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30 Cards in this Set
- Front
- Back
195. What is Malignant risk of Adenomatous polyps of colon associated with?
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a. Malignant risk is associate with:
1. ↑ size 2. Villous histology 3. ↑epithelial dysplasia 4. The more Villous the polyp, the more likely it is to be malignant!!!!!! “Villous = Villainous”! |
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196. Hyperplastic colonic polyps?
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a. Most common non-neoplastic polyp in colon.
b. >50% found in rectosigmoid colon. |
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197. Juvenile colonic polyps?
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a. Mostly sporadic lesions in children <5.
b. 80% in rectum. c. If single, no malignant potential!. |
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198. Juvenile polyposis syndrome?
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a. Multiple juvenile polyps in GI tract.
b. ↑ risk of adenocarcinoma. |
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199. Peutz-Jeghers syndrome inheritance type?
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a. Autosomal-dominant.
b. Single polyps are not malignant |
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200. Peutz-Jeghers sx?
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a. Multiple non-malignant hamartomas throughout GI tract
b. Hyperpigmented mouth, lips, hands, genitalia. c. Associated w/ ↑ risk of colorectal cancer and other visceral malignancies. |
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201. Colorectal cancer (CRC) epidemiology?
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a. 3rd most common cancer and 3rd most deadly
b. Most pts >50. c. 25% have family hx |
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202. Genetic conditions associated w/Colorectal cancer?
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1. Familial adenomatous polyposis (FAP)
2. Gardner’s syndrome 3. Turcot’s syndrome 4. Hereditary nonpolyposis colorectal cancer |
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203. Familial adenomatous polyposis (FAP)?
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a. Autosomal dominant mutation of APC gene on chromosome 5q.
b. 2-hit hypothesis. c. 100% progress to CRC! d. Thousands of polyps; pancolonic. e. Always involves rectum. |
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204. Familial adenomatous polyposis + osseous and soft tissue tumours, retinal hyperplasia?
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a. Gardner’s syndrome.
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205. FAP + malignant CNS tumour?
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a. Turcot’s syndrome.
b. “TURcot =TURban”. |
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206. Hereditary nonpolyposis colorectal cancer (HNPCC/Lynch syndrome)?
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a. Autosomal dominant mutations of DNA mismatch repair genes.
b. 80% progress to CRC. c. Proximal colon is always involved! |
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207. Additional risk factors for colorectal cancer?
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a. IBD
b. Streptococcus bovis bacteremia. c. Tobacco use d. Large villous adenomas e. Juvenile polyposis syndrome. f. Peutz-Jeghers syndrome. |
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208. Presentation of colorectal cancer?
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a. Distal colon- Obstruction, colicky pain, hematochezia (maroon coloured) so not melena which is high up and digested and not bright red (lower down).
b. Proximal colon- Dull pain, iron deficiency anaemia, fatigue. |
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209. Diagnosis of CRC?
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a. Iron deficiency anaemia in older males.
b. Screen pts >50 yrs w/stool occult blood test and colonoscopy. c. “apple core” lesion seen on barium enema radiograph. |
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210. Tumour marker for colorectal cancer?
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a. CEA!
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211. Molecular pathogenesis of Colorectal Cancer:
a. 2 molecular pathways that lead to CRC? |
1. Microsatellite instability pathway (15%)
2. APC/β-catenin (chromosomal instability) pathway (85%). |
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212. Microsatellite instability pathway of CRC?
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a. DNA mismatch repair gene mutations ->sporadic and HNPCC syndrome.
b. Mutations accumulate, but no defined morphologic correlates |
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213. APC/β-catenin (chromosomal instability) pathway (85%)?
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a. Normal colon->(Loss of APC gene)>Colon at risk> (K-RAS mutation)>Adenoma> (loss of p53)> Carcinoma.
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214. Carcinoid tumour?
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a. Tumour of neuro-endocrine cells.
b. Constitute 50% of small bowel tumours. c. Often produce 5-HT, which can lead to carcinoid syndrome d. If confined to GI system, no carcinoid syndrome is observed, since liver metabolizes 5-HT. e. If tumour or mets (usually to liver) exist outside GI, carcinoid is observed. |
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215. Carcinoid syndrome characteristic features (4)?
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1. Wheezing
2. Right-sided heart murmurs 3. Diarrhoea 4. Flushing |
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216. Most common sites of Carcinoid tumours?
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a. Most common sites are the appendix, ileum, and rectum.
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217. Where are carcinoid tumours most commonly malignant?
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a. Small intestine.
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218. Carcinoid tumour key feature seen on electron microscope.?
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a. “Dense core bodies” seen on EM.
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219. Liver cirrhosis?
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a. Diffuse fibrosis of liver, destroys normal architecture.
b. Nodular regeneration c. Micronodular/macronodular |
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220. Micronodular liver cirrhosis?
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a. Nodules <3 mm.
b. Uniform size. c. Due to metabolic insult (eg. Alcohol, hemochromatosis, Wilson’s disease). |
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221. Macronodular liver cirrhosis?
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a. Nodules >3 mm, varied size.
b. Usually due to significant liver injury leading to hepatic necrosis (e.g, postinfectious or drug-induced hepatitis). |
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222. What type of cirrhosis has increased risk of hepatocellular carcinoma- micro or macronodular?
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a. Macronodular!!! Makes sense since its post-infectious.
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223. What can relieve portal hypertension?
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a. Shunt between portal and systemic circulation.
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224. Effects of liver cell failure?
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a. Coma
b. Scleral icterus c. Fetor hepaticus (breath smells like a freshly opened corpse) d. Spider nevi e. Gynecomastia/testicular atrophy. f. Liver “Flap” = asterixis (course hand tremor). g. Bleeding tendency (decreased PT and clotting factors). h. Anaemia i. Ankle oedema. |