Gipath

Front 1

h pylori is ass with what cancer?

Back 1

primary B-cell gastric lymphoma - MALT LYMPHOMA!, gastric adenocarcinoma, etc

from chronic gastritis - no pmn, just lymphocytes

Front 2

Monilial plaques

Back 2

Candida - immunosuppress, raised white spots

Front 3

Metaplastic atrophic gastritis can be due to what 2 origins?

Back 3

1)Environment (DISTAL)- antrum, ass with H pylori, gastric cancer

2)Autoimmune (PROXIMAL)- body, Ab to PARIETAL CELLS, so ass w/ v gastric acid, Carcinoid tumors

Atropic gastritis MC in JAPAN

Front 4

Hyperplastic gastrin-producing neuroendocrine cells (found in nodules) (carcinoid tumor develop)

Back 4

pernicious anemia

Front 5

tumor of intersittial cells of Cajal (induce peristalsis)

Back 5

GIST

Front 6

oropharyngeal dysphagia with Liquids better than solids

Back 6

esophageal webs (Plummer-Vinson syn & Patterson-Kelly)
goiter
pharyngeal neoplasms
cervical osteoarthritis
cricopharyngeal dysfunction

mechanical d/o

Front 7

oropharyngeal dysphagia with Solids better than liquids

Back 7

Brainstem lesion
Myasthenia gravis
ALS
MS

neuromuscular d/o, usually have many complicating systemic conditions

Front 8

Individual that does not relax the upper esophageal sphincter

Back 8

Cricopharyngeal Achalasia (neuromuscular problem)

difficulty initiating a swallow, PHARYNGEAL DILATION

over time -> Zenker's diverticulum

Front 9

3 anatomical regions of esophageal compression

Back 9

1)aorta

2)main stem bronchus

3)esophageal hiatus

Front 10

Esophageal dysphagia where the person only intermittently experiences difficulty when swallowing solids

Back 10

Rings

Front 11

Progressive Esophagial Dysphagia ass with heartburn (3)

...not ass with heartburn

Back 11

1)stricture of the esophagus

2)Barrett's

3)Scleroderma


no heartburn, then CANCER

Front 12

Esophageal dysphagia with both food and water

1) intermittent

2) progressive

Back 12

1)Diffuse esophageal spasm (ass with angina-like chest pain)

2)Esophageal Achalasia (LES does not relax, loss of Meissner's and Auerbach's plexuses)

Front 13

Two common locations for recurent herpes

Back 13

1)gingiva
2)hard palate

Front 14

Major differences b/w aphthous ulcers and herpes labialas

Back 14

1)aphthous ulcers do NOT start as vesicles (start as ulcers)

2)aphthous ulcers NEVER occur in the keratinized mucosa (start on thin mucosa such as buccal mucosa and ventral tongue)

Front 15

What can inhibit aphthous ulcer formation

two diseases/syn ass with major aphthae

Back 15

Smoking

1)Crohn's

2)Behcet's syn

Front 16

Angular cheilitis is cuased by what? predisposed by (3)?

Best way to dx?

Back 16

MCC is candida

1)poorly fitting dentures

2)overclosure

3)Vit B12 deficiency

also linked to Crohn's disease

dx: simple swab and smear

Front 17

mucocele caused by

Back 17

mucous retention in area secondary to trauma and irritation (salivary stone)

tx: must completely remove salivary gland

Front 18

fordyce granules

Back 18

ectopic sebaceous gland on lips or buccal mucosa

very discree yellowish-gold pinpoint granules

Front 19

type of buccal lesion generally seen with certain syndromes, esp neurofibromatosis

Back 19

Lipoma

Front 20

Civatte bodies (orangeish thing in epithelium) & confined band of lymphocytes

Back 20

Lichen planus

-a chronic, inflammatory AUTOIMMUNE dz

bilateral, t-lymphocyte mediated

potentially PRE-CANCEROUS

Front 21

Candidiasis endocrinopathy syn

Back 21

patients have a thyroid disorder and will not respond ot treatment until you correct the underlying endocrine disorder

Front 22

cottage-chees like appearance that is scrapable, also ass with immunosuppressed patients

Back 22

Pseudomembranous candidiasis

Front 23

T/F nicotinic stomatitis pts are at high risk for cancer

Back 23

False!

ass with pip smokers

classic red dots on palate

Front 24

Salivary Gland Tumors:

1)location of major gland tumors

2)location of minor gland tumors

Back 24

1)MC major gland tumors = PAROTID

2)minor gland = palate

Front 25

1)Benign Salivary gland tumor?

