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PATHOLOGY Flashcards

1
Q

Chronic gastritis is most often due to what?

A

H. pylori

-Autoimmune gastritis is in 2nd place

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2
Q

Acute hemorrhagic gastritis is associated with what 5 things?

A

alcohol, NSAIDs, trauma, sepsis, or shock

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3
Q

describe the gross path of benign peptic ulcers

A

small, round, deep & punched out

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4
Q

what are the 3 clinical features of lactase deficiency?

A
  1. osmotic diarrhea
  2. flatulence
  3. acidic stool pH
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5
Q

Buzz word: string sign

A

crohn’s dz

string sign= sign on radiography of terminal ileum from luminal narrowing by inflammation, fistulas

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6
Q

buzz word: cobblestone pattern

A

Crohn’s dz

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7
Q

buzz word: creeping fat

A

Crohn’s dz

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8
Q

buzz words: noncaseating granulomas & fistulas

A

crohn’s dz

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9
Q

buzz word: smoking decreases risk

A

ulcerative colitis

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10
Q

buzz word: skip lesions

A

crohn’s dz

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11
Q

buzz word: toxic megacolon

A

Ulcerative colitis

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12
Q

buzz word: lead pipe appearance

A

Ulcerative colitis:

lead pipe sign=radiographical sign of UC

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13
Q

buzz words: inflammatory pseudopolyps

A

ulcerative colitis

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14
Q

buzz words: crypt abscesses containing neutrophils

A

ulcerative colitis

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15
Q

which type of IBD has apthous ulcers?

A

crohn’s dz

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16
Q

which type of IBD has transmural inflammation?

A

crohn’s dz

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17
Q

which type of IBD has mucosal only inflammation?

A

ulcerative colitis

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18
Q

smoking is a risk factor for which IBD?

A

crohn’s dz

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19
Q

what is the most common cause of small bowel obstruction?

A

adhesions

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20
Q

name the pathology:
autosomal dominant syndrome featuring multiple nonmalignant hamartomas throughout GI tract, along with hyperpigmented mouth, lips, hands, genitalia

A

Peutz-Jeghers Syndrome

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21
Q

Name the pathology: reduction in intestinal blood flow causes ischemia (pain out of proportion w/ physical findings), pain after eating–>weight loss, commonly occurs at splenic flexure & distal colon

A

ischemic colitis

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22
Q

double bubble sign

A

duodenal atresia

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23
Q

string sign

A

crohn’s disease

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24
Q

lead pipe sign

A

ulcerative colitis

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25
Q

congenital megacolon is also known as what?

A

Hirschsprung’s dz

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26
Q

name the pathology: FAP + osseous & soft tissue tumors, congenital hypertrophy of retinal pigment epithelium

A

gardner’s syndrome

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27
Q

name the pathology: FAP + CNS tumor

A

Turcot’s syndrome

Turcot=turban

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28
Q

on what chromosome do you find the APC gene that is mutated in FAP?

A

chromosome 5q (autosomal dominant)

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29
Q

apple core lesion is associated with what?

A

finding of colorectal cancer seen on barium enema xray

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30
Q

85% of CRC cancer goes through what molecular pathway?

A

APC/beta-catenin (chromosomal instability) pathway

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31
Q

what is the most common malignancy in the small intestine?

A

carcinoid tumor

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32
Q

what is asterixis?

A

coarse hand tremor

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33
Q

GGT is elevated in what kinds of disease?

A

increase in various liver & biliary diseases like ALP, but not in bone disease

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34
Q

ALT>AST name the etiology

A

viral hepatitis

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35
Q

AST>ALT name the etiology

A

alcoholic hepatitis

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36
Q

how can you cure hepatic steatosis?

A

short term change with moderate alcohol intake.

Macrovesicular fatty change that may be reversible with alcohol cesation

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37
Q

what is the most common primary malignant tumor of the liver in adults?

A

hepatocellular carcinoma

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38
Q

what are predisposing diseases that increase the risk of developing HCC?

A

HBV, HCV, Wilson’s dz, hemochromatosis, alpha1-antitrypsin deficiency, alcoholic cirrhosis, carcinogens (aflatoxin from aspergillus)

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39
Q

what is the tumor marker for HCC?

A

alpha-fetoprotein

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40
Q

name the pathology: occlusion of IVC or hepatic veins w/ centrilobular congestion & necrosis, leading to congestive liver disease

A

budd-Chiari syndrome

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41
Q

what physical finding is characteristically absent in budd-chiari syndrome?

