Term
| do cleft lip&palate occur together or independent? |
|
Definition
| they usually occur together. Isolated cleft lip/palates are pretty rare |
|
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Term
| Recurrent aphthous ulcers, genital ulcers, & uveitis |
|
Definition
Behcet syndrome
etiology is immune complex vasculitis of unknown origin (?virus) |
|
|
Term
| Where does HSV1 remain dormant |
|
Definition
| dorsal root ganglia (of trigeminal nerve) |
|
|
Term
| can oral candidiasis be scraped off? |
|
Definition
yes.
In contrast, leukoplakia (usually a pre-cancerous legion) cannot |
|
|
Term
| Hairy leukoplakia: location? Etiology? |
|
Definition
- lateral tongue
- EBV induced squamous cell hyperplasia. THIS IS NOT PRE-MALIGNANT |
|
|
Term
| vascularized leukoplakia (red plaque). Pre-malignant or not? |
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Definition
Erythroplakia
This lesion is highly suggestive of squamous cell dysplasia |
|
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Term
| Virus causing increased amylase, and aseptic meningitis? |
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Definition
Mumps
Can affect Parotid glands, Testis (orchitis), Pancreas, & meninges
Both pancreatitis & parotid infection can cause increased amylase. Increased lipase is very specific for pancreatitis |
|
|
Term
| Most common pathogen in sialadenitis? |
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Definition
| S.aureus (caused by sialolithiasis blocking salivary gland) |
|
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Term
Most common salivary gland tumor?
Histology?
Prognosis? |
|
Definition
- Pleomorphic adenoma
- has "biphasic" morphology: cartilage & epithelial tissue present
- high rate of recurrence due to incomplete resection
- this tumor rarely progresses to carcinoma, however rapid enlargement & involvement of CN-VII is indicative of transformation |
|
|
Term
| Parotid tumor w/ lymphocytes & germinal centers surrounded by eosinophilic-columnar epithelium. More common in males (only salivary tumor w/ this characteristic). Second most common salivary gland tumor (after pleomorphic adenoma). |
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Definition
warthin tumor
has lymphoid tissue b.c. parotid is last gland to separate from adjacent stroma during embryogenesis. The parotic COMMONLY has ectopic lymphoid tissue |
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Term
| Most common malignant salivary tumor. Has both mucinous & squamous components. |
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Definition
| Mucoepidermoid carcinoma. Usually in parotid |
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Term
|
Definition
esophagus ends in blind pouch & distal esophagus is connected to trachea:
- regurgitation
- polyhydramnios
- aspiration
- abdominal distention |
|
|
Term
| What part(s) of the esophageal wall (mucosa, submucosa, muscularis, serosa) are esophageal webs made out of? |
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Definition
|
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Term
| is a zenker diverticulum true or false? |
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Definition
false
from spasm of upper esophageal sphincter (crichopharyngeus muscle)
remember the D's: Dysphagia, Dysphonia, Diverticulum (false), bad breath |
|
|
Term
| most common cause of death in cirrhosis pts? |
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Definition
| bleeding esophageal varices (30% mortality rate per bleeding episode) |
|
|
Term
| Cancer risk in achalasia? |
|
Definition
yes, esophageal squamous cell cancer
remember irritants predisponse to squamous cell cancer in the esophagus. Here, the irritant is food. Similarly, esophageal webs predispose to squamous cell cancer by trapping food --> food rots. |
|
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Term
| bowel sounds in lung fields. lung hypoplasia (if present congenitally). |
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Definition
| Paraesophageal hernia (stomach fundus herneates through esophageal foramen) |
|
|
Term
| gerd w/ "hourglass" appearance of stomach on X-ray w/ contrast? |
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Definition
|
|
Term
| why do you get a stricture in GERD? |
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Definition
| acid damages basal layer of cells --> healed via fibrosis --> stricture |
|
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Term
name lymph nodes that esophageal cancer would spread to given its location:
1) upper 1/3
2) middle 1/3
3) lower 1/3 |
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Definition
1) Cervical nodes
2) Mediastinal or Tracheobronchial nodes
3) Celiac and Gastric Nodes |
|
|
Term
| dysphagia to solids progresses to dysphagis for solids & liquids. weight loss, pain & hematemesis. |
|
Definition
esophageal cancer.
