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*Unit 6 ER > Pathology > Flashcards

Pathology Flashcards

1
Q

What does atresia mean?

A

ends in a blind pouch

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2
Q

An esophageal web increases the chance for which caner?

A

esophageal squamous cell carcinoma

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3
Q

What are the characteristics of plumer-vinson syndrome?

A
  1. esophagel web
  2. glossitis
  3. chelosis
  4. iron deficient anemia
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4
Q

What is the most frequent cause of Esophageal varices?

A

portal HTN

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5
Q

Inability to relax the LES is called _______

A

Achalasia

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6
Q

In which layer of the gut wall is the myenteric ganglion? (M/SM/MP/S)

A

in between the inner circular and outer longitudinal layers of the muscularis propria

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7
Q

what infectious disease is known for causing damage to the myenteric ganglion?

A

Chagas Dz

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8
Q

What are the two M.C. hiatal hernias?

A
  1. Sliding hiatal hernia

2. Para-esophageal hernia

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9
Q

Reflux of acid from stomach due to low LES tone is called ____

A

GERD

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10
Q

Ulceration and stricture of the esophagus can be caused by _____

A

GERD

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11
Q

In Barrett’s esophagus there is metaplasia from Non-keratinized squamous epithelium to ________

A

Non-ciliated columnar epithelium with goblet cells

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12
Q

What are the 2 MC types of esophageal caner? where do they arise?

A
  1. Adenocarcinoma, lower 1/3

2. Squamous cell carcinoma, upper 2/3

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13
Q

congenital malformation with exposure of the abdominal contents is called _______

A

Gastroschisis

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14
Q

Congenital persistent herniation of the bowl into the umbilical cord is called _______

A

Omphalocele

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15
Q

Which is covered by peritoneum and amnion? (gastroschisis/ omphalocele)

A

omphalocele

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16
Q

What happens in pyloric stenosis?

A

Congenital hypertrophy of pyloric sm. muscle, esp. in males

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17
Q

What are the two gross categories that cause acute gastritis?

A

increased acid production

decreased mucosal protection

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18
Q

How does increased cranial pressure result in Cushing Ulcer?

A

increased vagal stimulation —> increased ACh –> increased parietal cell stimulation

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19
Q

What are the 3 receptors that signal stomach parietal cells to secrete gastric acid?

A
  1. ACh
  2. Gastrin
  3. Histamine
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20
Q

What are risk factors for acute gastritis?

A
  1. Severe skin burns
  2. NSAIDS, reduce prostaglandins
  3. Heavy alcohol use
  4. chemotherapy
  5. increased intracranial pressure
  6. shock
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21
Q

In the stomach, loss of the epithelium is called _______ while loss of the mucosal layer is called ______

A

loss of epithelium: Erosion

Loss of mucosal layer: Ulcer

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22
Q

In chronic autoimmune gastritis there is destruction of the parietal cells leading to ________ found in the serum

A

autoantibodies

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23
Q

Chronic Autoimmune gastritis is a type ____ HSR

A

type IV

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24
Q

chronic autoimmune gastritis leads to _______ anemia

A

pernicious, megaloblastic

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25
Q

Which cells make gastrin? where are they located?

A

G-cells, antrum

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26
Q

What is the M.C. cause of vitamin B12 deficient?

A

chronic autoimmune gastritis

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27
Q

Goblet cells in the stomach indicates _________

A

intestinal metaplasia, risk for adenocarcinoma

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28
Q

What virulence factors help H. pylori weaken the mucosal defenses?

A
  1. Urease

2. Proteases

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29
Q

What region of the stomach does H. Pylori effect vs. Autoimmune gastritis?

A

H.p: Antrum, distal and duodenum

Auto-imm: fundus and body

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30
Q

H. pylori infection increases the risk for what two cancers?

A
  1. Gastric Adenocarcinoma

2. MALT lymphoma

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31
Q

What type of cell proliferates in a MALT lymphoma?

A

B-cell

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32
Q

Triple therapy for H. pylori is

A

amoxicillin, clarithromycin, and a proton pump inhibitor

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33
Q

A solitary mucosal ulcer of the proximal duodenum (or distal stomach) is called a ______ ______

A

Peptic Ulcer

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34
Q

Epigastric pain that improves with meals: _______

Epigastric pain that worsens w/ meals: ______

A

improves, Duodenal ulcer

worsens, gastric ulcer

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35
Q

How can you Dx a duodenal ulcer?

