillis spread and what is the name of the organism?
Spread by direct sex contact or trnsplacentally.
Treponema pallidum.
386
What does the morphology look like of IBS?
Normal.
387
How is Vibrio cholerae diagnosed?
Direct microscopy or culture - medium of choice is TCBS agar (selective for salt-tolerant), will turn yellow for sucrose fermenter. Is also oxidase +.
388
When is there sufficient cell free fetal DNA for cffDNA analysis?
Week 11. (Originates in placental trophoblasts due to necrosis/apoptosis).
389
Are tumours in liver most likely to be primaries or metastatic?
Metastatic.
390
Describe the relationship between alpha fetoprotein and HCC.
Serum AFP is elevated in 50% of HCC cases. >100x normal virtually diagnostic of HCC of a germ cell tumour.
391
What is an ovarian follicular cyst?
A benign cyst lined by granulosa and theca interna cells - under 3cm is called a cystic follicle.
392
Describe granulomatous prostatitis.
Granulomas (collections of epithelioid histiocytes) prominent - most common cause in IS is attenuated mycoplasma (BCG) used to treat bladder cancer.
393
How much folate do women need and what's it found in?
400micrograms/day - 4mg (1000x more) if have had prior NTDs.
Green leafy veg, beans/peas, asparagus, okra, brussel sprouts, avocado, seeds and nuts.
394
What is the gold standard of diagnosis of choledocholithiasis? How is it dealt with?
ERCP scan.
Removed by ECRP, sphincterotomy, stent placement of needed.
395
What are the histological effects of HPV?
Acanthosis (increased number of prickle cells), Hyperkeratosis, Papillomatosis (epithelial spikes).
396
What phase of menstruation is cyclic breast pain associated with?
Luteal - worse in 2 weeks preceding menstrual cancer.
397
Can you immunize against HepB?
Yes, can give passive prophylaxis within 12 hours of exposure (needlestick exposure, neonates born to HBsAg mothers, liver transplant in +ve pts).
Can also actively immunize - Engerix-B, Recombivax, Twinrix (HBV+HAV).
398
Where is PUD most common?
In the duodenom/gastric antrum.
399
Describe Entamoeba histolytica.
Protozoan. Cyst ingested and excyst - digests epithelium and can enter veins. Incubation 1 week, gradual onset of symptoms over 1-3 weeks (major cause of diarrhea and dysentery in developing world).
Amoebic trophozoites are mobile with pseudopodia, cysts have 4 nuclei.
Affects colon, forms deep ulcers can cause serious complications (toxic megacolon, colonic perforation, liver abscess).
400
What is the recommendation for pregnant women to not pass on HIV?
For women with viral load over 1000/mL, recommend C-section and avoidance of breastfeeding.
401
How is syphillis treated?
Penicillin G - IV for congenital and late stage disease.
402
What is a serous borderline tumour?
Surface epithelial tumour of the ovary - non or minimally invasive with mild-moderate atypia.
Broad branching papillae, slow but may involve peritoneum with bowel/urethral obstruction.
Often youner, pregnant women.
403
What is Jarisch-Herxeimer reaction?
Malaise, pyrexia, flush, tachycardia, leukocytosis beginning 1-2 hours after treatment for syphillis, resolves in 6-12 hours.
404
What are fundic gland polyps?
Dilated fundic glands (chief and parietal cells) - can be caused by PPIs.
405
What are the indications for bariatric surgery?
Class 3 obesity (BMI 40 or over), Class 2 (35 or over) but with a serious weight-related problem, )Class 1 (30-34 but multiple problems.
406
What kind of diarrhea is in UC?
Frequent watery/bloody, maybe with pus/mucus.
407
What is the most common tumour of the appendix? Does it commonly metastasize?
Appendiceal carcinoid tumour - mostly in tip. Mets are rare.
408
Describe a dermoid cyst.
