EXAM #3 (1-of-2)

Question 1

1. Atelectasis – when something causes the lung tissue to _____ on itself
   a. Resorption atelectasis – due to something (usually mucous plugging) _____ the airway, passage of air into the distal segments of the lungs
   b. Compression atelectasis – some force/pressure from _____ the lungs compressing and pushing on the lungs
   i. Pressure from the _____ cavities
   ii. Pneumothorax – abnormal collection of _____ in the pleural cavity, air surrounds the lungs and compresses them
   iii. Pleural effusions – _____ build up (e.g. with CHF), compresses lungs
   iv. Hemothorax – blood in _____ cavity due to dissection or aortic rupture, compresses lungs
   c. Contraction atelectasis – lungs already severely damaged, so much damage and scar tissue built up, it’s an _____ collapse of lung tissue, no longer capable of facilitating air

Answer 1

1. Atelectasis – when something causes the lung tissue to collapse on itself
   a. Resorption atelectasis – due to something (usually mucous plugging) obstructing the airway, passage of air into the distal segments of the lungs
   b. Compression atelectasis – some force/pressure from outside the lungs compressing and pushing on the lungs
   i. Pressure from the pleural cavities
   ii. Pneumothorax – abnormal collection of air in the pleural cavity, air surrounds the lungs and compresses them
   iii. Pleural effusions – fluid build up (e.g. with CHF), compresses lungs
   iv. Hemothorax – blood in pleural cavity due to dissection or aortic rupture, compresses lungs
   c. Contraction atelectasis – lungs already severely damaged, so much damage and scar tissue built up, it’s an internal collapse of lung tissue, no longer capable of facilitating air

Question 2

2. ARDS - Acute Respiratory Distress Syndrome (lung injury)
   a. Clinical symptom of: _____ threatening respiratory insufficiency
   i. Patients are _____
   ii. Severe _____ _____ refractory to oxygen therapy (more oxygen pumped in, the levels of arterial oxygen don’t go up due to the area where air exchange occurs is damaged)
   b. Pathologically – DAD (Diffuse Alveolar Damage)
   i. Damage of _____ and _____ wall
   ii. Characteristic changes:
3. Grossly – marked _____ and edema fluid comes in response to inflammation
4. Microscopically – hyaline membranes (“sloughed material off the alveolar surface”)
   c. ARDS causes:
   i. Aspiration of gastric contents – elderly lose _____ reflex and gastric contents (hydrochloric acid) will be aspirated and damage lung tissue
   ii. Pulmonary contusion – _____ of lung tissue with traumatic accidents
   iii. Fat embolism – _____ or extensive _____ tissue trauma
   iv. Near _____ sensation, lack of oxygen exchange
   v. Inhalation injury – inhaling things that are toxic to the lungs like occupationally, or hot smoke like with exposure to fires
   vi. Reperfusion injury after lung transplantation - ?

Answer 2

2. ARDS - Acute Respiratory Distress Syndrome (lung injury)
   a. Clinical symptom of: life threatening respiratory insufficiency
   i. Patients are cyanotic
   ii. Severe arterial hypoxie refractory to oxygen therapy (more oxygen pumped in, the levels of arterial oxygen don’t go up due to the area where air exchange occurs is damaged)
   b. Pathologically – DAD (Diffuse Alveolar Damage)
   i. Damage of alveolar and capillary wall
   ii. Characteristic changes:
3. Grossly – marked congestion and edema fluid comes in response to inflammation
4. Microscopically – hyaline membranes (“sloughed material off the alveolar surface”)
   c. ARDS causes:
   i. Aspiration of gastric contents – elderly lose gag reflex and gastric contents (hydrochloric acid) will be aspirated and damage lung tissue
   ii. Pulmonary contusion – bruising of lung tissue with traumatic accidents
   iii. Fat embolism – orthopedic or extensive soft tissue trauma
   iv. Near drowning sensation, lack of oxygen exchange
   v. Inhalation injury – inhaling things that are toxic to the lungs like occupationally, or hot smoke like with exposure to fires
   vi. Reperfusion injury after lung transplantation - ?