A

endoscopic biopsy shows hypertrophy of brunner glands

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36
Q

What are the features of a benign gastric ulcer?

A

“punched-out,” small, regular boarders

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37
Q

What are the features of a malignant gastric ulcers?

A

Irregular, large, ‘pilling up’ of mucosa at the edge

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38
Q

Gastric carcinoma is a (squamous carcinoma/ adenocarcinoma)

A

adenocarcinoma

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39
Q

What is a signet ring cell?

A

cell with nucleus pushed to edge due to mucin production

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40
Q

What is desmoplasia?

A

Reactive response of stroma in response to an invasive tumor

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41
Q

What are the 2 types of gastric carcinoma?

A
  1. Intestinal type

2. Diffuse type

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42
Q

What are the risk factors for Intestinal type stomach cancer?

A

intestinal metaplasia, nitrosamine, smoked food, blood type A

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43
Q

What are the characteristics of Diffuse type gastric carcinoma?

A

Signet ring cell that infiltrate, resulting in desmoplasia

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44
Q

What is the Leser-Trelat sign?

What is it associated with?

A

explosive onset of multiple seborrheic keratoses

ass. w/ gastric carcinoma

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45
Q

Gastric carcinoma often spreads to this lymph node first:

A

Left supraclavicular node

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46
Q

Gastric carcinoma that spreads bilaterally to the ovaries is called a _________ tumor

A

Krukenberg tumor

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47
Q

Based on vomit, how can you tell if a baby has esophageal atresia vs. duodenal atresia?

A

Duodenal will have bilious vomit, esophageal will not have bile

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48
Q

What does the ‘double-bubble’ sign indicate?

A

duodenal atresia

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49
Q

How does the developing fetus receive nutrients from the yolk sac?

A

the vitelline duct

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50
Q

what is it called when the vitelline duct fails to involute?

A

Meckel’s diverticulum

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51
Q

Passing meconium via the umbilicus indicates ______

A

Complete Failure of vitelline duct to close

–a partial failure to close would cause a Meckel’s diverticulum

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52
Q

Twisting of the bowel on the mesentery is called _______

A

volvulus

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53
Q

What is the MC cause of intususpeption in children? in adults?

A

children: Lymphoid hyperplasia
adults: tumor

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54
Q

The lactase enzyme is found in the ____ _____ of enterocytes

A

brush boarder

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55
Q

in Celiac’s Dz, The pathogenic component of gluten is ______

A

gliadin

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56
Q

Which cell is responsible for the tissue damage in celiac Dz?

A

Helper T cells

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57
Q

celiacs: IgA deposits at the tips of dermal papillae is called ______ _____

A

Dermatitis herpetiformis (blisters that look like herpes)

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58
Q

What is found on biopsy of celiac Dz?

A

Flattening of villi, hyperplasia of crypt

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59
Q

In celiac Dz, most of the damage is in the (duodenum/ jejunum/ ilium)

A

duodenum

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60
Q

What are the two cancers ass. with celiacs?

A
  1. Small bowel carcinoma

2. T cell lymphoma

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61
Q

Damage to small bowel villi due to an unknown organism is called ________ ______

A

tropical sprue

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62
Q

In tropical sprue, most of the damage is in the (duodenum/ jejunum/ ilium)

A

jejunum and ileum

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63
Q

Where is folic acid absorbed? (duodenum/ jejunum/ ilium)

A

Jejunum

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64
Q

Where is vitamin B12 absorbed?

duodenum/ jejunum/ ilium

A

Ileum

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65
Q

In whipple’s disease, the partially destroyed Tropheryma whippelii will stain with ____ inside macrophages

A

PAS

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66
Q

What are the S+S of wipple disease?

A

fat malabsorption and steatorrhea (macrophages compress lacteals, block lymphatic fat transport )

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67
Q

Carcinoid tumor stains positive for _______

A

chromogranin

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68
Q

The most common site for a carcinoid tumor is the ______ _____

A

small bowel

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69
Q

Carcinoid tumor often secrete serotonin, when do they cause carcinoid syndrome?

A

Metastasis. (5HT made by tumor –> degraded by liver, 5HIAA metabolite excreted. If mets, the 5HT can reach systemic circulation –> carcinoid syndrome)

70
Q

What is carcinoid heart Dz?