Squamous cell cancer may additionally present w/ hoarseness & cough |
|
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Term
| Gastroschisis & Omphalocele. Which one is covered? |
|
Definition
Omphalocele is covered (failure of gut to return to abdomen from umbilical cord); NOTE: gut herniates in 6th week & returns in 10th week
Gastroschisis: failure of midline to close. Abdominal contents directly exposed to outside world |
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Term
Infant begins vomiting. PE shows olive-like mass in abdomen & visible peristalsis of stomach:
Is the vomitus bilious?
How old is the kiddo? |
|
Definition
Not bilious
Starts ~2weeks after birth (pyloric hypertrophy occurs after birth)
treatment is myotomy |
|
|
Term
Give reason for each cause of Acute gastritis:
1) Severe burn
2) NSAIDs
3) Increased intracranial pressure |
|
Definition
1) Curluing ulcers: due to decreased blood flow --> loss of mucosal defenses
2) decreased PGL production (esp PGE2) --> increased acid, decreased mucus production & bicarb secretion
3) Cushing ulcer: due to increased vagal output --> increased acid production
Other etiologies of acute gastritis = chronic EtOH, Chemo, & shock (all ICU pts are put on PPIs to prevent this)
Acid damage from acute gastritis results in erosions or ulcers |
|
|
Term
| 2 main causes of chronic gastritis? |
|
Definition
1) Chronic autoimmune (Type IV, i.e. T-cell, destruction of parietal cells in body & fundus)
2) H.pylori infection in antrum (by far more common, >90% of chronic gastritis) |
|
|
Term
| most common cause of B12 deficiency? |
|
Definition
| autoimmune gastritis (pernicious anemia) |
|
|
Term
Cancer risk in:
1) Chronic autoimmune gastritis?
2) H.pylori gastritis |
|
Definition
1) Adenocarcinoma (intestinal type): makes since since there is intestinal metaplasia (foveolar cells -> goblet cell transition)
2) Adenocarcinoma (intestinal type); MALToma |
|
|
Term
|
Definition
1) proximal duodenum (90%, anterior is more common)
2) Distal stomach (lesser curvature of antrum)
Pain of Duodenal ulcers improves w/ meals; reverse for stomach |
|
|
Term
| 2 causes of duodenal ulcers? |
|
Definition
H.pylori (>95%)
ZE syndrome |
|
|
Term
| duodenal ulcer ruptures & there is massive bleeding. Where was the ulcer? what artery did it hit? |
|
Definition
Posterior duodenal ulcer (anterior ulcers are more common)
gastroduodenal artery
ASIDE: another possible complication of a perforated posterior ulcer is acute pancreatitis |
|
|
Term
| This type of ulcer is caused by H.pylori (75%), NSAIDS, bile reflux, etc |
|
Definition
| Gastric ulcer (usually in lesser curvature of antrum) |
|
|
Term
1) 2 types of gastric carcinoma?
2) which one is associated w/ all the risk factors? (& which blood group is associated w/ it?)
3) Name 2 paraneoplastic syndromes
4) which one goes to ovaries (Krukenburg)? Sister Mary Joseph nodule (periumbilical)? |
|
Definition
1) Intestinal type & Diffuse
2) Intestinal type: chronic gastritis (H.pylori, autoimmune), nitrosamines (Japan), blood type A
3) Lesser Trelat sign (multiple, recently erupted seborrheic keratoses); Acanthosis nigricans
4) Diffuse type (signet ring cells/linitus plastica); Intestinal type
ASIDE: early satiety is more common in diffuse type (easy to see why) |
|
|
Term
polyhydramnios, bilious vomiting, & double bubble.
What is it? What genetic condition is it associated with? |
|
Definition
Duodenal atresia
Downs syndrome |
|
|
Term
| Embryonic origin of Meckel Diverticulum |
|
Definition
|
|
Term
| most common site for volvulus in elderly? Young adults? |
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Definition
|
|
Term
| Child has a rotavirus infection. Develops massive abdominal pain & bloody "current-jelly" stools. imaging shows pathology in the terminal ileum |
|
Definition
Intussusception
most common cause in kids is lymphoid hyperplasia (e.g. rotavirus). Occurs in termnial ileum b.c. that's where the peyers patches are located.