Mature cystic teratoma. Usually cystic and solid, disorganized adult-type tissue, usually all benign.
409
Describe Schistosomiasis.
Trematode. Snails are intermediate hosts.
Larvae in fresh water penetrate the skin, go to the blood, mature in lung and liver into adults. Adults live in the venules of hte intestine and bladder (lay eggs).
Larval penetration of skin can cause dermatitis. Egg laying in bladder can cause hematuria, liver can cause portal hypertension.
410
What is required for a diagnosis of Barrett's esophagus?
Goblet cells above the gastroesophageal junction.
411
What is bridging fibrosis in chronic hepatitis?
If fibrosis goes to the central vein.
412
What is a spermatocele?
Cystic dilation of epididymis, milky fluid in spermatozoa.
413
What are the symptoms of testicular torsion?
Nausea/vomiting, high position of testicle, abnormal cremasteric reflex.
414
Describe an embryonal carcinoma and how it stains
Large pleiomorphic
415
Describe a yolk sac/endodermal sinus tumour.
Pure in infants (very good prognosis), in adults only as component of mixed germ cell tumour.
Rich in AFP (EC and IC eosinophilic globules), highly aggressive.
Small cells, solid and microcystic networks of cuboidal cells, varied histology, Schiller-Duval bodies (central blood vessel with envelope of tumour cells).
416
What is acute, persistent, and chronic diarrhea?
Acute is <14 days, Chronic is >30, persistens is in between.
417
In which part of the colon is diverticulosis most common?
Sigmoid.
418
Describe a pancreatic serous cystadenoma.
Benign cystic mass, occurs more in females, in 7th decade - glycogen rich with clear cuboidal epithelium.
419
What ligaments support the uterus?
Vertically the uterosacral and cardinal ligament.
Horizontally the pubocervical and rectovaginal fascia.
420
How does Trichomoniasis present?
In women many are asymptomatic, can have vaginitis with foul-smelling odour, frothy yellow-green discharge, itching, burning, painful urination, erythema, 'strawberry cervix' punctate hemorrhages.
In men primarily asymptomatic carriers with the agent in the prostate/urethra, rarely causes urethritis, positive KOH whiff test, wet mount positive.
421
What are some characteristics on blood smear of G6PD deficiency?
Heinz bodies.
422
What is used to diagnose syphillis?
Darkfield microscopic identification hard but ideal for early detection of primary, DFA-TP is gold standard but doesn't differentiate between treponemes.
Treponemal Abs (EIATP, TP-PA, FTA-Abs (indirect)), Nontreponemal/Reagin Abs (IgG and IgMs develop against lipids).
423
What do the Paramesonephric/Mullerin ducts differentiate into?
Fallopian tubes, uterus, upper 1/3 of vagina.
424
What antibodies can you find in a Coeliac's patient?
IgAs to transglutaminase, IgA/IgGs to gliadin, antiendomysial Abs.
425
How do different genotypes of HepC respond to interferon and ribavirin treatment?
Genotype 1/RNA high: poorly reponds to IFNalpha
Genotype1/RNA low: responds intermediately to interferon
Genotype 1 needs 48wk treatment with higher ribavirin than 2/3.
Genotypes 2/3 respond well to IFNalpha and require a 24 week treatment.
426
What fraction of a pregnant woman's weight gain does the baby account for?
1/4
427
What is attenuated FAP?
Usually between 10 and 100 polyps, penetrance >80%, age of onset is 10 years later than classic FAP.
428
What is BRCA?
Proteins involved in the BRCA/Fanconi anemia pathway of dsDNA repair (or apoptosis induction). Tumour suppressors.
In tumours will see LoH.
429
Describe the Azoospermia factor on Y microdeletions a, b, and c.
AZFa microdeletion: Sertoli-cell only syndrome (germ cell aplasia).
AZFb microdeletion: Premeiotic spermatogenic arrest.