A

NO JVD

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42
Q

name the pathology: mildly decrease in UDP-glucuronyl transferase or decrease in bilirubin uptake. Bilirubin increases with fasting & stress

A

Gilbert syndrome

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43
Q

name the pathology: absent UDP-glucuornyl transferase. Presents early in life; pts die w/i few yrs

A

Crigler-Najjar Syndrome type 1

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44
Q

name the pathology: grossly black liver. Benign

A

Dubin-johnson syndrome

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45
Q

Kayser-fleischer ring is associated with what dz?

A

Wilson’s disease

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46
Q

Name the pathology: inadequate hepatic copper excretion and failure of copper to enter circulation as ceruloplasmin

A

wilson’s dz

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47
Q

what is the first line treatment for wildon’s dz?

A

penicillamine

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48
Q

hemochromatosis is also known as what?

A

bronze diabetes

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49
Q

term for the deposition of iron into the tissues

A

hemosiderosis

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50
Q

term for disease caused by excessive iron deposition

A

hemochromatosis

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51
Q

what is the classic triad in hemochromatosis?

A

cirrhosis
DM
Skin pigmentation

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52
Q

describe the liver studies in hemochromatosis (ferritin, iron, TIBC, transferrin saturation)

A

increased ferritin (storage of iron)
increased serum iron
decrease TIBC–>increased transferrin saturation (making less transferrin, bc more is saturated)

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53
Q

name the pathology: unknown cause of concentric onion skin bile duct fibrosis that leads to alternating strictures & dilation w/ beading of intra- & extrahepatic bile ducts on ERCP

A

primary sclerosing cholangitis

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54
Q

cholesterol gallstones are associated with what race of people?

A

native americans

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55
Q

what is charcot’s triad of cholangitis?

A

jaundice
fever
RUQ pain

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56
Q

what is the tumor marker associated with pancreatic adenocarcinoma?

A

CA-19-9

57
Q

what syndrome is associated with migratory thrombophlebitis-redness & tenderness on palpation of extremities?

A

Trousseau’s syndrome

58
Q

Name the pathology: Rapid onset of jaundice, Fever, muscle wasting, ascites, Hepatomegaly (liver is completely filled with fat) with tenderness in middle age pt, mod. ↑ AST (2

A

Alcoholic hepatitis

59
Q

name the pathology: mutation in jagged1 gene which is ligand for NOTCH1 receptor, causes syndromatic paucity of the intrahepatic bile ducts

A

Alagille syndrome

60
Q

where do most pancreatic adenocarcinomas occur anatomically?

A

occur MC in the head of the pancreas (65%)

61
Q

which microbe is most likely to cause sialdenitis?

A

staph aureus

62
Q

what is the clinical presentation of acute bacterial sialedenitis?

A

swollen, painful gland

63
Q

acute bacterial sialdenitis typically involves which salivary gland?

A

parotid

64
Q

whats usually the cause of chronic sialedenitis?

A

usually secondary to recurrent or persistent ductal obstruction due to stone

65
Q

what is the typical presentation of chronic sialadenitis?

A

episodic pain & swelling, usually at mealtime

66
Q

what is the general principle regarding benign and malignant salivary glands?

A

generally the smaller the salivary gland, the more likely the tumor in it is malignant

67
Q

what is the major complication of parotidectomy?

A

injury to the facial nerve

68
Q

what is the 2nd MC benign tumor of the parotid?

A

warthin’s tumor (strongly associated with smoking)

69
Q

how do pleomorphic adenomas typically present?

A

present with a slowly growing painless, movable, firm mass

70
Q

what are the 2 components of the distinctive histology of a warthin’s tumor?

A
  1. cystic spaces lined by a double layer of oncocytes

2. prominent lymphoid stroma

71
Q

Are most warthin’s tumor monoclonal or polyclonal?

A

polyclonal

72
Q

what is the most important determinant of prognosis for mucoepidermoid carcinoma?

A

GRADE

73
Q

what is the name for the type of relaxation of LES that accounts for most reflux episodes in healthy pts?

A

transient LES relaxation

  • lasts longer than swallow induced LESR
  • not associated w/ a swallow signal
74
Q

name some of the contributing factors for GERD:

A 
impaired esophageal clearance
decreased salivation
impaired tissue resistance
transient LES relaxation
decreased resting tone of LES
delayed gastric emptying
75
Q

what are the 3 cardinal symptoms of GERD?

