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123 Cards in this Set

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  • Back
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painless, movable mass in parotid
pleomorphic adenoma
Most common tumor of salivary gland;
Benign with a high rate of recurrence
bird's beak on barium swallow
achalasia: failure of relaxation due to loss of myenteric plexus (high proximal LES pressure)
dysphagia to both solids and liquids
achalasia...what does it increase risk of?
esophageal carcinoma
2 forms of secondary achalasia?
Chagas Disease or CREST Scleroderma
alcoholic with painless hematemesis?
Rupture of esophageal varices
alcoholic with painful hematemesis?
Mallory-Weiss Tears (also in bulemics)
reflux + punched out ulcers?
esophagitis due to HSV-1
reflux + linear ulcers?
esophagitis due to CMV
transmural esophageal rupture due to violent retching?
Boerhaave syndrome
dysphagia for food, beefy red tongue (glossitis), and iron deficiency anemia?
Plummer-Vinson syndrome (dysphagia from esophageal webs)
Cleft lip/palate stem from failure of..?
facial prominences to fuse
painful ulcer with gray base surrounded by erythema is? due to?
Apthous ulcer
Stress (resolves spontaneously)
Recurrent apthous ulcers, genital ulcers, and uveitis?
Behcet's syndrome
Immune complex vasculitis involving small vessels
Often seen after viral infection
Where does HSV-1 remain latent?
trigeminal ganglion
reactivation by stress or sunlight
Most common location for squamous cell cancer of mouth?
floor of the mouth
rough patch found on lateral tongue?
hairy leukoplakia
what is it due to?
EBV in immunocompromised (not dysplastic!)
bilateral inflamed parotid glands, orchitis,pancreatitis, and aseptic meningitis
Mumps due to paramyxovirus

who is highest risk of sterility?
Sialadenitis leads to what infection?
unilateral staph aureus infection due to obstructing stone
benign cystic tumor with abundant lymphocytes and germinal centers in salivary gland
Warthin's tumor

almost always in which gland?
only malignant tumor of salivary gland?
mucoepidermoid carcinoma

frequently involves what?
the facial nerve
baby with vomiting, polyhydramnios, abdominal distension and aspiration
Tracheoesophageal fistula
old man with dysphagia, obstruction and halitosis
Zenker's Diverticulum

where does it arise?
junction of esophagues and pharynx
most common cause of death in cirrhosis?
esophageal varices
heartburn, asthma in a fat smoker?
GERD: reduces LES tone
What are other risk factors?
alcohol, caffeine or hiatal hernia
replacement of non-keratinized stratified squamous epithelim with non-ciliated columnar epithelium with goblet cells in the distal esophagus
risk factors for squamous cell cancer of esophagous?
alcohol, smoking, achalasia, hot tea, esophagel webs
(occurs in upper 2/3 of esophagus)
weight loss, progressive dysphagia, pain and hematemesis,
esophageal carcinoma
Which nodes would upper, middle, lower spread to?
extrusion of abdominal contents thru the abdominal folds

covered or no?
in relation to umbilicus?
not covered
lateral to umbilicus
persistence of herniation of abdominal contents into umbilical cord
Omphalocele (more serious); it is supposed to return to abdominal cavity at 10 weeks

covered or no?
Covered by peritoneum and amnion
2 week old male with non-bilious vomiting
pyloric stenosis

what can you feel?
palpable olive
patient in ICU should be preventatively given what?
PPIs because stress ulcers occur
5 Risk factors for acute gastritis?
Curling ulcer (burns)
Heavy alcohol consumption
Increased ICP (Cushing ulcer)
ICU stress ulcers
how does an increase in intracranial pressure lead to an ulcer?
increased stimulation of the vagus nerve leads to increased acid production
Describe the autoimmune destruction in chronic gastritis
Type 4 hypersensitivity against parietal cells or intrinsic factor
megaloblastic anemia with achlorhydria and intestinal metaplasia?
Chronic autoimmune gastritis
How do you confirm eradication of h.pylori?
negative urea breath test and lack of stool antigen
what are the locations of the various gastritises?
autoimmune: body and fundus
Bacterial (H.pylori): antrum
epigastric pain that improves with meals
duodenal ulcer: solitary lesion due to h. pylori 95% of the time (ZE other 5%)

