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53 Cards in this Set

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The following IHC in anal Paget's disease indicates that the primary is most likely ___?

CK7+
CK20+
GCDFP-
Rectal or anal adenocarcionma (50-75% of anal Paget's assocaited with rectal/anal adenocarcinoma)
The following IHC in anal Paget's disease indicates that the primary is most likely ___?

CK7+
CK20-
GCDFP+
Intraepithelial apocrine carcinoma (minority of cases)
CK7 and CK20 staining in anal gland (apocrine) carcinoma?
CK7+
CK20-

(Note: rectal type adenocarcinoma of anus is CK7-, CK20+ like rectal/colon adenocarcinoma)
Autoimmune metaplastic atrophic gastritis lab values:
Anti parietal cell antibody
Intrinsic factor antibody
serum gastrin
Gastric pH
B12
Serum pepsinogen 1
Schilling test
H. pylori antibodies
HLA haplotyes
Autoimmune metaplastic atrophic gastritis lab values:
Anti parietal cell antibody: +
Intrinsic factor antibody: +
serum gastrin: Increased
Gastric pH: Alkaline
B12: Decreased
Serum pepsinogen 1: Decreased (loss of chief cells)
Schilling test: + (corrected by B12 injection)
H. pylori antibodies: - (if + is not related)
HLA haplotyes: B8, DR3
The histological findings are limited to the body/fundic mucosa with normal antral findings and consist of (1) chronic gastritis with prominent lamina propria lymphocytic and plasma cell infiltration directed at fundic glands, (2) loss of oxyntic glands, i.e, chief and parietal cells, (3) pseudopyloric metaplasia (glands that resemble mucus glands in the antrum but lack gastrin cells), and (4) intestinal metaplasia with goblet and paneth cells.
Autoimmune metaplastic atrophic gastritis
List 5 factors that increase the risk for esophageal SCC.
Risk factors for esophageal SCC:
1. nitrates and nitrosamine
2. vitamin deficiencies (A, C, thiamine riboflavin)
3. achalasia
4. hot beverage or lye burns
5. Plummer-Vinson syndrome (Triad - esophageal webs/dysphasia, glossitis, Fe deficiency anemia
What is the relative risk of esophageal adenocarcinoma in the setting of Barrett esophagus?
30x increase
Is eosinophilic esaphagitis related to reflux?
No because patients do not respond to anti-reflux medications.

NOTE: patients may respond to elemental diets indicating that protein sensitivities may lead to reflux-like symptoms.
What is the lower size limit threshold between ECL cell hyperplasia and carcinoid?
0.5 mm

NOTE: Or invasion into submucosa
What is the criteria for antrectomy and local excision of the fundic lesions, rather than endoscopic removal, for carcinoid?
1. If carcinoid is >1 cm or
2. More than 5 lesions
Inflammatory fibroid polyp IHC:
CD117
CD34
SMA
CD68
Inflammatory fibroid polyp IHC:
CD117 -
CD34 +
SMA focal +
CD68 focal +
Most common site for Peutz-Jegher polyp.
Small intestines
Peutz-Jegher: autosomal dominant or recessive?
dominant
Name the criteria for diagnosis of Peutz-Jegher syndrome? (4)
1. 3 or more histologically confirmed Peutz-Jeghers polyps or
2. Any number of Peutz-Jeghers polyps in a patient with a family history of PJS or
3. Characteristic, prominent, mucocutaneous pigmentation with a family history of PJS or
4. Any number of Peutz-Jegher polyps and characteristic, prominent mucocutaneous pigmentation
What cancers are people with Peutz-Jegher syndrome at increased risk for? (6)
1. GI carcinoma
2. Breast cancer
3. Pancreatic cancer
4. SCTAT (sex cord tumors with annular tubules) of ovary
5. Adenoma malignum of uterine cervix
6. Sertoli cell tumor of testis
KIT negative GIST have mutation in what?
Platelet-derived growth factor receptor (PDGFR) activating mutation
What are the two types of KIT activating mutations in GIST and which is responsive to Gleevec (imatinib)?
1. Regulatory site type (sensitive to Gleevec)
2. Enzymatic site type (resistant to Gleevec)
Glomus tumor IHC:
CD117
SMA
Chromogranin
S100
Glomus tumor IHC:
CD117 -
SMA +
Chromogranin -
S100 -
What is the PAS staining in Kaposi sarcoma?
PAS + hyaline bodies can be seen in endothelial cells
What is another name for HHV-8 monoclonal antibody?
LANA (latent nuclear antigen)
Does H. pylori produce urea?
No, it produces ureASE
What are the causes of reactive ("chemical") gastropathy? (8)
1. NSADs
2. EtOH
3. Chemotherapeutic drugs
4. Smoking
5. Uremia
6. Severe stress (surgery, burns)
7. Ischemia/shock
8. Bile reflux