A
  • Heartburn
  • Regurgitation
  • dysphagia (from esophageal dysmotility or strictures)
76
Q

what are 3 lifestyle modifications that you can do by exploiting gravity?

A
  1. don’t lie down after meals, avoid bedtime snacks
  2. elevation of head of bed at night
  3. sleep on left side
77
Q

what is one way you can treat GERD by alleviating abdominal pressure?

A

LOSE WEIGHT

78
Q

what does the micropath of GERD in the esophagus look like?

A

desquamation at the surface, w/ compensatory basal hyperplasia (+ elongated submucosal rete pegs)

79
Q

what are the complications of barrett’s esophagus?

A

intestinal metaplasia that can progress through dysplasia to adenocarcinoma

80
Q

describe the microscopic pathology of barrett’s esophagus?

A

columnar epithelium with goblet cells

81
Q

H. pylori is present in 70% of pts with PUD, but what percentage of pts with H. pylori get PUD?

A

10-15%

82
Q

how would you diagnose PUD?

A 
UGI barium xray of stomach
upper endoscopy (allows for biopsy of h. pylori)
83
Q

Air is present under the right hemidiaphragm in a pt with acute severe abd. pain. this pt probably had ZES and a perforated what?

A

anterior duodenal bulbar ulcer

84
Q

endoscopic gastritis caused by alcohol has a characteristic _______________ appearance

A

“blood under plastic wrap”

85
Q

what is the typical presentation of acute hemorrhagic gastritis?

A

presents w/ abd. discomfort or pain, heartburn, nausea, vomiting, hematemesis (can be massive)

86
Q

in what part of the stomach is h. pylori gastritis the worst?

A

more severe in the antrum of the stomach

87
Q

H. pylori favors which part of the gastric glands?

A

favors the neck of the gastric glands (lined by mucus cells like the surface)

88
Q

in chronic active gastritis due to h. pylori, what kind of cells do you see infiltrating?

A

neutrophils

89
Q

what does CagA due?

A
  • causes degradation of p53
  • activates pathways to cell proliferation
  • messes up cell polarization
90
Q

the CagA protein is injected into cells by h. pylori by what kind of secretion system?

A

Type IV Secretion system (T4SS)

91
Q

if you have G-cell hyperplasia in chronic gastritis, what kind of chronic gastritis is it?

A

autoimmune atrophic gastritis

92
Q

histology of chronic peptic ulcer (NIGS mnemonic)

A

Necrosis
Inflammation
Granulation tissue
Scar

93
Q 
Benign or malignant?
round oval
flat or overhanging margins
deeper, punched out
flask shape walls
smaller
radiating rugal folds
A

benign ulcer

94
Q 
benign or malignant?
irregular shape
heaped up margins
shallower
ulcerated or bowl shape
necrotic shaggy base
bigger
A

malignant ulcer

95
Q

what kind of stress ulcers happen with brain injury?

A

cushing injury (YOUR BRAIN NEEDS A CUSHION)

96
Q

what kind of stress ulcers happen with burns?

A

curling ulcers (BURN & CURL)

97
Q

h. pylori gastritis has _____________ inflammation commonly with germinal centers and neutrophils (which makes it active)

A

lymphocytic

98
Q

double bubble sign is associated with what?

A

duodenal atresia (baby presents vomiting days after birth)

99
Q

what is the presentation of pyloric stenosis?

A

baby starts projectile vomiting at 6 wks, also has olive like mass in abdomen

100
Q

how do you make a diagnosis of acute pancreatitis?

A

elevated serum amylase & lipase, inflamed pancreas on CT

101
Q

what are the 2 main causes of acute pancreatitis?

A

gallstones & Alcohol

102
Q

what is the supportive management of acute pancreatitis?

A

close observation
NPO
Very aggressive IV fluid replacement
pain relief

103
Q

most cases of acute pancreatitis are what type?

A 
interstitial pancreatitis (85%)
-necrotizing pancreatitis (15%)
104
Q

what is the most common benign cyst-like lesion in the pancreas?

A

pseudocyst (very common)

105
Q

of the neoplastic cysts, which ones have more malignant potential, serous or mucinous?

A

MUCINOUS (MUCINOUS ARE MUCH MORE MALIGNANT)

-(serrous is a softy)

106
Q

the vast majority of pancreatic adenocarcinomas are of _________origin

A

ductal (90%)

-10% are misc.

