Pathology Flashcards
1
Q
What does atresia mean?
A
ends in a blind pouch
2
Q
An esophageal web increases the chance for which caner?
A
esophageal squamous cell carcinoma
3
Q
What are the characteristics of plumer-vinson syndrome?
A
- esophagel web
- glossitis
- chelosis
- iron deficient anemia
4
Q
What is the most frequent cause of Esophageal varices?
A
portal HTN
5
Q
Inability to relax the LES is called _______
A
Achalasia
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
7
Q
what infectious disease is known for causing damage to the myenteric ganglion?
A
Chagas Dz
8
Q
What are the two M.C. hiatal hernias?
A
- Sliding hiatal hernia
2. Para-esophageal hernia
9
Q
Reflux of acid from stomach due to low LES tone is called ____
A
GERD
10
Q
Ulceration and stricture of the esophagus can be caused by _____
A
GERD
11
Q
In Barrett’s esophagus there is metaplasia from Non-keratinized squamous epithelium to ________
A
Non-ciliated columnar epithelium with goblet cells
12
Q
What are the 2 MC types of esophageal caner? where do they arise?
A
- Adenocarcinoma, lower 1/3
2. Squamous cell carcinoma, upper 2/3
13
Q
congenital malformation with exposure of the abdominal contents is called _______
A
Gastroschisis
14
Q
Congenital persistent herniation of the bowl into the umbilical cord is called _______
A
Omphalocele
15
Q
Which is covered by peritoneum and amnion? (gastroschisis/ omphalocele)
A
omphalocele
16
Q
What happens in pyloric stenosis?
A
Congenital hypertrophy of pyloric sm. muscle, esp. in males
17
Q
What are the two gross categories that cause acute gastritis?
A
increased acid production
decreased mucosal protection
18
Q
How does increased cranial pressure result in Cushing Ulcer?
A
increased vagal stimulation —> increased ACh –> increased parietal cell stimulation
19
Q
What are the 3 receptors that signal stomach parietal cells to secrete gastric acid?
A
- ACh
- Gastrin
- Histamine
20
Q
What are risk factors for acute gastritis?
A
- Severe skin burns
- NSAIDS, reduce prostaglandins
- Heavy alcohol use
- chemotherapy
- increased intracranial pressure
- shock
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
22
Q
In chronic autoimmune gastritis there is destruction of the parietal cells leading to ________ found in the serum
A
autoantibodies
23
Q
Chronic Autoimmune gastritis is a type ____ HSR
A
type IV
24
Q
chronic autoimmune gastritis leads to _______ anemia
A
pernicious, megaloblastic
25
Which cells make gastrin? where are they located?
G-cells, antrum
26
What is the M.C. cause of vitamin B12 deficient?
chronic autoimmune gastritis
27
Goblet cells in the stomach indicates _________
intestinal metaplasia, risk for adenocarcinoma
28
What virulence factors help H. pylori weaken the mucosal defenses?
1. Urease
| 2. Proteases
29
What region of the stomach does H. Pylori effect vs. Autoimmune gastritis?
H.p: Antrum, distal and duodenum
| Auto-imm: fundus and body
30
H. pylori infection increases the risk for what two cancers?
1. Gastric Adenocarcinoma
| 2. MALT lymphoma
31
What type of cell proliferates in a MALT lymphoma?
B-cell
32
Triple therapy for H. pylori is
amoxicillin, clarithromycin, and a proton pump inhibitor
33
A solitary mucosal ulcer of the proximal duodenum (or distal stomach) is called a ______ ______
Peptic Ulcer
34
Epigastric pain that improves with meals: _______
| Epigastric pain that worsens w/ meals: ______
improves, Duodenal ulcer
| worsens, gastric ulcer
35
How can you Dx a duodenal ulcer?
endoscopic biopsy shows hypertrophy of brunner glands
36
What are the features of a benign gastric ulcer?