NOTE: not associated with H. pylori
What are the 2 most specific antibodies in celiac disease?
Antiendomysial and antitissue transglutaminase antibodies
In what 2 groups is the presence of celiac disease higher than the general population?
Down's syndrome
Diabetes
What lymphoma are people with celiac disease at risk for?
Enteropathy-associated T-cell lymphoma
Name the 4 antibodies associated with celiac disease.
1. antigliadin
2. antireticulin
3. antiendomysial
4. antitissue transglutaminase
What is the location of the most aggressive carcinoids of the GI tract?
Ileal carcinoids are most aggressive (20% mortality).
What GI tract location for carcinoid is associated with MEN1?
Ileum
What is the most common appendicieal neoplasm?
Carcinoid
What is pseudolipomatosis?
Minor procedural complication of endoscopy which looks like fat diffusely involving lamina propria. In actuality, the empty spaces are trapped air.
What mutation is associated with Crohn disease?
CARD15/NOD2
Between UC and Crohn's, which is p-ANCA more associated with?
UC (75%), only 10% of Crohn's is associated with p-ANCA.
This gene which causes a familial syndrome with high risk of colon adenocarcinoma is in the Wnt signaling pathway.
APC
What is Garnder syndrome?
FAP with multiple osteomas, epidermal cysts, and fibromatosis.
What is Turcot's syndrome?
FAP with CNS tumors (medulloblastoma, glioma)
Where is the most common location for schwannoma in the tubular GI tract?
stomach
Is Juvenile polyposis syndrome autosomal dominant or recessive?
Dominant
Juvenile polyposis syndrome puts patients at increased risk for what cancers in the GI system? (5)
1. colon
2. stomach
3. small intestine
4. biliary tract
5. pancreas
MALT lymphoma is associated with H. pylori infection. What karyotype anomalies can be found? (2)
t(11;18)
11 = API2 = BIRC3
18 = MLT = MALT1 = MLT1

Trisomy 3
Is GVHD of the GI tract common in solid organ transplant?
No

NOTE: GVHD develops in 50% of BMT
What HLA are common in celiac disease? (2)
HLA-DQ2
HLA-DQ8
What is the most common presentation of celiac disease in adults?
Fe deficiency anemia
What is the most common variant of esophageal atresia?
Blind upper and lower esophagus segments with fistula between blind lower segment and trachea.
What is the most common location for granular cell tumor in the tubular GI tract?
Esophagus
What is the most common site for heterotopic pancreas in the tubular GI tract?
Stomach
What are the clinical features of Cowden's syndrome? (4)
1. hamartomatous polyps of GI tract
2. breast cancer
3. thyroid cancer
4. gingival hyperplasia
What are the 2 clinical features of Menetrier's disease?
1. marked foveolar hyperplasia in the gastric body
2. hypoproteinemia (2/2 protein-losing enteropathy)
Endoscopic removal of a pedunculated adenoma with submucosal adenocarcinoma is regarded as treatment provided when what histological conditions are met? (3)
1. Margins negative
2. No lymphovascular invasion
3. Carcinoma is NOT poorly diff
Injury due to this cause of the colon include concentric, diaphragm/ring-like strictures on the right side; discrete erosions/ulceratinos with little associated inflammation; collagenous colitis; ischemic-type mucosal damage.
NSAID injury to colon
What is diversion colitis?
Colitis in the unused part of the colon after ileostomy or colostomy due to lack of fecal material (short-chain fatty acids) running through the lumen.

NOTE: treatments include colostomy reversal or short-chain fatty acid enema
Most cases of Hirschsprung's disease involve what part of the tubular GI tract?
Rectum and sigmoid
Does Hirschsprung have a gender predilection?
M:F = 4:1
What gene mutations are associated with Hirschsprung's disease? (2)
RET
Endothelin B receptor