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USMLE GI > Pathology > Flashcards

Pathology Flashcards

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USMLE® Step 1 flashcards
1
Q

What salivary duct most commonly has stones?

A

Submandibular (Wharton duct)

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2
Q

What is Sialadenitis? and what can it be caused by?

A

Inflammation of salivary gland due to obstruction, infection (S. aureus, mumps) or immune related mechanisms (Sjorgen syndrome)

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3
Q

What are the 3 major salivary glands?

A

Submandibular, Sublingual, Parotid

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4
Q

What gland is most commonly affected by tumours (benign)?

A

Parotid gland

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5
Q

Are sublingual and submandibular gland tumours more likely to be malignant or benign?

A
  • Nearly half of submandibular are malignant

- Majority of sublingual are malignant

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6
Q

What symptoms of salivary gland tumours suggest there is a malignant cause?

A

Facial paralysis or pain

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7
Q

What is the most common salivary gland tumour?

A

Pleomorphic adenoma (composed of chondromyxoid stroma and epithelium)

  • May recurr if not excised properly
  • May undergo malignant transformation
  • Most commonly affect parotid
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8
Q

What is the most common malignant salivary tumour?

A

Mucoepidermoid carcinoma

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9
Q

What salivary tumour is associated with smoking?

A

Warthin tumour (Papillary Cystadenoma Lymphomatosum)

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10
Q

What are some of the features of Warthin tumours Warthin tumours? (Papillary Cystadenoma Lymphomatosum)

A

WARriors from GERMany loved SMOKING

  • Benign cystic tumour with germinal centres
  • Bilateral in 10%
  • Multifocal in 10%
  • Associated with smoking
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11
Q

What causes achalasia?

A
  • Failure of LES to relax

- Due to degeneration of inhibitory neurons (containing NO and VIP) in myenteric plexus

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12
Q

What can cause secondary achalasia?

A

Chagas disease
- T cruzi infection

Extraesophageal malignancies

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13
Q

What is eosinophilic esophagitis?

A
  • Infiltration of eosinophils in the esophagus often in atopic patients
  • Eitiology is multifactorial
  • Esophageal rings and linear furrows often seen on endoscopy
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14
Q

What can cause esophagitis?

A
  • Reflux andor infection in immunocompromised
  • Caustic ingestion (e.g bleach)
  • Pills (biphsophonates, tetracycline, NSAIDs, iron, KCl)
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15
Q

What organisms may cause esophagitis?

A
  • Candida - white pseudomembrane
  • HSV-1 - punched-out ulcers
  • CMV - linear ulcers
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16
Q

What are esophageal strictures and what are the causes?

A
  • Narrowings of esophagus

- Caustic ingestion, acid reflux, esophagitis

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17
Q

What are the signs/symptoms of Plummer-Vinson syndrome?

A
  • Dysphagia
  • Iron deficiency anemia
  • Esophageal webs
  • Glossitis
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18
Q

What can pulmmer-Vinson syndrome predispose to?

A

Squamous cell carcinoma

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19
Q

What is Mallory-Weiss syndrome?

A
  • Partial thickness, longitudinal lacerations of gastroesophageal junction
  • Confined to mucosa/submucosa due to severe vomitting
  • Presents with haematemesis possible abdo/back pain
  • Found in alcohol use disorder and bulimia nervosa
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20
Q

What is distal esophageal spasm?

A
  • Spontaneous, nonperistaltic (uncoordinated) contractions of the esophagus with normal LES pressure
  • Dysphagia and chest pain
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21
Q

How can distal esophageal spasm be diagnosed?

A
  • Corkscrew esophagus on barium swallow

- Manometry (strength of esophagus test) is diagnostic

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22
Q

What can treatment of distal esophageal spasm include?

A

Nitrates and CCBs

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23
Q

What is scleoderma esophageal involvement?

A
  • Esophageal smooth muscle atrophy which leads to decreased LES pressure and distal esophageal dysmotility -> acid reflux and dysphagia -> stricture, Barrett esophagus and aspiration
  • Part of CREST syndrome
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24
Q

What is boerhaave syndrome?

A

Transmural, usually distal esophageal rupture due to violent retching

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25
Q

What do burns in the stomach cause?

A

Curling ulcer (hypovolemia and mucosal ischaemia)

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26
Q

What is Cushing ulcer caused by?

A

Brain injury

- Increased vagal stimulation, ACh and then H+ production

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27
Q

What cancer can be caused by H pylori infection?

A

MALT lymphoma

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28
Q

What is Menetrier disease?

A
  • Hyperplasia of gastric mucosa -> hypertrophied rugae (wavy-like brain gyri)
  • Causes excess mucus production with resultant protein loss and parietal cell atrophy with decreased acid production

Presents with WAVEE
- Weight loss, anorexia, Vomiting, Epigastric pain, Edema due to protein loss

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29
Q

What are leser-Trelat’s sign and acanthosis nigricans?

A

Skin conditions, darkening of skin (acanthosis nigricans affects armpits)
- Can be a sign of gastric cancer

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30
Q

What mutation causes diffuse gastric cancer?

What are the findings usually?