"punched-out," small, regular boarders
37
What are the features of a malignant gastric ulcers?
Irregular, large, 'pilling up' of mucosa at the edge
38
Gastric carcinoma is a (squamous carcinoma/ adenocarcinoma)
adenocarcinoma
39
What is a signet ring cell?
cell with nucleus pushed to edge due to mucin production
40
What is desmoplasia?
Reactive response of stroma in response to an invasive tumor
41
What are the 2 types of gastric carcinoma?
1. Intestinal type
| 2. Diffuse type
42
What are the risk factors for Intestinal type stomach cancer?
intestinal metaplasia, nitrosamine, smoked food, blood type A
43
What are the characteristics of Diffuse type gastric carcinoma?
Signet ring cell that infiltrate, resulting in desmoplasia
44
What is the Leser-Trelat sign?
| What is it associated with?
explosive onset of multiple seborrheic keratoses
| ass. w/ gastric carcinoma
45
Gastric carcinoma often spreads to this lymph node first:
Left supraclavicular node
46
Gastric carcinoma that spreads bilaterally to the ovaries is called a _________ tumor
Krukenberg tumor
47
Based on vomit, how can you tell if a baby has esophageal atresia vs. duodenal atresia?
Duodenal will have bilious vomit, esophageal will not have bile
48
What does the 'double-bubble' sign indicate?
duodenal atresia
49
How does the developing fetus receive nutrients from the yolk sac?
the vitelline duct
50
what is it called when the vitelline duct fails to involute?
Meckel's diverticulum
51
Passing meconium via the umbilicus indicates ______
Complete Failure of vitelline duct to close
--a partial failure to close would cause a Meckel's diverticulum
52
Twisting of the bowel on the mesentery is called _______
volvulus
53
What is the MC cause of intususpeption in children? in adults?
children: Lymphoid hyperplasia
adults: tumor
54
The lactase enzyme is found in the ____ _____ of enterocytes
brush boarder
55
in Celiac's Dz, The pathogenic component of gluten is ______
gliadin
56
Which cell is responsible for the tissue damage in celiac Dz?
Helper T cells
57
celiacs: IgA deposits at the tips of dermal papillae is called ______ _____
Dermatitis herpetiformis (blisters that look like herpes)
58
What is found on biopsy of celiac Dz?
Flattening of villi, hyperplasia of crypt
59
In celiac Dz, most of the damage is in the (duodenum/ jejunum/ ilium)
duodenum
60
What are the two cancers ass. with celiacs?
1. Small bowel carcinoma
| 2. T cell lymphoma
61
Damage to small bowel villi due to an unknown organism is called ________ ______
tropical sprue
62
In tropical sprue, most of the damage is in the (duodenum/ jejunum/ ilium)
jejunum and ileum
63
Where is folic acid absorbed? (duodenum/ jejunum/ ilium)
Jejunum
64
Where is vitamin B12 absorbed?
| duodenum/ jejunum/ ilium
Ileum
65
In whipple's disease, the partially destroyed Tropheryma whippelii will stain with ____ inside macrophages
PAS
66
What are the S+S of wipple disease?
fat malabsorption and steatorrhea (macrophages compress lacteals, block lymphatic fat transport )
67
Carcinoid tumor stains positive for _______
chromogranin
68
The most common site for a carcinoid tumor is the ______ _____
small bowel
69
Carcinoid tumor often secrete serotonin, when do they cause carcinoid syndrome?
Metastasis. (5HT made by tumor --> degraded by liver, 5HIAA metabolite excreted. If mets, the 5HT can reach systemic circulation --> carcinoid syndrome)
70
What is carcinoid heart Dz?
5HT causes Rt sided valvular fibrosis
| tricuspid regurg, pulmonary valve stenosis
71
What are the characteristics of carcinoid syndrome?
Bronchospasm, skin flushing, diarrhea
72
Why don't you get Left sided heart Dz with carcinoid syndrome?