AZFc microdeletion: Sperm maturation defect.
430
Describe the HPV vaccines.
Capsid made of L1 protein (spontaneously forms pentamers which can form VLPs).
Bivalent (Cervarix) - HPV 16,18
Quadrivalent (Gardasil) - subunit vaccine HPV 6, 11, 16, 18
431
Describe bile duct hamartomas/von Meyerburg tumours.
Small white nodules near/within portal areas of the liver. Dilated irregular bile ducts,
*often clinically suspicious for metastatic carcinoma.
432
What is the IQ in Klinefelter's?
Normal to mental retardation.
433
What is carcinoid syndrome?
Flushing, hypertension, diarrhea. Test with 5HIAA in urine, chromogranin A in the blood.
Almost always seen with liver mets.
434
What does fecal lactoferrin indicate?
Neutrophil presence.
435
What is an endometrial stromal nodule?
Benign tumour of endometrial stroma - histology looks like stroma including spiral arteries. Circumscribed, soft, yellow-orange.
436
Describe 5 alpha reductase deficiency.
XY born looking female (maybe clitoromegaly), virilization at puberty.
Testosterone and estrogen at normal male levels.
Increased T:DHT ratio.
Normal internal male organs all ending in a blind-ending vagina.
437
Describe the HepC disease.
Hepatocyte damage induced by immune mechanisms, steatosis common feature of chronic infections - and HBC is main cause of chronic hep.
Severe acute hepatitis is rare but fulminant has been reported. Cirrhosis in 20% of cases.
438
Should you vaccinate a pregnant woman with rubella if she has no Abs?
No!
439
Which way does a testicle twist in torsion?
Inward and toward midline.
440
Describe neonatal herpes.
HSV2 generally - infection within 28 days of birth, associated with localized skin/eye/mouth disease, CNS disease, disseminated disease of multiple organs.
441
How is HepA treated?
No antiviral therapy currently exists.
442
Describe primary sclerosing cholangitis.
Inflammation and fibrosis of intrahepatic and extrahepatic bile ducts.
Probably autoimmune, see beaded appearance of biliary tree. 70% associated with ulcerative colitis.
Fibrosing lymphocytic infiltration of bile ducts - 'onion skin' concentric periductal fibrosis.
443
Describe integrated fetal screening.
NT + PAPP-A at week 10-13 and full quad test at week 15-18.
85% DS detection at 1% FP rate.
Serum integrated screening is just that without NT.
444
Describe breast medullary carcinoma.
Well-circumscribed, 'fish-flesh' appearance. Can be mistaken for fibroadenoma!
Syncytium-like growth pattern, cells with abundant cytoplsm, large and vesicular nuclei, prominent nucleoli.
Lymphocytic infiltration.
445
Describe an immature teratoma.
Embryonic and/or fetal tissues present. Malignant!
Grading and prognosis based on the amount of immature neuroepithelium.
446
Describe C. perfringens food poisoning.
Anaerobic gram+ spore - the spore is heat stable and is ingested in improperly cooked/stored meat.
Incubation 8-16h, duration 24-48h diarrhea + also sometimes nausea/vomiting.
Heat-labile pore formine enterotoxin which damages the ileal brush border.
447
Describe the HepA vaccine.
Inactivated, adjuvanted whole-virus vaccine given to kids 1-2, single-dose protects within 2 weeks and then a booster shot 6-12 months later gives lifelong immunity.
448
What abnormalities are associated with Mullerian Agenesis? What do you do?
33% have urinary, 12% have skeletal.
Make neovagina - Laproscopic Vecchietti procedure is best.
449
What is overflow incontinence?
Involuntary loss of urine associated with bladder overdistension in ansence of detrusor contraction.
450
What is yeast balanitis?
Yeast infection of the glans penis (endogenous infection!). Red, inflamed rash on the head and shaft, under the foreskin, itching/burning sensation, white/clumpy discharge, maybe pustules.
