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224 Cards in this Set
- Front
- Back
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whats the most common congenital disorder of the oral cavity
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cleft palate
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which disease is characterized by the failure of fusion of facial processes
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cleft palate
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most common oral infection AIDS related?
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candidiasis
|
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painful ulcer with shaggy gray membrane
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apthous ulcers
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what is a glossitis caused by EBV?
|
hairy leukoplakia
|
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what lesions are related with HHV8
|
kaposis sarcoma
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what bacteria creats an acid that erodes tooth enamal when reacting with sucrose?
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streptococcus mutans
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what syndrome is caused by recurrent apthous ulcers genital ulcerations, uveitis, conjunctivitis
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behcet's syndrome
|
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what two conditions cause melanin pigmentation in oral mucosa
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addisons disease (excess ACTH with defective adrenals)
peutz-jeghers syndrome |
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what bacteria causes a shaggy gray pseudomembrane in the posterior pharynx and upper airways?
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cornyebacterium diptheriae
|
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what bacteria causes a tonsillar abcess with a potential for rheumatic fever and glomerularnephritis
|
streptococcus pyrogens
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what bacteria causes scarlet fever
|
streptococcus pyrogens
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multiple oral ulcers occur in children located on the soft palate and pharynx
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coxsackievirus (herpangina)
|
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occurs in children
vesicals in mouth and distal extremities |
hand foot and mouth disease
coxsackivirus |
|
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may occur in
neonates immunocompromised common pre-aids disease diabetes mellitus following antibiotic therapy diabet |
candida albicans oral thrush
|
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myxedema of the tongue is caused by 5 things
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hypothyroidism, downs syndrome, amyloidosis, acromegaly, MEN IIb (mucosal neuromas)
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causes of glossitis imflammation of the tongue not myxedema 6 things
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iron def., B12, folate, EBV scurvy, and scarlet fever
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what can leukoplakia or erythroplakia develop into?
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squamous cell dyplasia
squamous cell cancer |
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what is the most common tumor of the oral cavity? benign
may occur in the tongue, gingiva, palate, or lips |
squamous papilloma
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what benign tumor can arise from a dentigerous cyst (associated with the crown of an unerupted or impacted third molar)
located in the mandible cause create a soap bubble on xray of mandible |
ameloblastoma
|
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malignant tumors of the oral cavity are usually in what sex
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males
|
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risk factors of oral tumors?
mcc |
smoking
alcohol HPV |
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what is the most common cancer of the upper lip
|
basal cell carcinoma
|
|
|
female dominate disease
autoimmune disease associated wtih RA distruction of salivary and lacrimal glands |
sjogrens syndrome
|
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most common cancer of the lower lip caused by smoking etoh and HPV
|
squamous cell carcinoma
|
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what is the most common salivary gland tumor
|
pleomorphic adenoma of parotid
|
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most common malignant salivary gland tumor
in parotid neoplastic and mucus secreting cells |
mucoepidermoid tumor
|
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what are causes of oropharyngeal dysphagia? upper esophageal dysphagia
|
dermatomyositis
myasthenia gravis stroke |
|
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what are causes of lower esophageal dysphagia
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achalasia
scleroderma CREST systemic sclerosis |
|
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maternal polyhydramnios (swallowed fluid can not be absorbed)
newborn with abdominal distention air in stomach difficulty feeding (regurg) pneumonia from aspiration |
tracheoesphageal fistula
|
|
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sydrome associated with verterbral abnormalities, TE fistula, anal atresia, absent radius and renal disease
|
VATER syndrome
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syndrome of intermittent dysphagia, due to web or stricture,
chronic iron def. leukoplakia in oral mucosa and esophagus |
plummer vinson syndrome
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whats the difference between a true and false (pulsion) diverticulum?
|
true includes outpouching of all 4 layers
false is outpouching of mucosa and submucosa |
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location of zenkers diverticulum?
|
cricopharyngeus muscle
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what is the most common esphageal hernia and characteristic
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sliding hernia
proximal stomach through widening of the diaphramatic hiatus |
|
|
patient has heartburn
nocternal epigastric distress hematemisis ulceration stricture |
hiatal hernia
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portion of the stomach herniates alongside the esophagus
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paraesophageal hernia
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loops of bowel seen on chest xray
contents herniate through the posterior lateral part of diaphram |
pleuroperitoneal diaphragmatic hernia
|
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risk factors from GERD?
