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Step 1 Gastrointestinal-First Aid 2017 > Pathology > Flashcards

Pathology Flashcards

1
Q

Facial pain or paralysis with a salivary gland tumor usually indicates what?

A

Malignant involvement of CN VII

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2
Q

Which salivary gland is most commonly affected by benign tumors?

A

Parotid gland

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3
Q

Malignant tumors of salivary glands are most commonly found in what size glands?

A

Small glands

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4
Q

Typical presentation of salivary gland tumors

A

Painless mass or swelling

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5
Q

Most common salivary gland tumor

A

Pleomorphic adenoma

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6
Q

Where are pleomorphic adenoma tumors most commonly located?

A

At angle of jaw

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7
Q

What happens if pleomorphic adenoma tumor is not completely excised or ruptures?

A

Recurs

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8
Q

A benign mixed tumor composed of chondromyxoid stroma and epithelium

A

Pleomorphic adenoma

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9
Q

Most common malignant salivary gland tumor

A

Mucoepidermoid carcinoma

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10
Q

Malignant salivary tumor that can present with facial nerve damage and has mucinous squamous components

A

Mucoepidermoid carcinoma

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11
Q

Benign cystic tumor with germinal centers and lymphoid tissue that is the 2nd most common tumor of salivary glands typically found in smokers

A

Warthin tumor

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12
Q

What population group is commonly affected by Warthin tumors?

A

Smokers

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13
Q

Infection in someone from South America that causes achalasia

A

T cruzi infection causing Chagas disease

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14
Q

What is the cause of achalasia

A

Destruction of Auerbach plexus causing esophageal dysmotility

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15
Q

Presents with “bird’s beak” on barium swallow and progressive dysphagia to solids and liquids

A

Achalasia

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16
Q

What neurons are affected in achalasia

A

Postganglionic inhibitory neurons

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17
Q

Loss of what regulatory substances can cause achalasia

A

NO and VIP

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18
Q

Transmural esophageal rupture, usually in the distal esophagus, with pneumomediastinum due to violent retching that is considered a surgical emergency

A

Boerhaave syndrome

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19
Q

Typical sign of Boerhaave syndrome

A

Crepitus in neck or chest region

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20
Q

Type of infiltrates seen in esophagus with esophageal rings and linear furrows on endoscopy caused by food allergens and common in atopic patients

A

Eosinophils

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21
Q

Esophageal pathology caused by food allergens leading to dysphagia and food impaction and unresponsive to GERD therapy

A

Eosinophilic esophagitis

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22
Q

Individual with caustic ingestion or acid reflux is at risk for what esophageal pathology

A

Esophageal strictures

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23
Q

Painless dilated submucosal veins that are 2ndary to portal HTN and commonly seen in cirrhotics which may cause life-threatening hemorrhage

A

Esophageal varices

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24
Q

Pill esophagitis is associated with what drugs?

A 
PINT Bis:
Potassium chloride
Iron
NSAIDs
Tetracycline
Bisphosphonates
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25
Q

Esophagitis caused by Candida infection will have what type of gross finding?

A

White pseudomembrane

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26
Q

Esophagitis caused by HSV-1 infection will have what type of gross finding?

A

Punched-out ulcers

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27
Q

Esophagitis caused by CMV infection will have what type of gross finding?

A

Linear ulcers

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28
Q

Esophagitis is commonly associated with what?

A

Reflux

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29
Q

Commonly presents with heartburn, regurgitation, dysphagia, cough or hoarseness

A

GERD

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30
Q

GERD is associated with what atopic condition?