2) Malignant Salivary gland tumor? (2)

Back 25

1)Pleomorphic adenoma (no ulceration)

2) Mucoepidermoid carcinoma (blueish hue reflecting the mucin component) & Adenoid cystic carcinoma (both have ulceration and pain)

Front 26

Beningn migratory glossitis (geographic tonge) is ass with?

Back 26

Psoriasis

also perhaps Lyme disease and Lupus

Front 27

Oral regions of high risk?

low risk?

Back 27

high risk: vental tongue, floor of mouth, solf palate, lips

low risk: buccal mucosa, ginvival/mucobuccal fold areas

Front 28

MC infections of colon

mech of dz?

Back 28

viral infections like Rotaviuses (kids, self-limited, dehydration is biggest problem) and ass Norwalk strain of viruses (adults)

Parasites and bacteria (ie Amoebic colitis) have a > inceidence in developing countries

Infects the enterocytes in the duodenum and jejunum -> cells damaged and shed -> immature cell line do not have same fxn (diarrhea ie lactose intolerance)

NO VILLOUS ARCHITECTURE

Front 29

Cholera mech

Back 29

attach to enterocytes -> produce cGMP & alter permeability -> ^ peristalsis and diarrhea

VILLOUS ARCHITECTURE IS PRESERVED

Front 30

Collagenous colitis & Lymphocytic colitis cause?

Back 30

Watery diarrhea w/ NO HEMORRHAGE (if blood in diarrhea than not CC or LC)

CC - thick collagen band in lamina propria

LC - CD8 T-lymphocyte in lamina propria

Front 31

how many days does it taek to clear out blood?

Back 31

3-5 days

Front 32

detect traces of blood in stool that are not necessarily visible by?

can remain psitive for how long?

Back 32

hemeocccult/guaiac test

2 weeks! usual point of discharge is when stool turns brown

Front 33

Shokc presents with ___ blood loss

Back 33

2L

Front 34

Thrombocytosis and leukocytosis without infection may be caused by?...as a result of what?

Back 34

Epinephrine and Cortisol

Shock

p.s. ADH released in shock will result in hyponatremia

Front 35

Supine hypotension =

Postrural hypotention =

Back 35

Supine hypotension = loss > 20% blood volume

Postrural hypotention = loss of 10-25% (sys drop > ~10 mg) of blood volume OR pulse ^ 20/min

Front 36

Overtransusion will cause?

most significant in?

Back 36

Recurrent bleeding

Cirrhotic patien

Front 37

UGI Vessel that bleeds without a mark or ulcer

Back 37

Dieulafoy's erosion

also Aortic graft

Front 38

in UGI bleeds, BUN:creatinine >10x indicates (BUN > 40)

Back 38

1)UGI bleed where the blood in the SMALl BOWEL is getting absorbed and being turned into urea and shows up in blood

2)Volume depletion

Front 39

Iron is reabsorbed where?

Fats?

Back 39

Iron = Duodenum

Fats = ileum

Front 40

Niacin deficiency

Back 40

Pellagra: 4D's

Diarrhea
Dementia
Dermatitis
Death

Front 41

Riboflavin deficiency

Back 41

Glossitis & cheilitis

Front 42

Thiamin (B1) deficiency?

Back 42

parasthesisas (beriberi)

Front 43

Folic Acid deficiency

Back 43

Megaloblastic anemia

(microblastic = iron def)

Front 44

**Ca deficiency?

Back 44

carpopedal spasm

Front 45

Seriology for celiac sprue

Back 45

tTG (tissue transglutaminase, most specific)

anti-endomyseial antibody

anti-gliadin (less specific)

Front 46

PAS stuffed macrophages

Back 46

Whipple's Disease

fever, neruologic symptoms, arthritis, diarrhea, weight loss

Front 47

if you see ulcer disease way down in the duodenum, past the ampulla, or in the jejunum think ____

Back 47

Zollinger-Ellison

(malignant cells make too much gastrin -> acid, but not as much as Pernicious anemia)

Front 48

The way to diferentiate ZE and Pernicious anemia (atropic gastritis) is by?

Back 48

pH of stomach

atrophic gastritis (PA): pH >4

ZE: pH = 2

Front 49

most common treatable of of malabsorption

Back 49

Giardiasis w/ metronidazole

Front 50

genes involved in defective DNA mismatch repair system (microsatellite instability) of HNPCC (2)

Back 50

MSH2 & MLH1

Front 51

what stain helps differentiate carcinoid from endocrie tumors?