107
Q

what is the tumor marker for pancreatic adenocarcinoma?

A

CA-19-9

108
Q

what is the tumor marker for mucinous cystic neoplasm of pancreas?

A

CEA

109
Q

what are some of the risk factors for pancreatic cancer (4)?

A
  1. cigarette smoking
  2. Alcohol in the setting of chronic pancreatitis
  3. hereditary pancreatitis
  4. family hx of pancreatic cancer
110
Q

most pancreatic adenocarcinomas arise in which part of the pancreas?

A

head 60%
body 10%
tail 10%
diffuse 10%

111
Q

if you see an old lady with painless jaundice you immediately start thinking what?

A

PANCREATIC ADENOCARCINOMA

112
Q

what 2 diagnostic modalities would you use to stage esophageal cancer?

A
  1. CT of chest-helps stage tumor and look for mediastinal spread
  2. EUS-helps determine depth of penetration into the wall of esophagus & presence of lymph node mets
113
Q

most adenomatous gastric polyps are in what part of the stomach?

A

antrum

114
Q

most adenomatous gastric polyps are associated with what underlying etiology?

A

atrophic gastritis

115
Q

what kind of point mutations are common early in the pathogenesis of squamous cell carcinoma of the esophagus?

A

p53

116
Q

name the lesion of the stomach: hyperplastic mucosal epithelium, inflamed edematous stroma on histology

A

hyperplastic gastric polyp

117
Q

what is the precursor to intestinal type gastric carcinoma?

A

intestinal metaplasia

118
Q

which type of gastric adenocarcinoma has no discrete mass and is often difficult to diagnose?

A

diffuse type Gastric adenocarcinoma (makes sense b/c its called diffuse)

119
Q

what is the MC type of colonic polyp?

A

adenomatous polyp

120
Q

what is the MC type of gastric polyp?

A

hyperplastic polyp (75%)

121
Q

what type of colonic polyps occur in long standing IBD, and are not neoplastic?

A

inflammatory polyps

122
Q

if you have a colonic tumor in the right colon, what is likely the type of presentation?

A

occult bleeding, anemia (left colon has a smaller lumen)

123
Q

if you have a colonic tumor in the left colon, what is the likely type of presentation?

A

obstructive symptoms

124
Q

if you see an apple core lesion on a barium enema study you can diagnose what?

A

colorectal cancer

125
Q

what are the 2 main goals of screening for CRC?

A
  1. decrease mortality from colon cancer

2. prevent colon cancer by removing adenomatous polyps

126
Q

what is the best test for an individual pt regarding colon screening?

A

the test that gets done

127
Q

what percentage of pts currently get screening that are b/w the age of 50 yrs and 75 yrs?

A

only 65% get screened

128
Q

the annular napkin ring form of CRC adenocarcinoma occurs more commonly on which side of colon?

A

more common in left colon

129
Q

what is the 2nd leading cause of cancer death in the US?

A

colon cancer

130
Q

what are the 2 most important risk factors for CRC?

A

age and family history of CRC

131
Q

which type of Gastric neuroendocrine tumor is associated with hypergastrinemia and is aggressive, has many metastases at diagnosis, and behaves like an adenocarcinoma

A

type 3 gastric neuroendocrine tumor

132
Q

which type of gastric neuroendocrine tumor is the result of very high levels of gastrin but gastrin is coming from a tumor that is outside the stomach (usually in the pancreas)

A

type 2 gastric neuroendocrine tumor

133
Q

which type of neuroendocrine tumor has hypergastrinemia (produced in the stomach), multiple nodules usually in the body

A

Type I gastric neuroendocrine tumor

134
Q

how do you treat type 1 gastric neuroendocrine tumor?

A
  1. take out all the nodules

2. remove the antrum (antrectomy), removes the source of gastrin

135
Q

how do you diagnose zolinger-ellison syndrome?

A

diagnosis made by:

  1. fasting gastrin level >1000 w/ gastric pH below 5
  2. secretein stim. test (measure gastrin levels at variable timed intervals)
136
Q

what is the most common neoplasm in the appendix?

A

intestinal neuroendocrine tumor (carcinoid)

137
Q

what kind of IHC stain do you do for GIST?

A

CD-117 (c-KIT)

138
Q

what are the 2 most common locations for GISTs?

A

stomach & small intestine

139
Q

what is the most common location for GI lymphoma?

A

stomach

GI (12 decks)

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