|
smoking
alcohol caffeine fatty food chocolate hiatal hernia |
|
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glandular metaplasia in the distal espohagus
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barretts esophagus
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what is the most common complication with barretts esophagus
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ulceration with stricture formation
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what are the three common infections of the esophagus?
|
usually with AIDS
CMV candida herpes simplex virus |
|
|
microscopic apperance of herpes infection in esophagus
|
multinucleated squamous cells with intranuclear inclusions
|
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CMV has what microscopic apperance
|
basophilic inclusions
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what are complications of corrosive esophagitis
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stricture, perforation, squamous cell carcinoma
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patient presents with massive hematemesis with a history of cirrhosis from alcohol abuse
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esophageal varices
|
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patient began bleeding after retching and teared the proximal stomach or distal esophagus
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mallory weiss syndrome
|
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rupture of the distal esophagus complications include hammans crunch which includes air in the subcutaneous tissue
pleural effusion contains food amylase and acid |
boerhaave's syndrome
|
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incomplete relaxation of LES
absent ganglion cells in myenteric plexus |
achalasia
|
|
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what causes dialtion of the promixal esophagus before LES
|
achalasia
|
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what disease can cause damage to the ganglian cells of esophagus leading to achalasia
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chagas
leishmanial forms |
|
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what finding on barium swallow with achalasia
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beak like tapering
|
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what is the most common benign esophageal tumor
|
lieomyoma
|
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most common primary cancer of the esophagus
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adenocarcinoma
|
|
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most common primary esophageal cancer in developing countries
|
squamous cell carcinoma
|
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what is the most common cause of esophageal squamous cell carcinoma
|
smoking
|
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what are two most typical clinical findings with esophageal cancer
|
weight loss and dysphasia
|
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msot common cause of hematemesis
|
PUD
|
|
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congenital progressive hypertrophy of pyloric sphincter
projectile vomiting NON-BILE |
congenital pyloric stenosis
|
|
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cause of aquired pyloric stenosis?
|
pyloric scaring from complicated duodenal ulcers
|
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early satiety
bloating weight loss vomiting of undigested food after eating |
gastroparesis
caused by neuropathy (D.M.) or vagotomy |
|
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most common cause of hemorhagic gastritis
|
NSAIDs
|
|
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involves fundus and body
most often due to pernicious anemia achlorhydria with hypergastrinemia (no feedback) macrocytic anemia due to B12 def. increased risk for adenocarcinoma |
type A chronic gastritis
|
|
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most commonly caused by H. pylori infection
involves antrum and pylorus |
type B chronic gastritis
|
|
|
gram negative rod
urease positive (converts amino groups in proteins to ammonia) fecal/oral transmission poor sanitation colonizes mucus layer |
H. pylori
|
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what intestinal microscopic change occurs with h. pylori infection which may lead to adenocarcinoma
|
intestinal metaplasia
|
|
|
duodenal and gastric ulcers
type B antral chronic gastritis gastric adenocarcinoma and low grade B cell malignant lymphoma |
diseases caused by H pylori
|
|
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giant rugal folds
hyperplasia of mucus secreting cells atrophy of parietal cells (achlorhydria) protein losing enteropathy increased risk for adenocarcinoma |
menetriers disease (hypertrophic gastropathy)
|
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never malignant?
duodenal or gastric ulcers |
duodenal
|
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excess gastrin secretion
most are malignant pancreatic islet cell tumors MEN I association |
zollinger-ellison syndrome
|
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most common location for ulcer
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duodenum
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most common h pylori ulcer
|
duodenum
|
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pathogenesis of duodenal ulcers?