Back 51

Chromogranin

Front 52

If colorectal carcinoma is >50% coloid content then tumor is considered?

ass with?

Back 52

Mucinous or Signet-cell type

ass with psedomyxoma pertoneum

Front 53

When does separation of foregut into trachea and esophagus occur?

common error in this process called?

Back 53

4th week gestation

Atresia (blind pouch)

Front 54

Eosinophilic esophagitis is differentiated from relux esophagitis by?

Back 54

eosinophils forming clusters @ surface epithelium

Front 55

MC acquired abnormality in teh pediatric population is?

Back 55

Congenital hypertrophic pyloric stenosis

Front 56

MCC of nonsyndromic IHBA

Back 56

A1 Antitrysin

also Trisomies 17,18 & 21

Front 57

Trisomy 17 & 18

Back 57

EHBA

females & non-familial

(unlike neonatal/giant cell hepatitis)

Front 58

MC liver tumor in 1st year of life

Back 58

infantile hemangioendothelioma

F > M

very rarely can present with bleeding diathesis called Kasabach-Merrit syndrome

Benign (along wiht Mesenchymal hamartoma: firm, nontender mass in uper abdoman, often cystic and some hemorrhage & extramedullary hematopoiesis

Front 59

what is used to Dx hepatobalstomas

Back 59

AFP (+) (90% cases)

M > F

fetal type - clear cytoplasm, central nuclei w/nucleoli

Embryonal type - dark cytoplasm, cells arranged in ribbons and cords

Fetal type has better prognosis

Front 60

^ AST/ALT =

^ AP (maybe in combe with GGT) =

Back 60

^ AST/ALT = primary hepatocyte damage

^ AP (maybe in combe with GGT) = bilary tree disease/cholestatic hepatitis

Front 61

thrombosis of hepatic vein

Back 61

Budd-Chiari Syn

causes vascular changes leading to chronic passive congestion (nutmeg liver)

Front 62

piecemeal necrosis hallmark of ?

Back 62

piecemeal necrosis or interface hepatitis hallmark of chronic hepatitis

(a lot of lymphocytes going beyond the limiting plate area)

Front 63

portal lymphoid aggreate with STEATOSIS indication of

other findings?

Back 63

steatosis = HEP C

bile duct damage, protal LYMPHOCYTE, & lobular activity

Front 64

Serology for autoimmune hepatitis

defining feature

Back 64

ANA (anti-nuclear antibody)

ASMA (anti-smooth muscle actin)

LKM-1 (liver-kidney microsomal antigen 1)

defining feature: PLASMA CELL portal inflammation

Front 65

Bilary disease:

primary biliary cirrhosis (PBC) vs primary sclereosing cholangitis (PSC) for 1)serology 2)sex 3)associations

Back 65

PBC -> AMA; F>M; periductal GRANULOMAS

PSC -> ^IgM; M>F; ass with IBD ass (usually UC) & cholangiocarcinoma; onion-skinning

Front 66

Chronic Hep Staging is measured by

Back 66

degree of fibrosis

Front 67

Primary (Hereditary) Hemochromatosis buzz words:

Back 67

Chr 6p
HFE (heffer) gene
C282Y (chris & ylie)
H63D (herfat & deldar almost 69)

gold standard for Dx is Hepatic Iron Index >2

AR

Front 68

3 factors creating gallstones

Back 68

1)superstaruation of cholesterol

2)hypomotility of GB

3)Nucleation

Front 69

Cholangiocarnioma risk factors are (3)?

dx tumor marker

sx

Back 69

1) PSC
2)stones
3)parasitic infection

CA 19-9

PAINLESS jaundice, weight loss, fever

arises from epithelial cells of intra and extra-hepatic bile ducts

Front 70

Cholangitis is?

caused by?

sx?

Back 70

bacterial infection of bile duct (enterobacter or gram neg are MC)

choledocholithiasis

Charcot's Triad: fever, jaundice, RUQ pain

Front 71

Gallbladdar cancer histology is mostly _____

sx?

Back 71

adenocarcinoma

1)RUQ pain, wight loss, jaundice

Front 72

Cholecystitis has idential sx as?

Back 72

cirrhosis

Front 73

Pathophysiology of fatty liver

Back 73

1)increased lipolysis: adrenal/pituitary stim of breaking down triglycerides to FFA which go to liver

2)v mito fatty acid oxidation

3)make more NADH which is a cofactor for glycerol production

4)increased esterification (3GP + FFA -> TG )

Front 74

difference b/w hepatic steatosis (fatty change) & steatohepatitis (alcoholic hepatitis) is ?