A

Asthma

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31
Q

What is considered the cause of GERD

A

Transient decrease in LES tone

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32
Q

Partial thickness mucosal laceration at GE junction due to severe vomiting

A

Mallory-Weiss tear

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33
Q

Clinical presentation of Mallory-Weiss tear

A

Painful hematemesis in alcoholics or bulimics

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34
Q

Mallory-Weiss tear can lead to what more serious condition

A

Boerhaave syndrome

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35
Q

Mallory-Weiss tear is commonly misdiagnosed with what other condition

A

Ruptured esophageal varices

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36
Q

Presents with Dysphagia, Iron deficiency anemia, and Esophageal webs with associated glossitis and beefy red tongue

A

Plumber-Vinson syndrome

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37
Q

Classic triad of Plumber-Vinson syndrome

A

Dysphagia, Iron deficiency anemia, Esophageal webs

Plumbers DIE

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38
Q

Part of CREST syndrome caused by esophageal smooth muscle atrophy leading to decreased LES pressure and dysmotility and acid reflux

A

Sclerodermal esophageal dysmotility

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39
Q

Complication of sclerodermal esophageal dysmotility

A

Barret esophagus, Aspiration, Strictures (BAS)

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40
Q

CREST syndrome

A

Calcinosis, Raynaud’s, Esophageal dysmotility, Telangiectasias

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41
Q

Replacement of Nonkeratinized stratified squamous epithelium with intestinal epithelium in distal esophagus

A

Barret esophagus

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42
Q

Type of epithelium seen on pathology in Barret esophagus

A

Non-ciliated columnar intestinal epithelium with goblet cells

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43
Q

What is Barret esophagus associated with?

A

GERD

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44
Q

Complication of Barret esophagus

A

Esophageal adenocarcinoma

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45
Q

Typical presentation of esophageal cancer

A

Progressive dysphagia (first solids then liquids) and weight loss

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46
Q

Adenocarcinoma is seen in what part of the esophagus?

A

Lower 1/3

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47
Q

Risk factors for adenocarcinoma of the esophagus

A

GERD, Barrett esophagus, obesity, smoking, achalasia

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48
Q

Adenocarcinoma of the esophagus is more prevalent in what part of the world?

A

America (west)

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49
Q

Squamous cell carcinoma is seen in what part of the esophagus

A

Upper 2/3

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50
Q

Risk factors for squamous cell carcinoma of the esophagus

A

Alcohol, hot liquids, caustic strictures, smoking, achalasia

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51
Q

Plumber-Vinson syndrome is associated with what risk factor?

A

Alcohol

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52
Q

Type of intestinal metaplasia caused by GERD or irritation to lower esophagus

A

Barret esophagus

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53
Q

Lymph nodes that drain the lower 1/3 of the esophagus

A

Celiac and gastric nodes

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54
Q

Lymph nodes that drain the middle 1/3 of the esophagus

A

Mediastinal or tracheobronchial nodes

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55
Q

Lymph nodes that drain the upper 1/3 of the esophagus

A

Cervical lymph nodes

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56
Q

How do NSAIDs cause acute gastritis?

A

NSAIDs decrease PGE2 decreasing gastric mucosa protection

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57
Q

How doe burns cause acute gastritis?

A

Hypovolemia causes intestinal ischemia

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58
Q

Type of ulcers caused by burns in acute gastritis

A

Curling ulcers

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59
Q

How does brain injury cause acute gastritis?

A

Increased vagal stimulation increases ACh which increases acid production

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60
Q

Type of ulcers caused by brain injury in acute gastritis

A

Cushing ulcers

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61
Q

Complication of chronic gastritis

A

Gastric cancers

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62
Q

H pylori infection affects what part of the stomach

A

Affects antrum first then spreads to body

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63
Q

Complications seen in H pylori infection

A

Peptic ulcer disease and MALT lymphoma

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64
Q

Treatment for H pylori infection

A

PPIs, Clarithromycin, Amoxicillin or Metronidazole

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65
Q

Most common cause of chronic gastritis

A

H pylori infection

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66
Q

Autoantibodies to parietal cells and intrinsic factor with increased risk of pernicious anemia is seen in what type of chronic gastritis

A

Autoimmune gastritis

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67
Q

What causes pernicious anemia in autoimmune gastritis

A

Parietal cells destroyed, cannot make intrinsic factor, vitamin B12 cannot be absorbed

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68
Q

What type of lymphocytes are involved in autoimmune gastritis?

