Rubin's path unit 6

Question 1

GI 7: Sliding hiatal hernias vs. paraesophageal hiatal hernia:

Answer 1

SHH: enlargement of hiatus and laxity of the circumferential CT allows cap of gastric mucosa to move upward above diaphragm;
PHH: herniation of a portion of the gastric fundus alongside the esophagus through a defect in the diaphragmatic CT membrane

Question 2

GI 8: Chemical injury to the esophagus usually reflects

Answer 2

accidental poisoning in children, attempted suicide in adults, or contact with meds; ingestion of strong acids produces an immediate coag necrosis in the esophagus, resulting in a protective eschar that limits injury and further chem penetration;
strong alkaline solutions accompanied by LIQUEFACTIVE NECROSIS

Question 3

GI 12: The most common type of esophagitis is

Answer 3

reflux esophagitis, often found in conjunction with a sliding hiatal hernia but could also arise through an incompetent lower esophageal sphincter without demonstrable anatomical lesion

Question 4

GI 19: Melena refers to

Answer 4

black, tarry stools composed largely of blood from the upper digestive tract that has been processed by the action of gastric juices; think CHRONIC PEPTIC ULCER DISEASE

Question 5

GI 21: ZE syndrome characterized by

Answer 5

unrelenting peptic ulceration in the stomach or duodenum (or even proximal jejunum) by action of tumor-derived gastrin

Question 6

GI 24: Menetrier disease is an

Answer 6

uncommon disorder of the stomach characterized by enlarged rugae; often accompanied by severe loss of plasma proteins (including albumin) from altered gastric mucosa. Disease can occur in kids with CMV and in adults with overexpression of TGF-alpha

Question 7

GI 25: GI stromal tumors are derived from

Answer 7

pacemaker cells of Cajal; include a vast majority of mesenchyme-derived stromal tumors of the entire GI tract. Gastric GISTs are usually submucosal and covered by intact mucosa. Look for spindle cells with vacuolated cytoplasms and low malignant potential

Question 8

GI 27: Bezoars are

Answer 8

foreign bodies in the stomach that are composed of food or hair that have been altered by the digestive process; trichobezoar is a hairball (long-haired girl eating own hair like Rapunzel) and phytobezoars are concretions of plant material

Question 9

GI 31: Hyperplastic polyps are

Answer 9

small, sessile mucosal excrescenes that display exaggerated crypt architecture. Think of them as the most common polypoid lesions of the colon and are particularly frequent in the rectum. Look for elongated crypts and cystic dilations

Question 10

GI 32: Tubular adenomas are

Answer 10

smooth-surface lsions, usually less than 2 cm in diameter, and often have a STALK. Look for closely packed epi tubules, which may be uniform or irregular with excess branching. Dysplasia and carcinoma often develop in tubular adenomas.

Question 11

GI 37: Metastatic carcinoma is

Answer 11

most common malignant disorder affecting the peritoneum

Question 12

GI 44: Crohn disease is a

Answer 12

transmural chronic inflamm disease that may affect any part of the digestive tract; intestinal obstruction and fistulas are most common intestinal complications of Crohn disease

Question 13

GI 50: What are some sequelae of ulcerative colitis?

Answer 13

Arthritis, uveitis and skin lesions like erythema nodosum and pyoderma gangrenosum;

Question 14

GI 51: Nephrotic syndrome in kids along with systemic infection seeding ascitic fluid with bacteria can lead to

Answer 14

spontaneous bacterial peritonitis that doesn’t occur with obvious perforation

Question 15

GI 52: Diverticulitis results from

Answer 15

irritation caused by retained fecal material that obstructs the lumen of a diverticulum

Question 16

GI 58: Anorectal malformations are associated with

Answer 16

relation of the terminal bowel to the levator ani muscle

Question 17

GI 59: How do anorectal malformations result? What else can develop?

Answer 17

Arrested development of the caudal region of the gut in the first 6 mos of fetal life;
fistulas b/w the malformation and the bladder, urethra, vagina, or skin

Question 18

GI 61: Stercoral ulcers result from

Answer 18

pressure necrosis of the mucosa caused by the fecal mass impacted; complications include rectal bleeding and perforation

Question 19

GI 62: Mucocele refers to a

Answer 19

dilated mucous-filled appendix; if nonneoplastic, you have retention of mucus in the appendiceal lumen;
in mucinous cystadenoma or mucinous cystadenocarcinoma, the dilated appendix is lined by a villous adenomatous mucosa

Question 20

GI 63: Radiation therapy for malignant disease of the pelvis or abdo

Answer 20

may be complicated by injury to the SI and colon

Question 21

LB 7: Acute viral hepatitis path changes include

Answer 21

disarray of liver cell plates, ballooning degen of hepatocytes, IC and EC bile statis, apoptotic (COUNCILMAN) bodies, and mononuclear inflamm cell infiltrates

Question 22

LB 12: Autoimmune hepatitis is a type of

Answer 22

chronic hepatitis, which is associated with circulating autoAbs (aninuclear Ab’s) and high levels of serum immunoglobulins; usually accompanied by other autoimmune diseases like Sjogren, SLE, etc
RESPONDS TO STEROIDS

Question 23

LB 13: Cholangiocarcinoma can originate

Answer 23

anywhere in the biliary tree, from the large intrahepatic ducts at the porta hepatis to the smallest bile ductules at the periphery of the hepatic lobules;
think liver fluke C. sinensis

Question 24

LB 14: In hepatorenal syndrome, this occurs

Answer 24

in setting of cirrhosis and heralds a poor prognosis; think renal hypoperfusion, including oliguria, azotemia, and increased levels of serum creatinine; microscopically the KIDNEY APPEARS NORMAL