Lungs have MOA, turns 5HT to 5HIAA
73
What usually block appendix outflow in children? in adults?
children: lymphoid hyperplasia
adults: fecalith
74
Describe the movement of pain in appendicitis
begins peri-umbilical, localizes to RLQ
75
What are the two broad categories of Inflammatory bowel disease ?
1. Ulcerative colitis
| 2. Crohn disease
76
Full thickness inflammation, knife like fissures (Ulcerative colitis/ Crohn disease)
Crohn disease
77
Begins in the rectum and extends proximally to the cecum (Ulcerative colitis/ Crohn disease)
Ulcerative colitis
78
LLQ pain and bloody diarrhea (Ulcerative colitis/ Crohn disease)
Ulcerative colitis
79
RLQ pain, non-bloody diarrhea (Ulcerative colitis/ Crohn disease)
Crohn disease
80
Anywhere from mouth to anus, skip lesions, terminal ilium M.C. (Ulcerative colitis/ Crohn disease)
Crohn disease
81
Crypt abscess with neutrophiles (Ulcerative colitis/ Crohn disease)
Ulcerative colitis
82
Has pseudopolyps (Ulcerative colitis/ Crohn disease)
Ulcerative colitis
83
can have positive p-ANCA (Ulcerative colitis/ Crohn disease)
Ulcerative colitis
84
smoking is protective (Ulcerative colitis/ Crohn disease)
Ulcerative colitis
85
Causes malabsorption with nutritional deficiencies (Ulcerative colitis/ Crohn disease)
Crohn disease
86
Which has cobble stoning? (Ulcerative colitis/ Crohn disease)
Crohn disease
87
Congenital defective relaxation and peristalsis of the rectum and sigmoid colon is called _______
Hirschsprung disease
88
The myenteric plexus is also called _______
Auerbach plexus
89
Where is the myenteric plexus located?
in the muscularis propria between the Inner circular layer and outer longitudinal
90
Meissner plexus is also called
The submucous plexus
91
What is missing in congenital hirschprung disease?
Both Auerbach and Meissner plexus
92
Air or stool in the urine indicates ______
colo-vesicular fistula
93
High pressure in the right colon ->______
| High pressure in the left colon->______
High pressure in the right colon -> Angiodysplasia
High pressure in the left colon-> colonic diverticula
(both can cause hematochezia)
94
the MC cause of ischemic colitis is atherosclerosis of the ____
SMA
95
K.O. the APC gene creates a risk for _____
developing an adenomatous polyp
96
What are the genes in the adenoma-carcinoma sequence?
APC -> KRAS -> P53 + increased COX
97
What are the two major types of polyps? Which has an increased risk for carcinoma?
1. Hyperplastic polyp, no inc. risk
| 2. Adenomatous polyp, inc risk for carcinoma
98
What findings are risk factor for polyp progression from adenoma to carcinoma?
1. size >2cm
2. Sessile growth pattern
3. Villous histology
99
In familial adenomatous polyposis, FAP, there is a mutation in the ______ gene on chromosome _____
APC gene
| Chromosome 5
100
FAP with fibromatosis and osteomas is called ________
Gardner syndrome
101
FAP with CNS tumors (medulloblastoma and glial tumors) is called ______
Turcot Syndrome
102
What are the two M.C. pathways for colorectal carcinoma to arise?
1. Adenoma-Carcinoma sequence
| 2. Microsatellite instability pathway
103
HNPCC is due to an inherited mutation in what?