Question 3

3. Additional risks of asbestos exposure
   a. Localized benign _____ _____ – most common problem of exposure
   b. _____ carcinomas – lung cancer, smoked and worked with asbestos = increased risk
   c. _____ - malignant tumor of pleura due to asbestos exposure, it grows and adheres to surface of the lung and thickens lung
   d. _____ carcinomas

Answer 3

3. Additional risks of asbestos exposure
   a. Localized benign pleural plaques – most common problem of exposure
   b. Bronchogenic carcinomas – lung cancer, smoked and worked with asbestos = increased risk
   c. Mesotheliomas - malignant tumor of pleura due to asbestos exposure, it grows and adheres to surface of the lung and thickens lung
   d. Laryngeal carcinomas

Question 4

4. Lobar versus Bronchopneumonia
   a. Lobar – _____ pattern affects entire lobe of lung (more severe pneumonia)
   b. Bronchopneumonia – foci (_____ of _____) of inflammatory consolidation throughout lung

Answer 4

4. Lobar versus Bronchopneumonia
   a. Lobar – pneumonia pattern affects entire lobe of lung (more severe pneumonia)
   b. Bronchopneumonia – foci (dots of pneumonia) of inflammatory consolidation throughout lung

Question 5

5. 1 of 4 diseases of COPD (all the result of dyspnea, difficulty of breathing)
   a. Chronic _____ – clinical diagnosis, persistent productive cough for 3 consecutive months in at least 2 consecutive years
   i. Common in _____ _____ and urban populations with bad _____ quality
   ii. Inflammation of _____, _____ gland hyperplasia
6. Types:
   a. _____ – mucoid material from inglammation from cough – no obstruction
   b. _____ _____ – hyper-responsive airways with vasospasm and wheezing
   c. _____ _____ – with associated asthma

Answer 5

5. 1 of 4 diseases of COPD (all the result of dyspnea, difficulty of breathing)
   a. Chronic Bronchitis – clinical diagnosis, persistent productive cough for 3 consecutive months in at least 2 consecutive years
   i. Common in cigarette smokers and urban populations with bad air quality
   ii. Inflammation of airways, mucous gland hyperplasia
6. Types:
   a. Simple – mucoid material from inglammation from cough – no obstruction
   b. Chronic asthmatic – hyper-responsive airways with vasospasm and wheezing
   c. Chronic obstructive – with associated asthma

Question 6

6. _____ – outside toxin is breathed into the lungs and causes damage to the lung initiates an inflammatory response which leads to fibrosis (scarring) of tissue
   a. _____ – simple accumulation of pigment in the lung
   b. _____ – exposure to asbestos leads to diffused pulmonary interstitial fibrosis (interstitium becomes inflamed and scarred causing lungs to shrink)
   c. _____ _____ _____ _____ – more intense coal deposition; but not significant pulmonary symptoms
   d. _____ _____ _____ _____ – intense build-up; followed by inflammation, scarring, shrinkage of lungs, and progressive symptoms

Answer 6

6. Pneumoconiosis – outside toxin is breathed into the lungs and causes damage to the lung initiates an inflammatory response which leads to fibrosis (scarring) of tissue
   a. Anthracosis – simple accumulation of pigment in the lung
   b. Asbestosis – exposure to asbestos leads to diffused pulmonary interstitial fibrosis (interstitium becomes inflamed and scarred causing lungs to shrink)
   c. Simple coal workers pneumoconiosis – more intense coal deposition; but not significant pulmonary symptoms
   d. Complicated coal workers pneumoconiosis – intense build-up; followed by inflammation, scarring, shrinkage of lungs, and progressive symptoms

Question 7

7. Tuberculosis
   a. Infection by Mycobacterium _____
   b. _____ most common site of infection
   c. Primary tuberculosis:
   i. Develops in previously _____ host
   ii. __% of newly infected develop significant disease
   iii. Inhaled organisms first form Ghon focus (collection of tubercles) – _____ necrosis
   iv. Ghon complex – focus plus infected regional lymph nodes
   d. Secondary tuberculosis
   i. Arises in _____ infected host
   ii. Happens in less than __% of primary TB patients
   iii. Can be _____ or activation of _____ organisms
   iv. Forms in _____ of lungs
   v. Rare complication – systemic miliary tuberculosis