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increased acid dumping
|
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most common location of gastric ulcer
|
lesser curvature of antrum same for cancer
|
|
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most common location for duodenal ulcer?
|
anterior 1st part
|
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what ulcer has burning soon after eating?
|
gastric
|
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which has burning 1-3 hours post prandial
|
duodenal ulcer
|
|
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complication of chonic gastritis and achlorhydria
hamartoma with no malignant potential |
hyperplastic polyp
|
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what polyp has potential for malignant transformation
|
adenomatous polyp
|
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most common benign tumor is gastrointestial tract
|
leiomyoma
|
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which country has an increasing incidence of gastric adenocarcinoma
|
japan
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risk factors for gastric adenocarcinoma
|
h pylori metaplasia (mmc)
poor diet/ lacking fruits and veg., smoked food type A chronic gastritis |
|
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most common location for gastic cancer
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lesser curvature
|
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linitis plastica
stomach does not paristalse signet-ring infiltrate the stomach wall Produces KRUKENBURG TUMOR of ovaries |
diffuse gastric adenocarcinoma
|
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common metatasic sites of gastic carcinoma
|
liver, lung, ovaries
lol |
|
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whats the name of the left supraclavicular node (mets of gastic carcinoma)
|
virchows node
|
|
|
acanthosis nigricans
multiple seborrheic keratoses mets to umbilicus (sister mary joseph sign) |
paraneoplastic skin lesions of gastric carcinoma
|
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most common site for extranodular malignant lymphoma
|
stomach
|
|
|
pain followed by a pain free interval
|
colicky
|
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colicky pain is a symptom of?
|
bowel obstruction
|
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malabsorption of what 3 things lead to anemia
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iron, folate, vitamin B12
|
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types of diarrhea
|
osmotic, secretory, invasive
|
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type of diarrhea with blood and leukocytes
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invasive
|
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3 leading causes of invasive diarrhea
|
shigella
campylobacter entamoeba histolytica |
|
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loss of isotonic fluid
high volume diarrhea no bowel inflammation no leukocytes |
secretory diarrhea
|
|
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a substance is drawing hypotonic salt solution out of bowel
high volume diarrhea no inflammation of bowel |
osmotic diarrhea
|
|
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bacteria causing secretory diarrhea via inhibiting adenylate cyclase and increasing Cl secretion
|
vibrio cholera
|
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what is the stool osmotic gap
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300 mOsm/kg (POsm)- 2 x random stool (Na + K)
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|
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if the stool osmotic gap is less 50mOsm/kg from the POsm?
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secretory diarrhea
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stool osmotic gap is greater than 100mOsm/kg from POsm
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osmotic diarhea
|
|
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3 MMC of malabsorptino
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pancreatic insufficiency
no bile salt/acid small bowel disease |
|
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most common cause of pancreatitis?
|
alcoholism
|
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pancreatitis will lead to maldigestion of?
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lipids and proteins, not carbs
|
|
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why are carbs not affected in pancreatic insufficiency?
|
salivary and brush border enzymes
|
|
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visual screening choice for chronic pancreatitis?
|
CT showing calcification
|
|
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causes of bile salt/acid def.
|
1) liver cirrhosis (no production)
2) intrahepatic/ extrahepatic blockage of flow (bile stone, or primary biliary cirrhosis) 3) distruction of bile salts from infection 4) excess bile salt binding from cholestyramine 5) terminal ileal disease and can't recycle bile salts ie chrohns or ileum resection |
|
|
three viruses causing diarrhea
|
norovirus
rotavirus (kids) cytomegalovirus (AIDS patients) |
|
|
gram positive ROD
food poisoning with toxin associated with fried rice or tacos |
bacillus cereus
|
|
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curved gram negative rod
eating chicken or milk dysentery with crypt abscesses and ulcers like ulcerative colitis |
campylobacter jejuni
|
|
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toxin in food that blocks release of acetylcholine
paralysis and mydriasis in spores of honey |
clostridium botulinum
|
|
|
gram positive endogenous
pseudomembranous colitis ANTIBOTICS leading to overgrowth leading to toxin production |
clostridium difficile
|
|
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travelers diarrhea
|
enterotoxin E. coli
|
|
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serotype O157:H7 leading to hemolytic uremic syndrome
|
enterohemmoragic E. coli
|
|
|
diarrhea in AIDS patients with low <50cell/microL
acid-fast rod (bacteria) macrophages stimulate whipples disease |
mycobacterium avium-intacellulare MAC
|
|
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acid fast organism
invade peyers patches leads to stricture formation with circumferential spread |
mycobacterium tuberculosis
|
|
|
cause of typhoid fever
|
salmonella typhi
|
|
|
salmonella chronic carrier state organ?