biopsy show?
ulcer with hypertrophy of Brunner's glands
epigastric pain that worsens with meals
gastric ulcer: h. pylor 70% of the time
(other causes are NSAIDS and bile reflux)
When is ulcer malignant vs. benign?
Benign: all duodenal and gastric ones that are small, sharply demarcated (punched out)
Malignant: large irregular gastric ones with heaped up margins
What are the risk factors for intestinal type gastric carcinoma?
Nitrosamines, intestinal metaplasia (h pylori and autoimmune gastritis) and blood type A.
weight loss, abdominal pain, anemia and early sateity
gastric carcinoma
two skin manifestations of gastric carcinoma?
Acanthosis nigracans: darkening of axilla
Leser-Trelat sign: dozens of sudden onset sebhorreic keratoses q
3 sites of gastric carcinoma metastases:
1) Virchow's node: left supraclavicular node
2) Periumbical region (intestinal type)
3) Kruckenburg tumor bilateral ovaries (diffuse type)
signet ring cells and linnitus plastica
diffuse gastric carcinoma
brain gyri appearance of stomach, gastric hypertrophy with protein loss, parietal cell atrophy and increased mucous cell
Menetrier's disease: precancerous
treatment of peptic ulcers?
triple therapy: PPI, amoxcillin and clarithromycin
double bubble sign, polyhydramnios and bilious vomiting
duodenal atresia

associated with what?
down's syndrome
bleeding, volvulus, intussception or obstruction can all be presentations of?
Meckel's diverticulum

rule of 2's?
how it arose?
2 inches long, within 2 feet of the ileocecal valve, first 2 years of life, 2% of population
failure of vitelline duct to involute
most common location of volvulus in elderly? young adults?
sigmoid colon
cause of currant jelly stools in child
Intussception due to lymphoid hyperplasia in terminal ileum due to rotavirus
cause of currant jelly stools in adult
tumor (intussception)
abdominal pain out of proportion to findings, bloody diarrhea and decreased bowel sounds
small bowel infarction (often splenic flexure)
where is lactase located and what does it cause?
tips of villi--> osmotic diarrhea
3 Antibodies in celiac disease?
antigliadin, anti tissue transglutaminase, antiendomysial
abdominal distension, diarrhea, failure to thrive and small vesicles on skin
celiac disease with dermatitis herpeteformis

damage most prominent in ?
flattening of villi, hyperplasia of crypts and increased intraepithelial lymphocytes in duodenum
celiac disease

late complications of celiace?
small bowel carcinoma and T-cell lymphoma (both very rare)
diarrhea with nutritional deficiencies after returning from the Carribean
tropical sprue (resolves with antibiotics)
older man with PAS +, foamy macrophages in intestinal lamina propria
Whipples disease (gram + tropheryma whippeli)

What are 3 other common sites of involvement?
cardiac, neurological and arthralgias
child with malabsorption and fat accumulation in enterocytes with neurological symptoms

What is the genetic defect?
deficiency of apo B-48 and apo B-100 thus absent plasma VLDL and LDL
submucosal polyp like nodule most commonly in the small bowel that stains + for chromogranin
Carcinoid tumor

What does it secrete and how is that detected?
serotonin detected via 5-HIAA in urine
bronchospasm (wheezing), diarrhea, flushing of the skin and right sided valvular fibrosis (tricuspid regurg) triggered by alcohol or emotional stress
Carcinoid syndrome (ONLY if carcinoid tumor has metastasized to the liver)

Why only right sided heart valve issues?
Monoamine oxidase in lung converts serotonin to 5-HIAA so doesn't get to left
periumbical pain, fever and nausea with pain localizing to right lower quadrant

what is cause in children? adults?
kids: lymphoid hyperplasia
adults: fecalith
left lower quadrant pain with bloody diarrhea and rectal involvement
Ulcerative colitis

what are complications of this?
toxic megacolon and carcinoma after 10 years
crypt abcesses with neutrophils
Ulcerative colitis

what is protective against this disease?
lead pipe sign on imaging
Ulcerative colitis

how much wall involvement?
other disease associations?
mucosal and submucosal ulceration
primary sclerosis cholangitis
full thickness inflammation with knife like fissures in terminal ileum and other parts of small bowel sparing rectum
Crohn's disease (skip lesions)