Answer 7

7. Tuberculosis
   a. Infection by Mycobacterium tuberculosis
   b. Lungs most common site of infection
   c. Primary tuberculosis:
   i. Develops in previously unexposed host
   ii. 5% of newly infected develop significant disease
   iii. Inhaled organisms first form Ghon focus (collection of tubercles) – casseation necrosis
   iv. Ghon complex – focus plus infected regional lymph nodes
   d. Secondary tuberculosis
   i. Arises in previously infected host
   ii. Happens in less than 5% of primary TB patients
   iii. Can be reinfection or activation of dormant organisms
   iv. Forms in apices of lungs
   v. Rare complication – systemic miliary tuberculosis

Question 8

8. _____ _____ – lung cancer, smoked and worked with asbestos = increased risk
   a. Non-small cell types:
   i. _____ – develop from bronchiole producing gland of the bronchi
9. _____
10. Usually _____ _____
11. Often arise in _____
12. Variant – _____ carcinomas – grow along pre-existing anatomic structures
    ii. _____ _____ _____ – develop from cells that are metaplastic (from bronchiole glands to flat squamous cells which become malignant)
13. Arise _____ portion of the lung (around the hilum)
14. Produce _____ that can provoke other reactions (large regions of _____)
15. More likely to _____ (form central _____ in the tumor)
    iii. _____ _____ _____ – cancers that began as either of the above and became so anaplastic you can’t recognize what the cell of origin was
16. _____ tumors

Answer 8

8. Bronchogenic carcinomas – lung cancer, smoked and worked with asbestos = increased risk
   a. Non-small cell types:
   i. Adenocarcinoma – develop from bronchiole producing gland of the bronchi
9. Adenocarcinoma
10. Usually peripheral lesions
11. Often arise in scars
12. Variant – bronchioalveolar carcinomas – grow along pre-existing anatomic structures
    ii. Squamous cell carcinoma – develop from cells that are metaplastic (from bronchiole glands to flat squamous cells which become malignant)
13. Arise central portion of the lung (around the hilum)
14. Produce keratin that can provoke other reactions (large regions of necrosis)
15. More likely to cavitate (form central cavity in the tumor)
    iii. Large cell carcinoma – cancers that began as either of the above and became so anaplastic you can’t recognize what the cell of origin was
16. Undifferentiated tumors

Question 9

9. _____
   a. Air in pleural sac
   b. Causes: emphysema, rupture of bullae, lesions near pleural surface, abscess, tumors, TB, rib fracture

Answer 9

9. Pneumothorax
   a. Air in pleural sac
   b. Causes: emphysema, rupture of bullae, lesions near pleural surface, abscess, tumors, TB, rib fracture

Question 10

10. _____ _____
    a. Fluid in the pleural cavity around the lungs
    b. Due to poor _____ _____ or _____

Answer 10

10. Pleural Effusion
    a. Fluid in the pleural cavity around the lungs
    b. Due to poor heart pumping or inflammation

Question 11

11. _____

a. Ruptured intrathoracic aortic aneurysm

Answer 11

11. Hemothorax

a. Ruptured intrathoracic aortic aneurysm

Question 12

12. _____
    a. Pleura sac filled with lymphatic fluid
    b. Usually results when major lymph ducts are obstructed by _____ cancers

Answer 12

12. Chylothorax
    a. Pleura sac filled with lymphatic fluid
    b. Usually results when major lymph ducts are obstructed by intrathoracic cancers

Question 13

5. 1 of 4 diseases of COPD (all the result of dyspnea, difficulty of breathing)
   b. _____ - abnormal permanent enlargement of airspaces distal to the terminal bronchiole with destruction of their walls (the very distal parts of the airways that results in rupture of alveoli)
   i. Most common cause of _____ is chronic bronchitis
   ii. Centriacinar
6. Seen in _____ _____
7. Most prominent in _____ lobes at the _____
   iii. Panacinar
8. Seen in _____ zones of lung
9. Characteristic of individuals with _____ (attributes to elasticity of alveoli which facilitates air exchange) deficiency
   iv. Distal acinar
10. Along pleural aspects (_____) and _____ of lung
11. May form _____
12. May be associated with spontaneous _____ in young adults
    v. _____
13. No distinct _____
14. Seen with _____; may be asymptomatic