In adults, the most common cause is malignancy
Of course, don't forget about juvenile polyps, etc |
|
|
Term
| Vasculitis classically associated w/ small bowel ischemia |
|
Definition
Polyarteritis nodosa
other things: thrombus from AFib, thrombosis of mesenteric vein (e.g. lupus anticoagulant, PCV) |
|
|
Term
|
Definition
tissue transglutaminase
deaminated gliadin is presented by APCs via MHC-II --> activated Th cells --> Th-mediated tissue damage |
|
|
Term
| Where does IgA deposit in dermatitis herpetiformis? |
|
Definition
at the tips of the dermal papillae --> create a blister @ top of papillae --> looks like dermatitis herpetiformis
This will resolve with a gluten-free diet |
|
|
Term
| Antibodies in celiac disease? |
|
Definition
IgA against:
Endomysial (who knows why)
tTG
Gliadin
May have to look for IgG in IgA-deficient people (which is associated w/ celiac disease) |
|
|
Term
| What part of small bowel is most affected by celiac disease? Tropical sprue? |
|
Definition
Celiac: Duodenum >> jejunum or ileum; associated w/ Fe-def anemia (explains why hemochromatosis is linked to celiac)
Tropical sprue: J&I > D --> B12/folate deficiencies more common |
|
|
Term
| Lymphoma associated w/ celiac disease? |
|
Definition
Enteropathy associated T-cell lymphoma (EATL)
NOTE: this is a T-cell lymphoma, which makes sense since the damage in celiac disease is Th-cell mediated |
|
|
Term
| treatment for tropical sprue? |
|
Definition
| antibiotics. It is caused by some yet-to-be-determined pathogen |
|
|
Term
PAS-positive macrophages in synovial joints (arthritis), mesenteric lymph nodes, cardiac valves, & brain.
diarrhea, weight loss, & malabsorption is the classic triad |
|
Definition
Whipple's disease (caused by the bacterial Tropheryma whippelii)
Macrophages actually accumulate in the lamina propria and end up compressing the lacteals |
|
|
Term
bronchospasm, diarrhea, flushing. 5HIAA found in urine.
Why don't you ever get left-sided valvular problems? |
|
Definition
Carcinoid syndrome. Cancer must met to liver (dumps serotonin directly into hepatic vein)
Lung has monoamine oxidase --> metabolizes 5HT in pulmonary circuit |
|
|
Term
most common location for carcinoid tumors?
what stain indicates its neuroendocrine origin? |
|
Definition
small bowel (also may arise in appendix, which is the most common tumor of appendix)
Chromogranin |
|
|
Term
| etiology of appendicitis in Kid? Adults? |
|
Definition
lymphoid hyperplasia
fecaliths
both result in obstruction of lumen |
|
|
Term
|
Definition
| 1/3 from anterior-superior iliac spine to umbilicus (i.e. closer to ASIS) |
|
|
Term
UC or Crohn's?
1) bloody diarrhea
2) granulomas
3) lead pipe sign
4) string sign
5) Carcinoma
6) primary sclerosing cholangitis
7) p-ANCA
8) Ca-oxalate nephrolithiasis
9) Ankylosing spondylitis, sacroiliitis, migratory polyarthritis, erythema nodosum, uveitis
10) Increased risk w/ smoking |
|
Definition
1) UC
2) Crohns
3) UC (loss of haustra)
4) Crohns
5) Both: UC(>10yrs); Crohns(only if colon is involved)
6) UC
7) UC (aside: this is also the marker for microscopic polyangiitis & churg-strauss)
8) Crohn's (from fat malabsorption)
9) Crohn's
10) Crohn's (Smoking decreases risk for UC) |
|
|
Term
| Down syndrome is associated w/ these 2 GI disorders that are due to inability to pass injested material past certain points |
|
Definition
1) duodenal atresia (remember bilious vomiting)
2) Hirschprung disease |
|
|
Term
Myenteric plexus eponym?