What are 3 complications?
Malabsorption/nutritional deficiency
Fistula formation
Calcium oxalate nephrolithiasis
lymphoid aggregates with granulomas and right lower quadrant pain with non-bloody diarrhea
Crohn's disease

What associations?
Ankylosing spondylitis, sacroileitis, migratory polyarthritis, erythema nodosum, uveitis
string sign on imaging
Crohn's disease

What other things can you see?
cobblestone mucosa, creeping fat and strictures
failure to pass meconium and empty rectal vault on DRE
hirschsprung disease

What is it due to?
Disease association?
Due to failure of neural crest cells to migrate, thus absent ganglion cells in plexus so no relaxation of bowel.
Down's syndrome
What are false diverticula?
outpouching of only submucosa and mucosa

Where do they occur most?
where vasa recta perforate the muscularis externa (weak point)
left lower quadrant pain, fever and leukocytosis with bright red rectal bleeding?

where are they most commonly located?
sigmoid colon
diverticulosis is many diverticula which can be remedied by...?
high-fiber diet

presents as?
painless rectal bleeding
hematochezia in an older adult

a malformation of submucosal and mucosal capillary beds arising in cecum and right colon
older individual with extreme post-prandial pain and bloody diarrhea
ischemic colitis

most common plac?
splenic flexure
middle aged female with bouts of bloating, flatulence and change in bowel habits (diarrhea or constipation) that improves with defecation
Irritable Bowel Syndrome
protrusion of colonic mucosa with serrated appearance
hyperplastic polyps

Benign or malignant?
most commonly found where?
Fully benign
rectosigmoid colon
multiple non-malignant hamartomas throughout the GI tract, hyperpigmented spots on lips, mouth, hands, genitalia
Peutz-Jeghers Syndrome

What does this increase your risk for?
Colorectal, breast and gynecological cancers
Name the 2 mechanisms of pathogenesis of Colorectal carcinoma
1) 15% via microsatellite instability leading to DNA mismatch repair gene mutations--> sporadic and HNPCC syndrome.
2) 85% APC/b-catenin pathway: loss of APC gene, K-Ras mutation, Loss of p53
cystic fibrosis patients with inability to pass stool at birth
meconium ileus
necrotizing enterocolitis is more common in which group?
most common bowel obstruction?
adhesions from prior surgery
thousands of polyps that inevitably become colon cancer by age of 40

due to what mutation?
two hit hypothesis on APC gene on chromosome 5
FAP+ osseous and soft tissue tumors and retinal hyperplasia
Gardener's syndrome
FAP+ malignant CNS tumors
Turcot syndrome
AD mutation of DNA mismatch repair genes leads to?
HNPCC/Lynch Syndrome

What part of colon is involved?
proximal colon (whereas vast majority of other colon cancer is in sigmoid colon)
napkin ring lesion (or apple core lesion) presenting with decreased stool caliber, left lower quadrant pain and blood streaked stool
left-sided carcinoma
raised lesion presenting with iron deficiency anemia and vague pain
right-sided carcinoma
Tumor marker for colorectal cancer?
what type of necrosis occurs in acute pancreatitis?
liquefactive hemorrhagic necrosis due to autodigestion by pancreatic enzymes AND fat necrosis leading to saponification
List risk factors for acute pancreatitis
Alcohol and gallstones (MC)
trauma, hypercalcemia, hyperlipidemia, drugs, scorpion stings, mumps, and rupture of a duodenal ulcer
Epigastric pain that radiates to the back?
acute pancreatitis

what enzymes would be raised?
amylase and lipase (ONLY for ACUTE pancreatitis)
Periumbical pain and flank hemorrhage with nausea and vomiting
acute pancreatitis

what complications arise?
DIC, ARDS, hypocalcemia, diffuse fat necrosis, pseudocyst formation, hemorrhage
Most common cause of chronic pancreatitis in adults? children?
Adults: alcoholism and smoking
Chirldren: Cystic fibrosis