Answer 13

5. 1 of 4 diseases of COPD (all the result of dyspnea, difficulty of breathing)
   b. Emphysema - abnormal permanent enlargement of airspaces distal to the terminal bronchiole with destruction of their walls (the very distal parts of the airways that results in rupture of alveoli)
   i. Most common cause of emphysema is chronic bronchitis
   ii. Centriacinar
6. Seen in cigarette smokers
7. Most prominent in upper lobes at the apices
   iii. Panacinar
8. Seen in lower zones of lung
9. Characteristic of individuals with alpha-1-antitrypsin (attributes to elasticity of alveoli which facilitates air exchange) deficiency
   iv. Distal acinar
10. Along pleural aspects (surface) and septae of lung
11. May form bullae (sacular dilations of lung at pleural surface)
12. May be associated with spontaneous pneumothorax in young adults
    v. Irregular
13. No distinct pattern
14. Seen with scarring; may be asymptomatic

Question 14

5. 1 of 4 diseases of COPD (all the result of dyspnea, difficulty of breathing)
   c. _____ – permanent dilation of bronchi and bronchioles, makes it harder to exchange air with the alveoli distal when bronchioles are widened
   i. Secondary condition results due to other disease
   ii. Causes:
6. Often necrotizing infections: severe _____
7. Bronchial obstruction: tumors, foreign bodies, mucous plugging
8. _____ _____
9. _____ states
10. _____ _____ syndrome – faulty cilia and therefore allow things to enter lungs that shouldn’t

Answer 14

5. 1 of 4 diseases of COPD (all the result of dyspnea, difficulty of breathing)
   c. Bronchiectasis – permanent dilation of bronchi and bronchioles, makes it harder to exchange air with the alveoli distal when bronchioles are widened
   i. Secondary condition results due to other disease
   ii. Causes:
6. Often necrotizing infections: severe pneumonia
7. Bronchial obstruction: tumors, foreign bodies, mucous plugging
8. Cystic fibrosis (MALE STERILITY)
9. Immunosuppressive states
10. Congenital Kartagener syndrome – faulty cilia and therefore allow things to enter lungs that shouldn’t

Question 15

5. 1 of 4 diseases of COPD (all the result of dyspnea, difficulty of breathing)
   d. _____ – chronic inflammatory disorder of the lung
   i. Episodic recurrent symptoms: _____ (bronchi become acutely inflamed and mucous fills and it takes a lot for air to come through), breathlessness, chest tightness, and cough
   ii. Inflammation appears to trigger hyper-response of airways (_____)
   iii. Many causes exist – many are linked to _____ (type __ hypersensitive) responses, allergic to things, exercised induced asthma, cold induced asthma
   iv. Not associated with development of emphysema because _____ of airflow after asthma attack

Answer 15

5. 1 of 4 diseases of COPD (all the result of dyspnea, difficulty of breathing)
   d. Asthma – chronic inflammatory disorder of the lung
   i. Episodic recurrent symptoms: wheezing (bronchi become acutely inflamed and mucous fills and it takes a lot for air to come through), breathlessness, chest tightness, and cough
   ii. Inflammation appears to trigger hyper-response of airways (vasospasm)
   iii. Many causes exist – many are linked to anaphylactic (type 1 hypersensitive) responses, allergic to things, exercised induced asthma, cold induced asthma
   iv. Not associated with development of emphysema because restoration of airflow after asthma attack

Question 16

b. Small cell type Bronchogenic carcinomas
i. Small cell carcinoma – develop from _____ cells (hormone producing cells)
1. Usually _____ located
2. Arise from _____ cells
3. Often present with multiple _____
4. Tumors grow exceedingly _____
5. Most have _____ at the time of diagnosis
6. _____ curable by surgery, too many little masses
7. More responsive to _____ and _____ kills all the fast dividing cells

Answer 16

b. Small cell type Bronchogenic carcinomas
i. Small cell carcinoma – develop from neuroendocrine cells (hormone producing cells)
1. Usually centrally located
2. Arise from neuroendocrine cells
3. Often present with multiple tumors
4. Tumors grow exceedingly fast
5. Most have metastasized at the time of diagnosis
6. Not curable by surgery, too many little masses
7. More responsive to chemotherapy and radiation kills all the fast dividing cells