|
gall bladder
|
|
|
no aminal reservoirs
curved shaped rod ulcerations dysentery |
shigella
|
|
|
food poisoning with toxin
gastroenteritis in 1-6 hrs post prandial no culture in stool severe diarrhea and vomiting |
staph aureus
|
|
|
enterotoxin stimulates adentylate cyclase in small bowel and causes secretion of Cl
drinking contaminated water or seafood |
vibrio cholerae
|
|
|
only ciliated bacteria causing dysentery and mesenteric lymphadenitis
|
yersinia enterocolitica
|
|
|
acid fast positive protozoa
contracted by eating oocytes |
cryptosporidium
|
|
|
flash shaped ulcers in cecum
trophozoites phagocytose RBC |
entamoeba histolytica
|
|
|
produces acute and chronic diarrhea
MMC of protozoal diarrhea in US detection with antigen testing in urine |
giardia lambria
|
|
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causes of anal itching and urethritis in girls
no eosinophila appendicitis Dx celophan tape |
enterobius vermicularis
|
|
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screening test to determine small bowel disease and rule out pancreatic insufficiency
|
d-xylose
|
|
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autoimmue disease that commonly involves duodenum and jejunum with flattened villi
hyperplastic glands with chronic inflammation |
celiac disease
|
|
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strong association with dermatitis herpetiformis
|
celiac disease
|
|
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blunting of villi with foamy PAS-postive macros in lamina propria
obstruction of lymphatics and reabsorption of chlyomicrons |
whipple's disease
|
|
|
best general screening test for malabsorption 2 tests
|
stool fat
check for decreased serum beta-carotene (precursor for fat-soluble retinoic acid (vit. A) |
|
|
why would you find ascites and pitting edema in malabsorption?
|
hypoproteinemia
|
|
|
colicky pain
on-xray bowel distention air/fluid levels with a step ladder appearance abscence of air distal to obstruction are all signs of what |
bowel obstruction
|
|
|
most common site for bowel obstruction?
|
small bowel
|
|
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most likely bowel to have ischemic damage?
|
small
|
|
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what is supplied by SMA
|
small bowel after bile duct enters
ascending and 2/3 of transverse |
|
|
what type of infarctions are in shock or hemmoraging?
|
mural or mucosal
|
|
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what is a common cause of mesenteric ischemia?
|
embolism from left atrium in atrial fibrillation
|
|
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what type of ichemia results in complete blockage of SMA
|
transmural
|
|
|
clinical findings of small bowel infarction? 5
|
bloody diarrhea, ab. pain, bowel distention, ileus, NO rebound tenerness early in infarction
|
|
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MMC of bowel obstruction
|
adhesions
|
|
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what would xray findings show with gallstone ileus?
|
air in biliary tree
|
|
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no stool found on finger during stool sample in newbord
|
hirschprungs disease
caused by a lack of meisseners and auerback plexus in the distal colon |
|
|
second most common cause of bowel obstruction and common in weight lifters
|
indirct inguinal hernia
|
|
|
associated with downs syndrome
double bubble sign on xray vomiting with bile fluids newborns |
duodenal atresia
|
|
|
what makes up the triangle in a direct inguinal hernia
|
lateral is inferior epigastric artery
medial rectus ab. interior inguinal ligament |
|
|
bulge located below the inguinal ligament
most common hernia in females |
femoral hernia
|
|
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which hernia enters the scrotal sac and hits the examiners finger within the inginal canal
|
indirect hernia
|
|
|
most common hernia in blacks, ascites patients, pregnany, obsese
protrusion through a fascial defect containing umbilical rements |
umbilical hernia
|
|
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herniation through a weakened area of surgical excision
|
ventral hernia
|
|
|
pain in the spenic flexture after eating
atherosclerotic narrowing of SMA or IMA patient doesn't eat for fear of pain |
ischemic colitis
|
|
|
gram positive endogenous
pseudomembranous colitis ANTIBOTICS leading to overgrowth leading to toxin production |
clostridium difficile
|
|
|
travelers diarrhea
|
enterotoxin E. coli
|
|
|
serotype O157:H7 leading to hemolytic uremic syndrome
|
enterohemmoragic E. coli
|
|
|
diarrhea in AIDS patients with low <50cell/microL
acid-fast rod (bacteria) macrophages stimulate whipples disease |
mycobacterium avium-intacellulare MAC
|
|
|
acid fast organism
invade peyers patches leads to stricture formation with circumferential spread |
mycobacterium tuberculosis
|
|
|
cause of typhoid fever
|
salmonella typhi
|
|
|
salmonella chronic carrier state organ?