What does this predispose them towards?
pancreatic carcinoma
chain of lake pattern on imaging
chronic pancreatitis

What are other features?
Pain radiating to the back, malabsorption with steatorrhea, secondary diabetes mellitus
thin elderly individual presenting with diabetes mellitus
pancreatic carcinoma (in body or tail)

what are the major risk factors?
smoking and chronic pancreatitis, age above 50, jewish and African american males
obstructive painless jaundice with pale stools and palpable gallbladder
pancreatic carcinoma (in head more common)
(courvoisier's sign)

what is the tumor marker?
CA 19-9
weight loss, redness and tenderness on palpation of extremities
Migratory thromophlebitis (Trousseau's sign) of Pancreatic carcinoma

Prognosis for pc?
less than a year survival
pruritis, jaundice, dark urine, light stools, and hepatosplenomegaly?
Extrahepatic biliary obstruction, PBC, PSC
jaundice, fever, RUQ pain

what are the 4 risk factors:
female, fat, fertile, forty
waxing and waning RUQ pain
biliary colic due to gallbladder contracting against a stone lodged in the cystic duct
RUQ pain radiating to right scapula, fever with increased WBC, nausea, vomiting and increase alk phos
acute cholecystitis

due to?
pressure ischemia, bacterial overgrowth and inflammation
radiolucent yellow stones
Cholesterol stones

risk factors?
4 F's, clofibrate, Native american, Crohn's and cirrhoisis
radioopaque pigmented stones
bilirubin stones

risk factors?
extravascular hemolysis, and biliary tract infection with Ascaris lumbricoides or Clonorchis sinensis
porcelain gallbladeer and herniation of gallbladder against muscular wall (Rokitansky-Ashoff sinus)
chronic cholycystitis

air in biliary tree?
fistula from gallbladder to small intestine
jaundice due to mildly low UGT activity or decreased bilirubin uptake
Gilbert's syndrome

precipitated by?
stress (such as severe infection)
jaundice and kernicterus due to absence of UDP-glucuronyl transferase
type I Crigler-Najjar syndrome
high levels of UCB (indirect bilirubin)
hemolytic jaundice

urine bilirubin and urine urobilinogen
Urine bilirubin is elevated
urine urobilinogen in normal or decreased
dark liver
Dubin-Johnson syndrome

due to?
deficiency of bilirubin canaliculare transport protein
bands of fibrosis and regenerative nodules of hepatocytes

what is the fibrosis mediated by?
TGF-B from stellate cells (Kuppfer cells)
3 features of cirrhosis and what they lead to:
1) Portal hypertension: ascites, congestive splenomegaly, varices, hemorrhoids, caput medusa
2) decreased detoxification: mental status change, asterixis and coma, gynecomastia, spider angiomata and palmar erythema
3) decreased protein synthesis: hypoalbunemia with edema, coagulopathy due to less synthesis of clotting factors
swelling of hepatocytes with mallory bodies
alcohol related liver disease

what is elevated?
fatty change, hepatitis and/or cirrhosis with no exposure to alcohol
NASH: middle aged woman with diabetes
cirrhosis, secondary diabetes mellitus and bronze skin

leads to what problems?
CHF and testicular atrophy and an increased risk of hepatocellular carcinoma
wear and tear?
lipofuscin (prussian blue distinguishes iron:blue from brown lipofuscin)
HFE gene mutations leads to what lab findings
increased ferritin, dec TIBC, inc serum iron, inc % saturation
child with cirrhosis, dementia, chorea, and Kayser-fleisher rings
Wilson's disease

due to?
defective ATP7B gene and D-penicillinamine
40 year old woman with obstructive jaundice
primary biliary cirrhosis

what antibody?
anti-mitochondrial antibody
periductal fibrosis with onion skin appearance
Primary sclerosing cholangitis

What is there an increased risk for?
beaded appearance on imaging
primary sclerosising cholangitis

what disease is associated?
UC and p-Anca positivity
what do aflotoxins from aspergillus do?
p53 mutations leading to hepatocellular carcinoma
hepatomegaly with a nodular free edge of the livr
metastasis to liver

from which site?
colon, pancreas, lung and breast