DNA mismatch repair enzymes
104
From what type of cells does a carcinoid tumor arise?
neuroendocrine cells of the midgut (jejunum, ileum, appendix, and cecum)
105
In carcinoid syndrome, there is excess secretion of _____ and ______, which causes the flushing
Serotonin and kallikrein, which causes flushing
106
What is the first enzyme activated in pancreatitis?
trypsin
107
The 2 M.C. causes of pancreatitis are _______ and _______
1. alcohol -> contraction at sphincter of oddi
| 2. gallstones -> mechanical obstruction of pancreatic outlet
108
Epigastric pain that radiates to the back with nausea and vomiting are classic clinical features of _______ _______
acute pancreatitis
109
What electrolyte is abnormal in pancreatitis?
Calcium (Hypocalcemia with Saponification of peri-pancreatic fat)
110
Which is more specific to pancreatic damage? (lipase/amylase)
lipase
| Amylase is in saliva and elsewhere
111
What is the MC cause of pancreatitis in adults? in children?
Adults: alcohol
Children: Cystic Fibrosis
112
How does chronic pancreatitis lead to vitamin deficiency?
Reduced enzymes -> reduced fat absorbtion -> Steatorrhea -> fat solubly vitamin loss
113
Pancreatic carcinoma at the head of the pancreas, S+S are _______
Pancreatic carcinoma at the tail of the pancreas, S+S are _______
Head: obstructive jaundice with pale stool
Tail: Secondary diabetes mellitus, islet cells in tail
114
inflammation of a vein is called ________
phlebitis
115
vein inflammation due to a blood clot is called __________
thrombophlebitis
116
What is Trousseau sign of malignancy? what malignancies is it related to?
migratory thrombophlebitis, recurrent thrombophlebitis at different locations.
associated with pancreatic and lung cancers
117
What is the serum tumor marker for pancreatic carcinoma?
CA19-9
118
What is a whipple procedure?
Removal of Antrum of stomach, 1st and 2nd portion of the duodenum, head of pancreas, common bile duct and gallbladder
119
A 3 mo old with jaundice w/conjugated bilirubin could have ______ ______
biliary atresia causing bile obstruction
120
Which are radiopaque? (bilirubin/ cholesterol) stones
bilirubin: radiopaque
cholesterol: radiolucent
121
Extravascular hemolysis increases the risk for (cholesterol/ bilirubin) gallstones
Bilirubin
122
RUQ pain radiating to scapula w/ fever and elevated WBC count indicates ________
Acute cholecystitis
123
Rokitansky-Aschoff sinus formation is characteristic of _______ ______
Chronic cholecystitis
| mucosa in sm. muscle of gallbladder wall
124
What is a porcelain gallbladder? what does it indicate?
dystrophic calcification of the gallbladder, seen on x-ray
| indicates chronic cholelithiasis
125
Bacterial infection of the bile ducts is called _______ _______
Ascending cholangitis
126
presence of gallstones in the common bile duct is called _______________
Choledocholithiasis
127
What are 5 complications of gallstones?
1. biliary colic
2. Acute cholecystitis
3. chronic cholecystitis
4. ascending chlangitis
5. Gallstone ileus
128
Gallbladder symptoms in elderly woman, X-ray shows porcelain gallbladder, diagnosis?
Gallbladder carcinoma
129
What is kernicterus?
physiologic jaundice of the newborn--> UCB deposits in basal ganglia --> neurological deficits, death
130
What is the treatment for kernicterus?
phototherapy --> makes UCB water soluble --> excreted in urine
131
In extravascular hemolysis, dark urine is due to increased urine ___________
urobilinogen (has been converted by gut flora)
132
An autosomal recessive low activity UGT activity is called __________
Gilbert syndrome
133
Absence of UGT (UDP-Glucuronosyltransferases) is called ________
Crigler-Najjar syndrome
134
AR deficient bilirubin canalicular transport protein is called _________
Dubin-Johnson syndrome
135
What does a pitch dark liver indicate? what should be done?
Dubin-Johnson syndrome, not clinically significant
136
biliary tract obstruction does what to the urine? what to the stool?