Submucosal plexus eponym?
What is absent in Hirschprungs? |
|
Definition
Auerbach & Meissner
Both are absent in Hirschprung |
|
|
Term
where does the outpouching occur in colonic diverticula?
what gets herniated? |
|
Definition
| Usually sigmoid colon. Herniation of mucosa & submucosa through area where vasa recta traverse the muscularis propria (weak point) --> risk for bleeding |
|
|
Term
| Air/fecal material in urine of old person on a low fiber diet with diverticulosis. |
|
Definition
| Colovesicular fistula: inflammed diverticula ruptures & attaches to adjacent bladder (other types of fistulas possible) |
|
|
Term
| common etiology of both diverticula & angiodysplasia |
|
Definition
High pressure
both cause hematochezia in older adults. Angiodysplasia is in right colon, diverticulosis is in left colon |
|
|
Term
| Atherosclerotic process causing fear of eating? |
|
Definition
Ischemic colitis. Causes postprandial pain (b.c. stomach shunts blood from intestines) & weight loss.
Watershed area (splenic flexure) is most likely to become infarcted |
|
|
Term
Does IBS:
1) improve w/ defecation?
2) have a distinctive pathological change
3) improved by dietary modifications |
|
Definition
1) yes
2) no distinctive histology (there is a problem w/ the physiology of motility)
3) increased dietary fiber may improve disease |
|
|
Term
| inheretence of hereditary hemorrhagic telangiectasia |
|
Definition
|
|
Term
| histologic appearance of hyperplastic polyp |
|
Definition
| serrated. usually in left colon. no malignant potential |
|
|
Term
| Describe mutations in the colon adenoma-carcinoma sequence |
|
Definition
| APC --> kRAS --> p53&increased COX activity |
|
|
Term
| What chromosome is APC on? |
|
Definition
|
|
Term
which is more associated w/ malignant potential for colon adenomas:
1) pedunculated or sessile growth
2) <2cm or >2cm in size
3) villous, tubular, or serrated |
|
Definition
1) sessile
2) >2cm
3) villous (serrated=hyperplastic, no malignant potential at all) |
|
|
Term
Gardner syndrome
Turcot syndrome |
|
Definition
Gardner: FAP + retroperitoneal destructive fibromas & osteomas of skull (& epidermoid cysts)
Turcot: FAP + CNS tumors (medulloblastoma/glial cell tumors) |
|
|
Term
| Are juvenile polyps hamartomas? |
|
Definition
yes. Usually solitary & present w/ rectal prolapse
if multiple --> increased cancer risk |
|
|
Term
Hamartomatous polyps w/ smooth muscle in stalk found throughout GI tract, hyperpigmentation of skin/mucosa.
1) Diagnosis?
2) Mode of inheritance?
3) Carcinomas that person is at increased risk for? |
|
Definition
1) Peutz Jeghers syndrome
2) AD
3) Colorectal, Breast, Gynecologic (e.g. endometrial) |
|
|
Term
| 2 main ways that colon cancer develops. |
|
Definition
1) Adenoma-Carcinoma sequence (APC->kRAS->p53/COX)
2) microsatellite instability (indicates defective DNA copy mechanisms, e.g. mismatch repair in HPNCC) |
|
|
Term
| When do you start colon cancer screening? |
|
Definition
|
|
Term
|
Definition
DNA mismatch repair. Colon cancer arises through microsatellite instability mechanisms.
increased risk for colorectal, ovarian, and endometrial cancers (very similar to peutz jegher, except breast not involved) |
|
|
Term
Left or Right colon cancer:
1) decreased stool caliber & blood in stool
2) iron deficiency anemia. vague pain. occult blood. |
|
Definition
1) left. LLQ pain common
2) right. Older adult w/ Fe-def anemia has colon cancer until proven otherwise |
|
|
Term
| Endocarditis is caused by this bug in people with colon cancer |
|
Definition
|
|
Term
| Tumor marker for colon cancer (can be used to assess successful treatment response & detecting recurrance) |
|
Definition
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