|
gall bladder
|
|
|
no aminal reservoirs
curved shaped rod ulcerations dysentery |
shigella
|
|
|
food poisoning with toxin
gastroenteritis in 1-6 hrs post prandial no culture in stool severe diarrhea and vomiting |
staph aureus
|
|
|
enterotoxin stimulates adentylate cyclase in small bowel and causes secretion of Cl
drinking contaminated water or seafood |
vibrio cholerae
|
|
|
splenic flexure pain and bloody diarrhea
|
ichemic colitis
|
|
|
dilation of cecal submucosal venules
hematochezia associated with von Willebrand disease and calcific aortic stenosis |
angiodysplasia
|
|
|
newborn
fecal material in umbilical area bleeding (common cause of iron def. in newborns) |
mechels diverticulum
|
|
|
how do you differentiate between meckels and appendicitis?
|
99 Tc nuclear scan to identify parietal cells in ectopic gastic mucosa
|
|
|
wide mouth diverticulitis in the duodenum could suggest what?
small bowel pulsion diverticulum |
systemic sclerosis
|
|
|
most common site for diverticulum?
|
sigmoid colon
|
|
|
what is a risk associated with diverticulum
|
they are juxtaposed to small vessels therefore rupture and severe bleeding
|
|
|
what hereditary diseases are associated with diverticulum
|
marphans and ehler-danlos
|
|
|
most common complication of diverticulUM
|
diverticulITIS
|
|
|
what causes diverticulitis
|
fecalith or compacted stool in diverticulum sac
|
|
|
most common cause of hematochezia?
|
diverticulOSIS
|
|
|
pneumaturia
|
colovesical fistula-caused by connection between the large bowel and bladder
|
|
|
most common IBS
chronic relapsing ulceroinflammatory disease ulcers limited to the mucosa and submucosa ulcerations are continuous |
ulcerative colitis
|
|
|
transmural discontinuous inflammation
chronic granulomatous ulceroconstrictive disease |
crohns disease
|
|
|
location of crohns
|
ileum
or ileum and colon |
|
|
location ulcerative colitis
|
rectum left colon or rarely entire colon
|
|
|
which leads to obstruction crohns or ulcerative colitis
|
crohns
|
|
|
gross: deep linear lesions with cobblestone apperance
fat creeping around serosa Microscopic: noncaseating grandulomas, lymphoid aggregates, dysplasia and cancer less likely |
crohns
|
|
|
ulcers and crypt abscesses containing neutrophils dysplasia and cancer might be present
|
ulcerative colitis
|
|
|
recurrent right lower quad pain with diarrhea
bleeding only occurs with fistula or colon involvment |
crohns
|
|
|
string sign with luminal narrowing in the lower ileum by inflammation and fistulas
|
crohns
|
|
|
crohn disease can cause increased absorption of calcium oxalate leading to
|
kidney stones (renal calculi
|
|
|
toxic megacolon (hypotonic and distended bowel)
primary sclerosing cholangitis (fibrosis around common bile duct leading to jaundice HLS B27) adenocarcinoma possible and pancolitis is the greatest risk for cancer |
ulcerative colitis
|
|
|
alternating diarrhea and constipation
abdominal pain relieved by defication simulates ulcerative colitis normal endoscopy |
irritable bowel syndrome
|
|
|
caused by intrinsic colonic motility disorder
|
irritable bowel syndrome
|
|
|
least common site for GI cancer
|
small bowel
|
|
|
most common small bowel malignancy characterized by neuroendocrine tumor
|
carcinoid tumor
|
|
|
which carcinoid tumors rarely metastaize of what region?midgut (stomach) and hindgut (rectum)
|
midgut (stomach) and hindgut (rectum)
|
|
|
what region of GI do carcinoid tumors mets and invade
|
midgut (terminal ileum)
|
|
|
most common site for carcinoid tumors
|
vermiform appendix
|
|
|
how do carcinoid tumors met.?