Question 25

LB 17: Common cause of massive hepatic necrosis is

Answer 25

HBV; liver appears shrunken, capsule is wrinkled, and the parenchymal tissue is soft and flabby;
the massive hepatic necrosis can lead to fulminant hepatic failure

Question 26

LB 20: Acute alcoholic hepatitis characterized by

Answer 26

hepatic steatosis, hydropic swelling of hepatocytes, focal hepatocellular necrosis, neutrophilic infiltration, and cytoplasmic hyaline inclusions within the hepatocytes (Mallory bodies)

Question 27

LB 25: Budd-Chiari a

Answer 27

congestive disease of the liver caused by occlusion of the hepatic veins and their tributaries; think thrombosis of hepatic veins

Question 28

LB 27: Most complications associated with cholelithiasis

Answer 28

are related to obstruction of the biliary tree

Question 29

LB 29: What is the best way to assess extent of liver disease in a patient with viral hepatitis? What can you see with this method?

Answer 29

Liver biopsy; ballooning degen of liver cells, IC and EC bile stasis, acidophilic bodies, and mononuclear cell infiltrate seen

Question 30

LB 30: Chemicaly-induced hepatic injury is classified as “predictable” when; indirect injury of the liver is caused by

Answer 30

toxicity is immediate and dose-dependent;

metabolites and free rads that are produced as byproducts of xenobiotic metabolism

Question 31

LB 31: Patients with persistent HBV infection have a

Answer 31

200-fold increased risk of developing primary HCC

Question 32

LB 34: alpha1-antitrypsin deficiency characterized by

Answer 32

presence of round-to-oval cytoplasmic globular inclusions of misfolded alpha1-antitrypsin proteins in hepatocytes;
glboules stain red with PAS after removing glycogen with diastase

Question 33

LB 35: pyogenic liver abscesses are caused by

Answer 33

staph, strep, and gram-neg enterobacteria; these bacteria gain access to the liver by direct extension from contiguous organs or through the portal vein or hepatic artery; maybe diverticulitis and inflamm bowel diseases

Question 34

LB 36: Massive hepatic necrosis the most feared variant of

Answer 34

acute hepatitis; look for massive death of hepatocytes, leaving a collapsed collagenous framework

Question 35

LB 37: What can suggest acetaminophen toxicity?

Answer 35

Centrilobular necrosis

Question 36

LB 43: Andersen disease is

Answer 36

also known as glycogen storage disease type IV, an autosomal recessive genetic disease caused by deficiency of a glycogen-branching enzyme; without this enzyme, you have accumulation of abnormal glycogen (amylopectin) in liver, muscle, and other tissues

Question 37

LB 44: Acute intermittent porphyria is the

Answer 37

most common genetic porphyria; it’s AD and caused by deficiency of porphobilinogen deaminase activity in liver

Question 38

LB 45: Histologic features of neonatal hepatitis include

Answer 38

prolonged cholestasis, inflamm, and cell injury; look for giant cell transformation of hepatocytes

Question 39

P 9: Majority of pancreatic carcinomas arise from

Answer 39

pancreatic duct epi; acinar cell carcinoma much less common

Question 40

ID 13: P jireveci causes

Answer 40

progressive, often fatal pneumonia in persons with impaired cell-mediated immunity and on of the most common opportunistic pathogens in persons with AIDS;
trophozoites attach to alveolar lining, and they feed, enlarge, and transform into cysts within host cells

Question 41

ID 17: RSV is a(n) _____ virus, the major cause of

Answer 41

RNA; bronchiolitis and pneumonia in infants; think expiratory and inspiratory wheezing, cough, and hyperexpansion of both lung fields;
hyperinflation, interstitial infiltrates, segmented atelectasis

Question 42

ID 19: Measles virus is a(n) ____ virus that causes

Answer 42

RNA; acute, highly contagious, self-limited illness with UR tract symptoms, fever, and rash;
think respiratory droplets and secretions, and look for skin rash and Koplik spots on posterior buccal mucosa

Question 43

ID 21: Measles virus can cause fusion of

Answer 43

infected cells, producing multinucleated cells termed “Warthin-Finkeldey giant cells”;

Question 44

ID 24: Rhizopus, Mucor, Rhizomucor, and Absidia can produce

Answer 44

necrotizing opportunistic infections that begin in the nasal sinuses or lungs; Mucor ubiquitous in the nasal sinuses and invades surrounding tissues, and look for hard palate or nasal cavity covered by black crust

Question 45

ID 30: Toxoplasmosis is a

Answer 45

potentially necrotizing meningoencephalitis with infection of the CNS; can see ocular infections causing chorioretinitis

Question 46

ID 32: Rickettsia typhi characterized by

Answer 46

fever, severe headache, and myalgias, followed by appearance of maculopapular rash on the upper trunk and axillary folds, going to extremities

Question 47

ID 37: MAC is a

Answer 47

rare granulomatous pulm disease in immunocompetent persons, but is a progressive systemic disorder in patients with AIDS; can see progressive involvement of small bowel to produce malabsorption and diarrhea

Question 48

ID 51: Erysipelas is an

Answer 48

erythematous swelling of the skin caused chiefly by S pyogenes infection

Question 49

ID 54: Yellow fever is an

Answer 49

acute hemorrhagic fever, associated with hepatic necrosis and jaundice; caused by mosquito-borne flavivirus (tropism for liver cells), with Councilman bodies and microvesicular fatty changes

Question 50

ID 55: Visceral leishmaniasis presents with

Answer 50

persistent fever, progressive weight loss, HSM, anemia, thrombocytopenia, and leukopenia; can develop darkening of the skin

Question 51

ID 61: If humans ingest eggs from Taenia solium,

Answer 51

eggs release oncospheres and differentiate to cysticerci and they can lodge in tissues like the brain and get headaches and seizures