451
Describe the types of endometrial hyperplasia.
Simple (dilated proliferative glands), Complex (crowded complex glands), Atypical (nuclear atypia).
452
What genes are commonly lost in esophageal squamous cell carcinoma?
p53 and p16.
453
What is Lynch syndrome?
Accounts for 2-6% of colorectal cancers (endometrial cancers 2nd most common). Is a mutation in DNA mismatch repair mechanisms (2-hit hypothesis).
MSH2 mostly (can also be MLH1, PMS2, MSH6). MSH2 and MLH1 have highest penetrance. Deletion in EPCAM can also lead to epigenetic silencing of MSH2.
Cancers develop from adenomas (few polyps present).
Will see microsatellite instability.
454
Describe type II endometrial carcinoma. What are the 3 types?
RF is estrogen deficiency. Aneuploid, associated with p53 and PIK3A. Aggressive, has intraperitoneal and lymphatic spread (poor prognosis).
Serous type is from endometrial surface epithelium, has papillary projections, high nuclear grade, p53 mutations common and early.
Clear cell resembles vaginal clear cell adenocarcinoma.
Malignant Mixed Mullerian Tumor (MMMT) is where both glandular and stromal components are malignant. Usually large polypoid mass in atrophic uterus. May show malignant cartilage (chondrosarcoma) or skeletal muslce (rhabdomyosarcoma).
455
How is HepC transmitted?
Through blood, but sexual/vertical/perinatal possible.
456
What are gastric carcinoid tumours?
Neuroendocrine carcinoma. Has good prognosis.
Sheets and tubules of uniform round cells with minimal atypia. Abundant neurosecretory granules on EM.
Has strong reactivity for markers like synaptotrypsin and chromogranin A.
457
What is responsible for Neisseria gonorrheae antigenic variation?
Pilin genes.
458
How do non-seminomatous testicular germ cell tumours compare to seminomatous ones?
More aggressive with hematogenous mets /- LN spread.
Necrosis/hemorrhage more likely, relatively radioresistant but respond well to chemo.
459
What are the symptoms of an ovarian torsion?
Enlarged tender ovary and cul-de-sac. Right more common than left.
460
What PSA values are indicative of prostatic adenocarcinoma?
>4ng/mL, or change of 0.75ng/mL/year.
461
How is H. pylori transmitted?
Fecal-orally.
462
How do ALT and AST increase in acute and chronic viral Hepatitis, acute alcoholic Hep, and extensive hepatic necrosis?
Low 100s in chronic viral and acute alcoholic
High 100s-1000s in acute viral
>10,000 in extensive hepatic necrosis
463
Describe ETEC and how it's pathogenic.
Has CFA (pili), STa (heat stable toxin - small peptide that binds guanylin receptor and converts GTP to cGMP), LT (heat labile toxin - similar to cholera toxin).
464
What tests are done in second trimester screening and in what weeks?
Weeks 15-18.
Done for anyone who hasn't had first semester screening.
AFP (accurate gestational age very important for interpretation) decreased indicates Down's, increased indicates NTDs (anencephaly further right than spina bifida).
Down's also shows decreased uE3. Increased betaHCG in Trisomy 18.
465
What does the ligament of Treitz separate?
The 3rd and 4th parts of the duodenum - the upper and lower GI.
466
How is Hepatitis E diagnosed?
Diagnosis of exclusion.
467
Where does pancreatic adenocarcinoma metastasize to?
Regional LNs, liver, peritoneum, lungs, adrenals, bones.
Extends to neighbouring organs, 10% have migratory thrombophlebitis/Trousseau syndrome.
468
What are the diagnostic criteria for binge eating disorder?
Bingeing at least once a week for 3 months, marked distress regarding binge eating.
Recurrent binges with at least 3 of: rapid eating, feeling uncomfortably full, eating large amounts when not physically hungry, eating alone because of embarrassment, feeling disgusted with oneself/depressed/guilty after eating.