|
portal system
|
|
|
where is 5-HIAA detected?
|
urine
|
|
|
does serotonin enter the systemic circulation
|
no its completely metabolized in the liver to 5-HIAA
|
|
|
what must happen to produce the carcinoid syndrome for serotonin to be released into the systemic circulation?
|
liver mets serotonin secretion from tumor nodules
|
|
|
flushing, diarrhea (increased bowel motility)
tricuspid regurgitation and pulmonary stenosis from increased collagen prouction |
metastisized carcinoid tumor
|
|
|
most common type of polyp in adult?
|
harmatomatous polyp (hyperplastic)
|
|
|
haramtomas are commonly found?
|
sigmoid colon
|
|
|
most common polyp in children
|
juvenile retention polyp
|
|
|
autosomal dominate
polyps predominate in small bowel clinical findings: mucosal pigmentation of bucca mucosa and lips |
peutz jaghers syndrome
|
|
|
greatest risk for developing colon cancer
|
villous adenoma
|
|
|
polyps expressing
adenoma larger than multiple polyps villious components show an increaed risk of? |
malignancy
|
|
|
autosomal dominant
all develop tubular adenomas and cancer polyps develop between 10-20 years malignant conformation occurs between 35-40 years |
familial polyposis
|
|
|
whats the pathogenesis of familial polyposis?
|
inactivation of adematous polyposis coli suppressor gene
|
|
|
Risk factors for Colon Cancer (6)
|
-older than 50
-low fiber/high sat. fat diet -cigarette smoking -familial polyposis syndrome -family history -ulcerative colitis |
|
|
Genes associated with Colon Cancer (33)
|
-APC (ademitis Polyposis Coli Suppressor Gene)
-RES -TP53 |
|
|
Most common location for Colon Cancer?
|
Rectosigmoid
|
|
|
Which side of Colon Cancer involvement causes obstruction?
|
Left side
|
|
|
Which side of Colon Cancer involvement causes bleeding?
|
Right Side
|
|
|
What's the most common metastasis for Colon Cancer?
|
The liver
|
|
|
What is the pathogenesis of appendicitis in children?
|
Lympohoid hyperplasia due to secondary viral infection
|
|
|
What is the pathogenesis of appendicitis in adults?
|
Poop obstructs proximal lumen and causes bacterial invasion of appendix.
|
|
|
What type of pain is associated with acute appendicitis?
|
colicky periambilical pain
|
|
|
What proceeds nausea, vommiting, and fever in acute appendicitis?
|
periambilical pain
|
|
|
What area is associated with appendicitis?
|
McBurney's point
|
|
|
Complications with appendicitis (3)
|
-Periappendiceal abscess
-Pylephlebitis (infection of portal vein) -Portal vein thrombosis |
|
|
Causes of bleeding in rectal disorders (3)
|
-Internal hemorrhoids
-Anorectal cancer -Infection or fissure |
|
|
Most commom cause of anorectal pain? (2)
|
Fissure or external hemorrhoids
|
|
|
Causes of internal hemorrhoids (2)
|
-Straining at stool
-Pregnancy |
|
|
Most common complication with internal hemorrhoids?
|
Bleeding
|
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Which veins are associated with external hemorrhoids?
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Inferior hemorrhoidal veins
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What causes inteception of rectum through anus?
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Weak rectal support mechanism
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Excess hair in deep gultial fold, traumatically buried into sinus
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Pilonidal cyst and abscess
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Most common type of anal carcinoma (located above the pectanate line) (female dominant)
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Basaloid
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Anal cancer associated with hpv in homosexual men?
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Squamous cell carinoma
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