A

T-cell mediated damage (type IV)

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69
Q

Precancerous condition caused by hyperplasia of the gastric mucosa leading to hypertrophied rugae that look like brain gyri, excess mucus production with resultant protein loss and parietal cell atrophy with decreased acid production

A

Ménétrier’s disease

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70
Q

Bilateral metastases to ovaries with abundant mucin-secreting, signet ring cells

A

Krukenberg tumor

71
Q

Krukenberg tumor is associated with which type of cancer?

A

Diffuse type gastric cancer

72
Q

Virchow node is associated with what condition?

A

Metastasis from stomach

73
Q

Left supraventricular node by metastasis from stomach cancer

A

Virchow node

74
Q

Subcutaneous periumbilical metastasis

A

Sister-Mary-Joseph nodule

75
Q

Sister-Mary-Joseph nodule is associated with which type of cancer?

A

Intestinal type gastric cancer

76
Q

Type of stomach cancer not associated with H. pylori infection

A

Diffuse type

77
Q

Stomach cancer with signet ring cells and stomach wall that is grossly thickened and leathery

A

Diffuse type

78
Q

Mucin-filled cells with peripheral nuclei seen in diffuse type gastric cancer and Krukenberg tumor

A

Signet ring cells

79
Q

Gastric cancer associated with H. pylori infection, dietary nitrosamines, tobacco, achlorhydria and chronic gastritis

A

Intestinal type

80
Q

Most common type of gastric cancer

A

Adenocarcinoma

81
Q

Acute onset of multiple eruptive seborrheic keratoses common in gastric cancer

A

Leser-Trelat sign

82
Q

Which type of peptic ulcer is seen most commonly with H. pylori infections?

A

Duodenal > Gastric ulcer

83
Q

Which type of peptic ulcer has pain that is greater with meals and weight gain is seen?

A

Gastric ulcer

84
Q

What are common causes of gastric ulcers?

A

H. pylori, NSAIDs

85
Q

What are common causes of duodenal ulcers

A

Zollinger-Ellison syndrome

86
Q

Which type of peptic ulcer has a greater risk of carcinoma?

A

Gastric ulcer

87
Q

Type of peptic ulcer that has hypertrophy of Brunner glands on biopsy?

A

Duodenal ulcer

88
Q

Type of peptic ulcer in which biopsy of margins needs to be done to rule out malignancy?

A

Gastric ulcer

89
Q

Type of peptic ulcer in which weight loss is seen and pain is increased with meals?

A

Gastric ulcer

90
Q

Which artery is at risk of bleeding from a ruptured gastric ulcer on the lesser curvature of the stomach?

A

Left gastric artery

91
Q

What is the most common complication of peptic ulcers

A

Posterior hemorrhage

92
Q

Which artery is at risk of bleeding from an ulcer on the posterior wall of duodenum?

A

Gastroduodenal artery

93
Q

Which area, anterior or posterior duodenal, when ruptured, will cause free air under diaphragm with referred pain to the shoulder?

A

Anterior > posterior

94
Q

What nerve, when irritated, will have referred pain to the shoulder?

A

Phrenic nerve

95
Q

Celiac disease is an autoimmune-mediated intolerance to what product found in wheat products

A

Gliadin

96
Q

What HLA subtypes are associated with Celiac disease?

A

HLA-DQ2 and HLA-DQ8

97
Q

Which group of people are commonly affected by Celiac disease?

A

Northern Europeans

98
Q

Disease seen in Celiac disease that is caused by IgA deposits on dermal papillae?

A

Dermatitis herpetiformis

99
Q

What will a biopsy in Celiac disease show?

A

Villi atrophy and crypt hyperplasia

100
Q

What section of the GI tract is mostly affected by Celiac disease?