469
What is the structure of Neisseria gonorrheae?
Oxidase positive, gram - diplococcus.
470
What's the difference between beginning of breastfeeeding milk and end of breastfeeding milk?
End is more fat heavy (less protein).
471
What is abetalipoproteinemia?
Rare AR disease with inability to secrete TG-rich lipoproteins.
Mutation of MTP. Presents as malabsorption - intestinal lining cells unable to transport lipoproteins/FFAs and so TGs accumulated.
Fat soluble vitamin deficiency can cause acanthocytes/Spur cells.
472
What are the risks for a BRCA1 and BRCA2 mutation carrier?
BRCA1 - breast cancer 57%, ocarial 40-50%
BRCA2 - breast cancer 44%, ovarian 10-25%, also male breast cancer 60X risk, prostate 4.7x, pancreatic 3.5x
Homozygotes can have Fanconi anemia.
473
Differentiate between H. pylori and autoimmune caused chronic gastritis.
H. pylori is variable acid/gastrin, happens in antrum, causes inflammatory polyps.
Autoimmune has low acid, high gastrin, occurs mostly in body/fundus, causes pernicious anemia.
474
What are the genetic ways you can have Turner Syndrome?
Monosomy, mosaicism (30-40% of cases), 46Xi.
475
What is a Curling's ulcer?
Acute peptic ulcer due to severe burn.
476
Is gastric adenocarcinoma aggressive?
Yes, metastasizes early.
477
What is avoidant / restrictive food intake disorder?
Apparent lack of interest in eating, avoidance based on sensory characteristics of food, concern about aversive consequences of eating.
478
What condition is necrotizing ulcerative gingivitis associated with?
HIV.
479
What is Trichomonas vaginalis?
How do you treat it?
A urogenital flagellated protozoan with an undulating membrane - exists solely as a trophozoite. Can be seen in the pap smear.
Treat with metronidazole.
480
What tests should you do if NTDs are suspected in the fetus?
High resolution ultrasound or amniocentesis (clear AChE cutoff).
481
What can the C. difficile toxin cause?
Pseudomembranous colitis.
482
What are Clue cells?
Cells that have had >75% of their margins obliterated by bacteria.
483
What prenatal findings can suggest esophageal atresia?
Polyhydramniosis and absence of stomach bubble on sonography.
484
What is ovarian clear cell adenocarcinoma probaly a variant of?
Ovarian endometrioid adenocarcinoma.
485
How can you differentiate Whipple's disease from atypical mycobacterium intestinal infection?
Both PAS+ and have similar histology. Acid fast stain will label mycobacteria but not Whipple's.
486
What is Trousseau syndrome?
Migratory thrombophlebitis.
487
Where is an ectopic pregnancy common?
The ampulla.
488
Describe the histology of IBD.
Distorted branched glands, paneth cells distal to right colon.
Changes of chronic colitis.
489
What is Fitz-Hugh-Curtis syndrome?
Perihepatitis associated with PID. Chlamydia 5x more common than gonococcal infection. RUQ pain/tenderness, radiates to right shoulder, aminotransferases abnormal in 1/2 of patients.
490
Describe penile carcinoma in situ, Bowen's Disease, Bowenoid Papulosis.
Penile carcinoma in situ (usually caused by HPV 16) is a full-thickness architectural disorder - atypia of squamous epithelium.
Bowen's Disease: Sharply demarcated, elevated, opaque grey-white or red plaque (red and shiny = erythroplasia of Queyrat). 10% progress to squamous cell carcinoma.
Bowenoid Papulosis: multiple reddish brown papules. Often spontaneously regresses.
491
What are the symptoms of Gonorrhea for men and women? What are some complications?
Women mainly asymptomatic - genital tract infection, infects endocevical columnar epithelium.