A

5HT causes Rt sided valvular fibrosis

tricuspid regurg, pulmonary valve stenosis

71
Q

What are the characteristics of carcinoid syndrome?

A

Bronchospasm, skin flushing, diarrhea

72
Q

Why don’t you get Left sided heart Dz with carcinoid syndrome?

A

Lungs have MOA, turns 5HT to 5HIAA

73
Q

What usually block appendix outflow in children? in adults?

A

children: lymphoid hyperplasia
adults: fecalith

74
Q

Describe the movement of pain in appendicitis

A

begins peri-umbilical, localizes to RLQ

75
Q

What are the two broad categories of Inflammatory bowel disease ?

A
  1. Ulcerative colitis

2. Crohn disease

76
Q

Full thickness inflammation, knife like fissures (Ulcerative colitis/ Crohn disease)

A

Crohn disease

77
Q

Begins in the rectum and extends proximally to the cecum (Ulcerative colitis/ Crohn disease)

A

Ulcerative colitis

78
Q

LLQ pain and bloody diarrhea (Ulcerative colitis/ Crohn disease)

A

Ulcerative colitis

79
Q

RLQ pain, non-bloody diarrhea (Ulcerative colitis/ Crohn disease)

A

Crohn disease

80
Q

Anywhere from mouth to anus, skip lesions, terminal ilium M.C. (Ulcerative colitis/ Crohn disease)

A

Crohn disease

81
Q

Crypt abscess with neutrophiles (Ulcerative colitis/ Crohn disease)

A

Ulcerative colitis

82
Q

Has pseudopolyps (Ulcerative colitis/ Crohn disease)

A

Ulcerative colitis

83
Q

can have positive p-ANCA (Ulcerative colitis/ Crohn disease)

A

Ulcerative colitis

84
Q

smoking is protective (Ulcerative colitis/ Crohn disease)

A

Ulcerative colitis

85
Q

Causes malabsorption with nutritional deficiencies (Ulcerative colitis/ Crohn disease)

A

Crohn disease

86
Q

Which has cobble stoning? (Ulcerative colitis/ Crohn disease)

A

Crohn disease

87
Q

Congenital defective relaxation and peristalsis of the rectum and sigmoid colon is called _______

A

Hirschsprung disease

88
Q

The myenteric plexus is also called _______

A

Auerbach plexus

89
Q

Where is the myenteric plexus located?

A

in the muscularis propria between the Inner circular layer and outer longitudinal

90
Q

Meissner plexus is also called

A

The submucous plexus

91
Q

What is missing in congenital hirschprung disease?

A

Both Auerbach and Meissner plexus

92
Q

Air or stool in the urine indicates ______

A

colo-vesicular fistula

93
Q

High pressure in the right colon ->______

High pressure in the left colon->______

A

High pressure in the right colon -> Angiodysplasia
High pressure in the left colon-> colonic diverticula
(both can cause hematochezia)

94
Q

the MC cause of ischemic colitis is atherosclerosis of the ____

95
Q

K.O. the APC gene creates a risk for _____

A

developing an adenomatous polyp

96
Q

What are the genes in the adenoma-carcinoma sequence?

A

APC -> KRAS -> P53 + increased COX

97
Q

What are the two major types of polyps? Which has an increased risk for carcinoma?

A
  1. Hyperplastic polyp, no inc. risk

2. Adenomatous polyp, inc risk for carcinoma

98
Q

What findings are risk factor for polyp progression from adenoma to carcinoma?

A
  1. size >2cm
  2. Sessile growth pattern
  3. Villous histology
99
Q

In familial adenomatous polyposis, FAP, there is a mutation in the ______ gene on chromosome _____

A

APC gene

Chromosome 5

100
Q

FAP with fibromatosis and osteomas is called ________

A

Gardner syndrome

101
Q

FAP with CNS tumors (medulloblastoma and glial tumors) is called ______

A

Turcot Syndrome

102
Q

What are the two M.C. pathways for colorectal carcinoma to arise?

A
  1. Adenoma-Carcinoma sequence

2. Microsatellite instability pathway

103
Q

HNPCC is due to an inherited mutation in what?

A

DNA mismatch repair enzymes

104
Q

From what type of cells does a carcinoid tumor arise?