A

Mostly distal duodenum and/or proximal jejunum

101
Q

What is the treatment for Celiac disease?

A

Gluten-free diet

102
Q

A d-xylose test that shows decreased blood and urine levels is indicative of what type of disease?

A

Mucosal defects or bacterial overgrowth

103
Q

In what disease is a d-xylose test normal

A

Pancreatic insufficiency

104
Q

What type of immune cells mediate Celiac disease?

A

T-cell mediated

105
Q

What antibodies are seen in Celiac disease?

A

IgA anti-tissue transglutimase, anti-endomysial, and anti-deaminated gliadin peptide antibodies

106
Q

What test is done to test for lactose intolerance?

A

Lactose hydrogen breath test

107
Q

What level is necessary to diagnose lactose intolerance in a lactose hydrogen breath test?

A

> 20 ppm compared with baseline

108
Q

What is a common finding in lactose intolerance?

A

Osmotic diarrhea with decreased stool pH

109
Q

What are biopsy findings in lactose intolerance?

A

Normal-appearing villi

110
Q

What vitamins are commonly deficient in pancreatic insufficiency?

A

Fat-soluble vitamins and vitamin B12

111
Q

What are common findings in pancreatic insufficiency?

A

Decreased pH and fecal elastase

112
Q

Type of malabsorption syndrome that is responsive to antibiotics and seen in recent visitors to tropics?

A

Tropical sprue

113
Q

What vitamin deficiencies are seen in tropical sprue?

A

Vitamin B9 and B12

114
Q

What area of the GI tract is commonly affected in tropical sprue?

A

Jejunum and ileum > duodenum

115
Q

What is the cause of Whipple disease?

A

Tropheryma whipplei

116
Q

Disease more commonly seen in older man and causes cardiac symptoms, arthralgias, and neurologic symptoms that is PAS positive and has foamy macrophages in intestinal lamina propria?

A

Whipple disease

117
Q

Refractory cases of Celiac disease can lead to what complication?

A

Small bowel carcinoma and T-cell lymphoma

118
Q

Which group of individuals are commonly affected with IBS?

A

Middle-aged women

119
Q

What are the symptoms in IBS?

A

Diarrhea predominant, Constipation predominant or Mixed

120
Q

Symptoms in change in stool frequency with increased diarrhea in middle-aged women points to what disease?

A

IBS

121
Q

What is the most common cause of appendicitis in children?

A

Lymphoid hyperplasia

122
Q

What is the most common cause of appendicitis in adults

A

Fecalith obstruction

123
Q

What is the treatment for appendicitis

A

Appendectomy

124
Q

Abdominal pain with psoas, obturator and Rovsing sings with guarding and rebound tenderness indicated what disease?

A

Appendicitis

125
Q

Where is the initial pain in appendicitis usually felt?

A

Periumbilical

126
Q

What disease in elderly can mimic appendicitis?

A

Diverticulitis

127
Q

What pregnancy condition can mimic appendicitis?

A

Ectopic pregnancy

128
Q

What test is done to exclude ectopic pregnancy in a women of child-bearing age?

A

B-hCG

129
Q

What layers of the gut are found in a false or pseudo diverticulum?

A

Mucosa and submucosa

130
Q

What type of diet is associated with diverticulosis?

A

Low-fiber diets

131
Q

What is the most common location of diverticulum?

A

Mostly in sigmoid colon

132
Q

Pain caused by diverticulitis is typically felt in what abdominal quadrant?

A

LLQ

133
Q

What signs and symptoms are seen in diverticulitis?

A

LLQ pain, fever, leukocytosis

134
Q

What are complications of diverticulitis?

A

Abscess, fistula, obstruction or perforation

135
Q

What is a complication of fistulas seen in diverticulitis?

A

Colovesical fistula causing pneumaturia

136
Q

What is a complication of obstruction seen in diverticulitis?