A

Mostly E-cadherin mutation; signet ring cells (mucin-filled cells with peripheral nuclei) ; stomach wall grossly thickened and leathry (lintis plastica)

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31
Q

What is Krukenberg tumour?

A

Metastises from stomach to ovaries (typically bilateral). Abundant mucin-secreting signet ring cells

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32
Q

What is Sister Mary Joesph nodule?

A

Subcutaneous periumbilical metastases from stomach

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33
Q

What is Blumer shelf?

A
  • Rectouterine pouch (of Douglas) metastasis from stomach

- Palpable on DRE

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34
Q

What is scleroderma esophageal involvement (eitiology and symptoms)?

A
  • Esophageal and smooth muscle atrophy
  • Decreased LES pressure and distal esophageal dysmobility
  • Acid reflux and dysphagia
  • Stricture, Barrett’s esophagus, aspiration
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35
Q

What connective tissue disorder can scleroderma esophageal involvement be a part of?

A
  • CREST syndrome (aka limited cutaneous form of systemic sclerosis)
  • CREST refers to 5 main features: calcinosis, Raynaud’s phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia
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36
Q

Compare the spread of H. pylori and autoimmune chronic gastritis

A
  • H pylori affects antrum first then spreads to body of stomach
  • Autoimmune affects the body/fundus of stomach
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37
Q

Comapre the pain of gastric and duodenal ulcers

A
  • Gastric can increase with meals - weight loss

- Duodenal can decrease with meals - weight gain

38
Q

Which peptic ulcer is more likely to be malignant?

A

Gastric (biopsy margins to rule out malignancy)

- If duodenal is benign appearing ulcers are not biopsied

39
Q

What are other causes of peptic ulcers other than H pylori?

A
  • Gastric - NSAIDs

- Duodenal - Zollinger-Ellison syndrome

40
Q

Are anterior or posterior peptic ulcer more likely to bleed?

A

Posterior ulcers more likely to bleed

41
Q

Are anterior or posterior ulcers more likely to perforate?

A

Anterior more likely to perforate - pneumoperitoneum (free air in anterior abdominal cavity)

42
Q

Name 5 malabsorption syndromes?

A
  • Celiac disease
  • Lactose intolerance
  • Pancreatic insufficiency
  • Tropical spure
  • Whipple disease
43
Q

How do the villi look in lactose intolerance?

A

Normal (except when secondary to injury at tips of villi, e.g viral enteritis)

44
Q

What findings show lactose intolerance?

A
  • Osmotic diarrhea with decreased stool pH (colonic bacteria ferment lactose)
  • Lactose hydrogen breath test: post-lactose breath hydrogen value rises > 20 ppm compared with baseline
45
Q

What can conditions may cause pancreatic insufficiency?

A
  • Chronic pancreatitis
  • Cystic fibrosis
  • Obstructing cancer
46
Q

How does pancreatic insufficiency affect the body?

A
  • Malabsorption of fat and fat-soluble vitamins (ADEK) as well as B12
  • Decreases duodenal bicarbonate (and pH) and fecal elastase
47
Q

What protein are celiac disease patients intolerant to?

A

Gliadin

48
Q

What serotypes are associated with celiac disease?

A
  • HLA-DQ2
  • HLA-DQ8
    Northern european descent
49
Q

What part of the GI tract is affected in celiac disease?

A

Distal duodenum and/or proximal jejunum

50
Q

What antibodies are positive in celiac disease?

A
  • IgA anti-tissue transglutaminase
  • Anti-endomysial
  • Anti-deamidated gliadin peptide antibodies
51
Q

What blood tests / immunoglobulins / antibodies are positive in celiac disease?

A
  • IgA anti-tissue transglutaminase
  • Anti-endomysial
  • Anti-deamidated gliadin peptide antibodies
52
Q

What does histology show in celiac disease?

A
  • Villous atrophy
  • Crypt atrophy
  • Crypt hyperplasia
  • Intraepithelial lymphocytosis
53
Q

What are the findings in tropical sprue?

A
  • SI villi blunting (like celiac)
  • Responds to antibiotics
  • Seen in visitors to tropics
  • Decreased mucosal absorption affecting duodenum and jejunum sometimes ileum
  • Associated with megaloblastic anemia due to folate and possible B12 deficieny
54
Q

How can Whipple’s disease be diagnosed?

A
  • Periodic acid Schiff identifies Tropheryma whipplei
  • Foamy macrophages in lamina propria
  • Mesenteric nodes
55
Q

What are other features of Whipple’s disease?

A
  • Cardiac Symptoms
  • Arthralgias
  • Neurological symptoms
  • Diarrhoea/steatorrhea
  • Affects older males mostly
56
Q

What antibodies may Crohn’s disease sufferers be positive for?

A

Anti-Saccharomyces cerevisiae antibodies (ASCA)

57
Q

What antibodies are positive in UC?

A

MPO-ANCA/p-ANCA

58
Q

How deeply does UC affect the colon?

A

Mucosa and submucosa only

59
Q

What extraintestinal disease is associated with Crohn’s?