A

neuroendocrine cells of the midgut (jejunum, ileum, appendix, and cecum)

105
Q

In carcinoid syndrome, there is excess secretion of _____ and ______, which causes the flushing

A

Serotonin and kallikrein, which causes flushing

106
Q

What is the first enzyme activated in pancreatitis?

107
Q

The 2 M.C. causes of pancreatitis are _______ and _______

A
  1. alcohol -> contraction at sphincter of oddi

2. gallstones -> mechanical obstruction of pancreatic outlet

108
Q

Epigastric pain that radiates to the back with nausea and vomiting are classic clinical features of _______ _______

A

acute pancreatitis

109
Q

What electrolyte is abnormal in pancreatitis?

A

Calcium (Hypocalcemia with Saponification of peri-pancreatic fat)

110
Q

Which is more specific to pancreatic damage? (lipase/amylase)

A

lipase

Amylase is in saliva and elsewhere

111
Q

What is the MC cause of pancreatitis in adults? in children?

A

Adults: alcohol
Children: Cystic Fibrosis

112
Q

How does chronic pancreatitis lead to vitamin deficiency?

A

Reduced enzymes -> reduced fat absorbtion -> Steatorrhea -> fat solubly vitamin loss

113
Q

Pancreatic carcinoma at the head of the pancreas, S+S are _______
Pancreatic carcinoma at the tail of the pancreas, S+S are _______

A

Head: obstructive jaundice with pale stool
Tail: Secondary diabetes mellitus, islet cells in tail

114
Q

inflammation of a vein is called ________

115
Q

vein inflammation due to a blood clot is called __________

A

thrombophlebitis

116
Q

What is Trousseau sign of malignancy? what malignancies is it related to?

A

migratory thrombophlebitis, recurrent thrombophlebitis at different locations.
associated with pancreatic and lung cancers

117
Q

What is the serum tumor marker for pancreatic carcinoma?

118
Q

What is a whipple procedure?

A

Removal of Antrum of stomach, 1st and 2nd portion of the duodenum, head of pancreas, common bile duct and gallbladder

119
Q

A 3 mo old with jaundice w/conjugated bilirubin could have ______ ______

A

biliary atresia causing bile obstruction

120
Q

Which are radiopaque? (bilirubin/ cholesterol) stones

A

bilirubin: radiopaque
cholesterol: radiolucent

121
Q

Extravascular hemolysis increases the risk for (cholesterol/ bilirubin) gallstones

122
Q

RUQ pain radiating to scapula w/ fever and elevated WBC count indicates ________

A

Acute cholecystitis

123
Q

Rokitansky-Aschoff sinus formation is characteristic of _______ ______

A

Chronic cholecystitis

mucosa in sm. muscle of gallbladder wall

124
Q

What is a porcelain gallbladder? what does it indicate?

A

dystrophic calcification of the gallbladder, seen on x-ray

indicates chronic cholelithiasis

125
Q

Bacterial infection of the bile ducts is called _______ _______

A

Ascending cholangitis

126
Q

presence of gallstones in the common bile duct is called _______________

A

Choledocholithiasis

127
Q

What are 5 complications of gallstones?

A
  1. biliary colic
  2. Acute cholecystitis
  3. chronic cholecystitis
  4. ascending chlangitis
  5. Gallstone ileus
128
Q

Gallbladder symptoms in elderly woman, X-ray shows porcelain gallbladder, diagnosis?

A

Gallbladder carcinoma

129
Q

What is kernicterus?

A

physiologic jaundice of the newborn–> UCB deposits in basal ganglia –> neurological deficits, death

130
Q

What is the treatment for kernicterus?

A

phototherapy –> makes UCB water soluble –> excreted in urine

131
Q

In extravascular hemolysis, dark urine is due to increased urine ___________

A

urobilinogen (has been converted by gut flora)

132
Q

An autosomal recessive low activity UGT activity is called __________

A

Gilbert syndrome

133
Q

Absence of UGT (UDP-Glucuronosyltransferases) is called ________

A

Crigler-Najjar syndrome

134
Q

AR deficient bilirubin canalicular transport protein is called _________

A

Dubin-Johnson syndrome

135
Q

What does a pitch dark liver indicate? what should be done?

A

Dubin-Johnson syndrome, not clinically significant

136
Q

biliary tract obstruction does what to the urine? what to the stool?

