Sweep 1.5

Question 1

Fibroadenoma is the most common benign tumor of the female breast and usually appears in prepubertal girls and young women, with the peak prevalence in the third decade. They result from ———-. These tumors are ————– and comprised of both glandular epithelium and fibrous tissue. They usually appear as a solitary, discrete, freely movable nodule (1-10 cm in diameter). ———— is mandatory to verify its benign nature.

Answer 1

increased estrogen

encapsulated

Biopsy

Question 2

Carcinoma of the breast can be classified as ————- or ——— carcinoma (arising from glandular acini).

Answer 2

ductal carcinoma (arising from ductal epithelium)

lobular

Question 3

Both ductal and lobular carcinoma have ——- precursor stages, termed ————- in which the neoplasm has not penetrated the ——— and thus has not invaded or infiltrated the ————–.

Answer 3

noninvasive

ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS),

basement membrane

connective tissue stroma

Question 4

D. Portal hypertension

1. Increased pressure of portal blood flow can occur:

Answer 4

prehepatic (obstructive thrombi), intrahepatic (cirrhosis), and post hepatic (right sided heart failure).

Question 5

D. Portal hypertension

2. Consequences of portal hypertension:

Answer 5

1) ascites (excess fluid in peritoneal cavity-fluid is generally serous in nature), 2) esophageal varices, 3) splenomegaly, 4) hepatic encephalopathy, 5) hypogonadism.

Question 6

E. Jaundice and cholestasis

1. Excess bilirubin. 2.0 mg/dl
   • Unconjugated: ——–
   • Conjugated: ———-

Answer 6

Insoluble, toxic

Soluble, nontoxic

Question 7

3. Hepatitis A is a ————. ——— is transient-rarely screen donor blood for HAV.

Answer 7

benign, self-limiting disease

HAV viremia

Question 8

Hep A

• ——— of transmission, seen with overcrowding/unsanitary conditions. Ingestion of contaminated water and food

Answer 8

Fecal-oral route

Question 9

Hep A

• Incubation

Answer 9

2-6 weeks

Question 10

Hep A

• NO ——- state. No —— disease

Answer 10

carrier

chronic

Question 11

4. Possible results of Hepatitis B infection:

a. ——- carrier state. Hepatitis B induced liver disease is an important precursor for —————.

Answer 11

asymptomatic

hepatocellular carcinoma

Question 12

Hep B

• ——- virus

Answer 12

DNA

Question 13

Hep B

• Incubation —–

Answer 13

4-26 weeks

Question 14

Hep B

• ————— determines the ultimate outcome. Hepatocyte damage-likely reflects————— to Hepatitis B infected hepatocytes. Optimal outcome is to obtain viral clearance without a lot of collateral damage to liver tissues.

Answer 14

Host immune response

CD8+ cytotoxic T cell damage

Question 15

Hep B

• Serology:

Answer 15

Remains in blood

Question 16

Hep B

• Vaccine:

Answer 16

95 % protective Ab response

Question 17

Hep B

• Increased risk of

Answer 17

hepatocellular response

Question 18

5. Hepatitis C is a major cause of liver disease worldwide. Unlike Hepatitis B, with Hepatitis C infection the progression to ———- occurs in the majority of patients and ——– develops in 20-30% of infected individuals. With Hepatitis C, note ————–

Answer 18

chronic disease

cirrhosis

persistent infection, chronic hepatitis.

Question 19

5. Hepatitis C

• ———- virus
•

Answer 19

RNA

Question 20

5. Hepatitis C

• Incubation ———-, acute phase is ———

Answer 20

7-8 weeks

asymptomatic

Question 21

5. Hepatitis C

• No vaccine because of ————–

Answer 21

genomic instability

Question 22

5. Hepatitis C

• ———– occurs in approximately 80-85%, and may develop 5 to 20 years later.

Answer 22

Cirrhosis

Question 23

5. Hepatitis C

• Risk factor for ————.
• Most frequent viral infection associated with the need for ———–. Previously treated with ————.

Answer 23

hepatocellular carcinoma

liver transplantation

interferon and ribavirin

Question 24

5. Hepatitis C

Treatment with ————— now considered curative.

Answer 24

protease and nucleoside inhibitors

Question 25

5. Hepatitis C

o Combination drugs:

Answer 25

Harvoni (2014, sofosbuvir & ledipasvir). 12 week course, several others since 2014; often given with ribavirin

o Curative in most patients. Side effects fatigue and headache.
o Very expensive (Harvoni $95K, Mavyret [2017] 12 weeks $40K)

Question 26

8. Hepatitis E (similar to A) is an ———- transmitted, ———– infection-high mortality rate in ———. Not associated with ————–.

Answer 26

enterically

water-borne

pregnant women

chronic liver disease

Question 27

9. Hepatitis G (some similarity to C but is not hepatotropic) infection does not increase liver enzymes such as ————-. Replicates in ————

Answer 27

serum aminotransferases

bone marrow and spleen.

Question 28

10. Autoimmune hepatitis is a

Answer 28

chronic, progressive, hepatitis variant with an unknown etiology.

Question 29

Autoimmune hepatitis

Pathology is associated with

Answer 29

T-cell mediated autoimmunity.