Can cause vaginal discharge, dysuria, abdominal pain, can have ascending genital infection, sterility and ectopic pregnancy.
Men - 95% have acute symptoms, urethritis, proctitis, purulent urethral discharge with painful urination.
Complications: skin lesions in disseminated disease, septic disease (more common in women - knees, ankles, wrists), opthalmia neonatorum.
492
What is indicated in a diagnosis of Lynch syndrome?
Removal of colon. If refused, frequent endoscopy.
493
What kind of tumours is Klinefelter's associated with?
Mediastinal germ cell tumours.
494
What is the cutoff for a cervical cancer 'microinvasion'?
Width <7mm, depth <3mm. Good prognosis.
495
In which abdominal quadrant does diverticulitis tend to hurt?
LLQ.
496
What drugs were found to help binge-eating disorders?
Esciptalopram (SSRI), appetite suppressants, atomoxetine (SNRI), also two anticonvulsants - zoniamide and topiramate.
497
What are the Anorexia diagnostic criteria?
Persistent restriction of food intake leading to SIGNIFICANTLY LOW BODY WEIGHT, Intense fear of gaining weight (worsens as weight lost), Distorted perception of body weight/shape.
498
What is MUTYH/MAP?
AR base excision repair defect so G->T mutations accumulate.
Phenotype is variable, generally 10 or more polyps, gastric/duodenal tumours and non-GI tumours can occur.
Usually only suspected with FAP has been excluded.
In homozygote, associated cancers are: duodenal, gastric, hepatobiliary, bladder, ovarian, breast, endometrial, skin.
499
Which way does a volvulus twist?
Clockwise.
500
How is esophageal squamous cell carcinoma characterized?
By lots of keratin production and desmosomes.
501
Describe testicular dysgenesis syndrome.
Cryptoorchidism, hypospadias, poor sperm quality.
502
When is a fetus at major risk of rubella?
Until 20th week.
503
How do you confirm acute cholecystitis?
HIDS scan - positive means GB not visualized within 4 hours of IV dye injection.
504
Describe congenital syphillis.
In-utero infection, most born without disease, eventually get rhinitis and then rash similar to secondary syphillis.
Teeth/bone malformations, blindness, deafness, Sabre Shins, Hutchinson's teeth, circumcorneal inflammation.
505
Describe Giardia and Giardiasis.
Protozoan. 4 nuclei cyst, flagellated 2 nuclei trophozoite. Cysts ingested in lakewater - excystate in stomach, attach to SI mucosa with ventral disk, divide, disrupt brush border. No invasion/exotoxins.
Incubation is 1-2 weeks and then diarrhea, cramps, bloating, flatulence, anorexia. No fever.
Chronic (lasting>a week) - weight loss, malabsorption.
506
What is a Brenner tumour?
Benign tumor of ovary - nests of urothelial-like cells in fibrous stroma. Rarely borderline/malignant.
Epithelial cells have nuclear grooves, often coexist with mucinous. Unclear if epithelium truly urothelial or serous.
507
What are the VACTERL defects?
Vertebral defects, anal defects, cardiac defects, TEF, renal defects, limb deformities.
508
What's the difference between colostrum and milk?
Colostrum is lower calorie, lower fat content, higher protein. Milk carbs are mostly lactose.
509
What are some acute hepatitis histological findings?
Swollen hepatocytes, dead hepatocytes (acidophilic bodies), Kupffer cell hyperplasia.
No neutrophils! Often it's the portal area that's affected (piecemeal necrosis).
510
How should you investigate diverticulitis?
CT of abdomen and pelvis with oral and IV contrast. Colonoscopy contraindicated.
511
Above what hCG level should a gestational sac be visible?
1000/1500 IU/mL.
512
Describe congenital B19/Parvovirus/Fifth Disease.
Kills erythrocyte precursors, can lead to anemia, CHF, hydrops fetalis.
If survives, not associated with any congenital abnormalities.