A

Dark urine, pale stool

137
Q

Which is water soluble (conjugated/ unconjugated) bilirubin?

A

conjugated

138
Q

In viral hepatitis which is higher (AST/ALT)

139
Q

In alcoholic hepatitis, which is higher (AST/ALT)

A

AST

AST is in mitochondria

140
Q

Which hepatitis has no chronic state with IgG protective against future infection?

141
Q

Which hepatitis most frequently results in chronic Dz?

A

HCV, 80% of the time
HBV only 20% of the time
HAV and HEV acute only

142
Q

In cirrhosis, liver fibrosis is mediated by the ______ cell

A

stellate cell

143
Q

What are three portosystemic shunts associated with portal HTN?

A

caput medusa, esophageal varacies, hemorrhoids

144
Q

How can cirrhosis lead to generalized edema?

A

hypoalbuminemia

145
Q

What is a mallory body? when do they occur?

A

damaged intermediate filaments within the hepatocytes

seen in alcoholic hepatitis

146
Q

Iron deposit in tissues is called _______

Iron damaging tissues (fenton rxn) is called ________

A

deposition: hemosiderosis
damage: hemochromatosis

147
Q

Primary hemochromatosis is most frequently a mutation in the gene ________

148
Q

What is the MC cause of secondary hemochromatosis?

A

many transfusions

149
Q

How can you tell apart Lipofuscin on a hepatocyte biopsy?

A

Prussian blue stain

150
Q

An ATP7b mutation is seen in _______ ________

A

wilson’s disease

151
Q

What are Kayser-Fleisher rings?

A

Rings in the cornea of a person with wilson’s disease

152
Q

Hepatic periductal fibrosis with an onion skinning appearance is characteristic of __________

A

Primary sclerosing cholangitis

153
Q

Primary sclerosing cholangitis may have + pANCA and is associated with ________

A

ulcerative colitis

154
Q

Aflatoxins derived from aspergillus increases the chance of _____ _______

A

hepatocellular carcinoma

155
Q

occlusion of the hepatic veins resulting in pain, ascites, and liver enlargement is called ________

A

Budd-Chiari syndrome

156
Q

Which is more common in men? woman?

Primary biliary sclerosis/ primary sclerosing cholangitis

A

Men: PSC
Women: PBC

157
Q

Which is MC pANCA (+), which is ass. w/ autoimmune dz?

Primary biliary sclerosis/ primary sclerosing cholangitis

A

PSC: +PANC
PBC: auto imm dz associated

158
Q

Which has anti-mitochondrial antibodies

Primary biliary sclerosis/ primary sclerosing cholangitis

159
Q

What molecules stimulate exocrine pancreatic secretions?

A
  1. Ach
  2. secretin
  3. CCK
160
Q

What are the 4 “C’s” of measles

A

cough, coryza, conjunctivitis, Kopilik spots

161
Q

What are virally caused lesions of the oral mucosa called? what virus causes them?

A

Koplik spots = measles virus, a paramyxo

162
Q

What are the two pathognomonic findings with measles?

A
  1. Koplik spots in oral mucosa

2. Warthin-Finkeldey cells, eosinophilc multinucleated giant cells in lymphoid organs

163
Q

How do you treat RSV in adults?

164
Q

What virus causes both parotitis and orchitis?

A

Mumps

lumps with mumps

165
Q

What types of viruses are MMR?

A

Measles: paramyxo
Mumps: paramyxo
Rubella: toga, also called german measles

166
Q

In what ways are poliovirus presentations and west nile virus presentations similar?

A

both are usually clinically silent, but occasionally cause severe disease

167
Q

What causes roseola?

168
Q

What viruses have glassy intranuclear type a cowdry bodies?

A

HSV, especially HSV-1, HSV-2 and VZV=HSV-3

169
Q

What virus causes herpetic whitlow?

170
Q

Which virus creates large infected cells with intranuclear basophilic inclusion, “owl eyes”

A

CMV, HSV-5

171
Q

What causes scarlet fever? Necrotizing fascitis?

A

streptococcus pyogenes erythrogenic toxin: scarlet fever

Exotoxin B: Necrotizing fasciitis

172
Q

premalignant disease of the stomach characterized by 1. massive gastric folds, 2. excessive mucous production and 3. resultant protein loss

A

Ménétrier disease

*Unit 6 ER (3 decks)

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