Back 74

which the balloon hepatocytes in steatoheaptitis are 1)EOSINOPHILIC CYTOKERATIN & 2)MALLORY BODIES

also wire fibrosis in Zone 3

Front 75

1st and 2nd hit of NAFLD

Back 75

1st hit: insulin resistance

2nd hit: ROS


insulin ^ cAMP & stimulates hormone-sensitive lipase thereby ^ plasma FFA

Front 76

Key difference d/w fatty liver from alcohol & insulin resistance?

Back 76

Alcohol v FA oxidation while Obesity increases FA oxidation and liver cell is overwhelmed

both ^ FFA
both v VLDL export
both can result in steatohepatitis

Front 77

a primary ademnocarcinoma that is very fibrous

Back 77

Cholangiocarcinoma

Front 78

Difference b/w Boerhaave's syn and Mallory-Weiss tear

Back 78

Mallowry-Weiss tear - a mucosal (superficial) tear in esophagus (nontransmural)

Boerhaave's syn - transmural perforation (hole) of esophagus

both can be caused by vomitting/eating d/o

Front 79

what vessels join to form the portal vein?

Back 79

IMV, SMV and splenic vein

Front 80

pateints on PPI long term can get

Back 80

gastinomas or endocrine hyperplasia after many years

Front 81

migratory necrolytic erythema on legs found with

Back 81

glucagonoma

Front 82

Watery diarrhea found with

Back 82

VIPoma

Front 83

Only hepatitis that is DNA

Back 83

Hep B

Front 84

Which Hep's have fecal oral transmission (water)

Back 84

Hep A & Hep E

Front 85

Which Hep's have chrnicity

Back 85

Hep B (chronic & acute)

Hep C (chronic onl)

Front 86

Only Hep that can spread by semen and saliva

Back 86

Hep B

Front 87

Which Hep is mostly seen in 3rd world countries?

Back 87

Hep E

Front 88

MC cause of liver transplants in US?

Back 88

Hep C

Front 89

Incubation period for Hep A

Dx by

Back 89

28 days

anti-Hep A IgM Ab

Self-limiting virus, ususlly does NOT cause fulminant liver failure

fecal-oral

Front 90

If you are leaving in less than 3 weeks, you should take what to prevent Hep A

Back 90

immunoglobulin instead of vaccine

Front 91

Incubation period for Hep B

Window Period b/w

Back 91

120 days

HBsAg & HBsAb, use HBcAb IgM

Front 92

best liver fxn test

Back 92

INR

Front 93

first clinical sign of Hep C may be

Back 93

throwing up blood

also look for:

prophyria cutanea tarda or palpable pupura

proteinuria

cryoglobulin in blood

arthralgias & arthritis

Front 94

first lab sign of Hep C

anti-HCV appears?

RNA appears?

Back 94

first: AST & ALT

anti-HCV: 2-3 months

RNA: 2 weeks

Front 95

main blood screening test

Back 95

EIA (enzyme immunoassay), tests for HepC Ab

if +, then perform quantitative HepC RNA by PCR to cover false positives

Front 96

Hepatic Adenoma

Back 96

Noncirrhtic liver solid liver lesion

F>M

ass with oral contaceptive and anabolic steroid use

absence of bile ducts or portal area with the proliferation of neoplastic haptocytes

Front 97

noncirrhotic liver with characteristic CENTRAL SCAR

Back 97

focal nodular hyperplasia

Front 98

What is the one condition that can cause carcinoma without cirrhosis

Back 98

anabolic steroids

Front 99

Tumor Marker for Hepatocellular Carcinoma (HCC)

Back 99

AFP (only seen in 60% of cases, so positive is useful but negative doesnt rule out HCC

Front 100

Only morphologic varient of HCC that matters

Back 100

Fibrolamellar Carcinoma

FAVORABLE prognosis! (HCC usually highly aggressive tumor with poor prognosis)

age <30

L side of liver (al others on R)

AFP not elevated but serum ferritin is

Front 101

Bening cystic lesion of portal area nearly always found in famales and lined by mucinous epithelium with overian type stroma

Back 101

Biliary cystadenoma

Front 102

MC benign neoplasm of the liver

Back 102

Hemangioma (tumor arising from blood vessels)

Front 103

MC primary mesenchymal tumor of liver

Back 103

Angiosarcoma

Front 104

MC primary malignant tumor in pediatric age group

Back 104

Hepatoblastoma

Front 105

MC malignant tumor in teh liver

Back 105

Metastatic carcinoma