A

Inflammatory stenosis

137
Q

What is a complication of perforation seen in diverticulitis?

A

Peritonitis

138
Q

Obstruction, dysphagia and halitosis in an elderly male points to what disease?

A

Zenker’s diverticulum

139
Q

What type of diverticulum is Zenker’s diverticulum, true or false diverticulum?

A

False diverticulum

140
Q

Where is the common location of Zenker’s diverticulum?

A

Killian triangle

141
Q

Where is Killian’s triangle located in the GI tract?

A

Between thyropharyngeal and cricopharyngeal parts of the inferior pharyngeal constrictor

142
Q

What is the cause of Zenker’s diverticulum?

A

Esophageal dysmotility

143
Q

What is considered a true diverticulum?

A

Meckel diverticulum

144
Q

What is the cause of Meckel diverticulum?

A

Persistence of vitelline duct

145
Q

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

A

Meckel diverticulum

146
Q

What are common findings in Meckel diverticulum?

A

RLQ pain, intussusception, volvulus or obstruction near terminal ileum with bleeding

147
Q

Cystic dilation of the vitelline duct?

A

Omphalomesenteric cyst

148
Q

What are the rule of 2’s in Meckel diverticulum?

A 
2 times as likely in males
2 inches long
2 feet from ileocecal valve
2% of the population
2 years of life
2 types of epithelia (gastric/pancreatic)
149
Q

Congenital megacolon characterized by lack of ganglion cells/enteric nervous plexuses in distal segment of colon?

A

Hirschsprung disease

150
Q

What gene mutation is associated with Hirschsprung disease?

A

RET mutation

151
Q

What is the cause of Hirschsprung disease?

A

Failure of neural crest cell migration

152
Q

What chromosomal trisomy is associated with Hirschsprung disease?

A

Down syndrome

153
Q

What is a common finding in Hirschsprung disease?

A

Dilation of normal colon proximal to aganglionic segment

154
Q

Patient presents with bilious emesis, abdominal distention, and failure to pass meconium within 48 hours points to what disease?

A

Hirschsprung disease

155
Q

Where is Meckel diverticulum usually located?

A

Near terminal ileum

156
Q

How is Hirschsprung disease diagnosed?

A

Absence of ganglionic cells on rectal suction biopsy

157
Q

Squirt sign is a common finding in what disease?

A

Hirschsprung disease

158
Q

What is the treatment for Hirschsprung disease?

A

Resection of aganglionic segment

159
Q

Complication of malrotation of bowel

A

Volvulus or duodenal obstruction

160
Q

What is the cause of malrotation?

A

Anomaly of midgut rotation during fetal development

161
Q

What are common findings in malrotation?

A

Improper position of bowel and Ladd bands

162
Q

Fibrous bands from liver to colon caused by malrotation

A

Ladd bands

163
Q

Volvulus affects what area of gut in infants and children?

A

Midgut

164
Q

What are of colon is affected most in elderly?

A

Sigmoid colon

165
Q

Coffee bean sign on X-ray in an elderly person points to what disease?

A

Sigmoid volvulus

166
Q

What is a complication of volvulus?

A

Obstruction and infarction of colon

167
Q

Twisting of portion of bowel around its mesentery

A

Volvulus

168
Q

Telescoping of proximal bowel segment into distal segment commonly at ileocecal junction

A

Intussusception

169
Q

Who is mainly affected by intussusception?

A

Children

170
Q

What are common causes of intussusception in children?

A

Recent viral infection

171
Q

Mechanism of viral infection causing intussusception

A

Adenovirus causes Peyer path hypertrophy leading to a lead point for intussusception

172
Q

What vaccine is associated with intussusception?

A

Rotavirus vaccine

173
Q

What is the most common cause of intussusception in adults

A

Mass or tumor causing lead point

174
Q

What is the most common pathologic lead point causing intussusception?

A

Meckel diverticulum

Step 1 Gastrointestinal-First Aid 2017 (5 decks)

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