Dark urine, pale stool
137
Which is water soluble (conjugated/ unconjugated) bilirubin?
conjugated
138
In viral hepatitis which is higher (AST/ALT)
ALT
139
In alcoholic hepatitis, which is higher (AST/ALT)
AST
| AST is in mitochondria
140
Which hepatitis has no chronic state with IgG protective against future infection?
A and E
141
Which hepatitis most frequently results in chronic Dz?
HCV, 80% of the time
HBV only 20% of the time
HAV and HEV acute only
142
In cirrhosis, liver fibrosis is mediated by the ______ cell
stellate cell
143
What are three portosystemic shunts associated with portal HTN?
caput medusa, esophageal varacies, hemorrhoids
144
How can cirrhosis lead to generalized edema?
hypoalbuminemia
145
What is a mallory body? when do they occur?
damaged intermediate filaments within the hepatocytes
| seen in alcoholic hepatitis
146
Iron deposit in tissues is called _______
| Iron damaging tissues (fenton rxn) is called ________
deposition: hemosiderosis
damage: hemochromatosis
147
Primary hemochromatosis is most frequently a mutation in the gene ________
C282Y
148
What is the MC cause of secondary hemochromatosis?
many transfusions
149
How can you tell apart Lipofuscin on a hepatocyte biopsy?
Prussian blue stain
150
An ATP7b mutation is seen in _______ ________
wilson's disease
151
What are Kayser-Fleisher rings?
Rings in the cornea of a person with wilson's disease
152
Hepatic periductal fibrosis with an onion skinning appearance is characteristic of __________
Primary sclerosing cholangitis
153
Primary sclerosing cholangitis may have + pANCA and is associated with ________
ulcerative colitis
154
Aflatoxins derived from aspergillus increases the chance of _____ _______
hepatocellular carcinoma
155
occlusion of the hepatic veins resulting in pain, ascites, and liver enlargement is called ________
Budd-Chiari syndrome
156
Which is more common in men? woman?
| Primary biliary sclerosis/ primary sclerosing cholangitis
Men: PSC
Women: PBC
157
Which is MC pANCA (+), which is ass. w/ autoimmune dz?
| Primary biliary sclerosis/ primary sclerosing cholangitis
PSC: +PANC
PBC: auto imm dz associated
158
Which has anti-mitochondrial antibodies
| Primary biliary sclerosis/ primary sclerosing cholangitis
PBC
159
What molecules stimulate exocrine pancreatic secretions?
1. Ach
2. secretin
3. CCK
160
What are the 4 "C's" of measles
cough, coryza, conjunctivitis, Kopilik spots
161
What are virally caused lesions of the oral mucosa called? what virus causes them?
Koplik spots = measles virus, a paramyxo
162
What are the two pathognomonic findings with measles?
1. Koplik spots in oral mucosa
| 2. Warthin-Finkeldey cells, eosinophilc multinucleated giant cells in lymphoid organs
163
How do you treat RSV in adults?
Ribavirin
164
What virus causes both parotitis and orchitis?
Mumps
| lumps with mumps
165
What types of viruses are MMR?
Measles: paramyxo
Mumps: paramyxo
Rubella: toga, also called german measles
166
In what ways are poliovirus presentations and west nile virus presentations similar?
both are usually clinically silent, but occasionally cause severe disease
167
What causes roseola?
HSV-6
168
What viruses have glassy intranuclear type a cowdry bodies?
HSV, especially HSV-1, HSV-2 and VZV=HSV-3
169
What virus causes herpetic whitlow?
HSV-1
170
Which virus creates large infected cells with intranuclear basophilic inclusion, "owl eyes"
CMV, HSV-5
171
What causes scarlet fever? Necrotizing fascitis?
streptococcus pyogenes erythrogenic toxin: scarlet fever
| Exotoxin B: Necrotizing fasciitis
172
premalignant disease of the stomach characterized by 1. massive gastric folds, 2. excessive mucous production and 3. resultant protein loss
Ménétrier disease