A
  • Kidney stones (calcium oxalate)
60
Q

What extraintestinal disease is associated with UC?

A

Primary sclerosing cholangitis

61
Q

What is the characteristic appearence of UC on imaging?

A

Lead pipe (loss of haustra)

62
Q

What is the treatment of Crohn’s disease?

A
  • Corticosteroids
  • Azathioprine
  • Antibiotics (ciprofloaxacin, metronidazole)
  • Biologics (infliximab, adalimumab)
63
Q

What is the treatment of UC?

A
  • 5-aminosalicylic acid preparations (eg mesalamine)
  • 6-mercaptopurine
  • Infliximab
  • Colectomy
64
Q

What is the difference between a true and false diverticulum?

A
  • True diverticulum is when all gut layers outpouch

- False is when only mucosa and submucosa outpouch

65
Q

What are the features of microscopic colitis?

A
  • Older females mostly
  • Chronic watery diarrhoea (inflammation of colon)
  • Endoscopy is normal
  • Histology shows inflammatory infiltrate in lamina propria with thickened subepithelial collagen band or intraepithelial lymphocytes
66
Q

What is Zenker diverticulum?

A
  • Pharyngoesophageal false diverticulum
  • Esophageal dysmobility causes herniation of mucosal tissue at Killian triangle
  • Symtoms of dysphagia, obstruction, gurgling, aspiration, foul breath, neck mass
  • Old men mostly
67
Q

Where does Zenker diverticulum herniate?

A

Killian triangle
- Triangular area in the wall of the pharynx between the cricopharyngeus and thyropharyngeus which are the two parts of the inferior constrictors

68
Q

What is the most common congenital anomaly of the GI tract?

A

Meckel diverticulum

69
Q

What causes Meckel diverticulum?

A

Persistence of vitelline (omphalomesenteric) duct

70
Q

In what type of diseases is there an abnormal d-xylose test?

A
  • Intestinal diseases (eg Celiac)

- Normal in pancreatic diseases

71
Q

What mutation causes Hirchsprung disease?

A

RET

72
Q

What syndrome is Hirchsprung disease associated with?

A

Down syndrome

73
Q

What bands are formed in malrotation (anomaly of midgut rotation)?

A

Fibrous Ladd bands

74
Q

How is Meckel diverticulum diagnosed?

A

99m^2Tc-pertechnetate scan (aka Meckel scan) for uptake by heterotopic gastric mucosa

75
Q

What can Meckel diverticulum cause?

A
  • Haemarochezia/melena
  • RLQ pain
  • Intussusception
  • Volvulus
  • Obstruction near terminal ileum
76
Q

What is the rule of 2s relating to Meckel diverticulum?

A
  • 2x more likely in males
  • 2 inches long
  • 2 ft from ileocecal valve
  • 2% of population
  • Presents in first 2 years of life
  • 2 types of epithelia (gastric/pancreatic) may be present (May have ectopic acid-secreting gastric mucosa and/or pancreatic tissue)
77
Q

What causes intermittent severe abdo pain with currant jelly dark red stool in infants?

A
  • Intassusception
78
Q

What may cause intassusception?

A
  • Children - Meckel diverticulum
  • Adults - intraluminal mass/tumour
    Associated with IgA vasculitis (HSP), recent viral infection (e.g adenovirus; Peyer patch hypertrophy creates lead point)
79
Q

What will a physical exam on a patient with intassusception cause?

A
  • Sausage-shaped mass in right abdomen, patient may draw legs to ease pain
80
Q

What does imaging of the abdomen suggest?

A

US/CT may show “target sign”

81
Q

What is “intestinal angina” known as?

A

Chronic mesenteric ischaemia (atherosclerosis of celiac/IMA/SMA)
- Postprandial epigastric pain

82
Q

What is angiodysplasia?

A

Tortous dilation of vessels

- Causes haematochezia (fresh blood from anus)

83
Q

Where is andiodysplasia usually found?

A

Righ sided colon (midgut)

84
Q

What is angiodysplasia associated with?

A
  • Elderly patients
  • End-stage renal disease
  • Von Willebrand disease
  • Aortic stenosis
85
Q

What is colonic ischemia?

A
  • Crampy abdominal pain followed by hematochezia
  • Affects watershed areas
  • Elderly patients
  • Thumbprint sign on imaging due to mucosal edema/hemorrhage
86
Q

What is ileus associated with?

A
  • Abdo surgeries
  • Opiates
  • Hypokalemia
  • Sepsis
87
Q

What can be seen on imagin in ileus?

A

No transition zone

88
Q

What is the treatment of ileus?

A
  • Bowel rest
  • Cholinergic drugs
  • Electrolyte correction
89
Q

What genetic conditon is associated with meconium ileus?

A

Cystic fibrosis

90
Q

What is necrotizing eneterocolitis?

A
  • Necrosis of intestinal mucosa (most common terminal ileum and proximal colon)
  • May lead to pneumatosis intestinalis, penumoperitoneum, portal venous gas
91
Q

What kind of infants is necrotizing eneterocolitis associated with?

A

Premature, formala-fed infants with immature immune system

USMLE GI (4 decks)

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