Question 17

1. Leukoplakia
   a. White, fixed _____ on oral mucosa
   b. Histological – _____ with or without underlying epithelial changes
   c. __-__% undergo malignant transformation

Answer 17

1. Leukoplakia
   a. White, fixed patches on oral mucosa
   b. Histological – hyperkeratosis with or without underlying epithelial changes
   c. 3-25% undergo malignant transformation

Question 18

2. Sialadenitis
   a. Infection of the _____ glands
   b. Bacterial – most often _____ obstruction
   i. Sialolithiasis (stone formation)
   c. Autoimmune – _____ syndrome
   i. Chronic process – leads to decreased _____
   d. Xerostomia – _____ _____ resulting from reduced or absent saliva flow

Answer 18

2. Sialadenitis
   a. Infection of the salivary glands
   b. Bacterial – most often duct obstruction
   i. Sialolithiasis (stone formation)
   c. Autoimmune – Sjogren syndrome
   i. Chronic process – leads to decreased saliva
   d. Xerostomia – dry mouth resulting from reduced or absent saliva flow

Question 19

3. 2 Most common tumors of the Salivary Glands
   a. _____ _____ – mixed tumor salivary gland tumor and the most common tumor of the parotid gland
   b. _____ _____ – benign cystic tumor of the salivary glands containing abundant lymphocytes and germinal centers

Answer 19

3. 2 Most common tumors of the Salivary Glands
   a. Pleomorphic adenoma – mixed tumor salivary gland tumor and the most common tumor of the parotid gland
   b. Wharthin tumor – benign cystic tumor of the salivary glands containing abundant lymphocytes and germinal centers

Question 20

4. _____ _____
   a. “Replacement of the normal distal stratified squamous mucosa by metaplastic columnar epithelium containing goblet cells”
   b. Complication of long standing GERD
   c. Grossly – alters appearance of _____
   d. Microscopically – not typical intestinal _____
   e. Complications: ulcers, stricture
   f. Major problem – risk of developing _____ (__-__ fold greater risk)
   g. Screened for _____ – low grade/high grade

Answer 20

4. Barretts Esophagus
   a. “Replacement of the normal distal stratified squamous mucosa by metaplastic columnar epithelium containing goblet cells”
   b. Complication of long standing GERD
   c. Grossly – alters appearance of mucosa
   d. Microscopically – not typical intestinal mucosa
   e. Complications: ulcers, stricture
   f. Major problem – risk of developing adenocarcinoma (30-100 fold greater risk)
   g. Screened for dysplasia – low grade/high grade

Question 21

5. 2 types of Esophageal Carcinoma
   a. Produces dysphagia and later obstruction
   b. Invade lymphatics early – bad prognosis
   c. Two types are seen:

i. Squamous cell:
1. __% world wide
2. Associated with _____ and _____ use
3. Association with _____ moving food through esophagus and _____
4. Most in _____ _____; but can occur in more proximal and more distal areas as well

ii. Adenocarcinoma:
1. Most _____ variety in United States
2. Precursor lesion – _____ _____
3. Develop in distal _____ _____ of esophagus in areas of Barretts changes

Answer 21

5. 2 types of Esophageal Carcinoma
   a. Produces dysphagia and later obstruction
   b. Invade lymphatics early – bad prognosis
   c. Two types are seen:

i. Squamous cell:
1. 90% world wide
2. Associated with tobacco and alcohol use
3. Association with slower moving food through esophagus and toxins
4. Most in middle third; but can occur in more proximal and more distal areas as well

ii. Adenocarcinoma:
1. Most common variety in United States
2. Precursor lesion – Barretts Esophagus
3. Develop in distal one third of esophagus in areas of Barretts changes

Question 22

6. Acute versus Chronic Gastritis

a. Acute Gastritis:
i. Usually _____
ii. Heavy use of _____ anti-inflammatory drugs, excessive _____, heavy _____, _____, _____, _____

b. Chronic Gastritis:
i. _____ common disease
ii. Leads eventually to _____ and _____ _____
iii. Causes: _____ _____ most important
iv. Many have organism and symptoms but are asymptomatic

Answer 22

6. Acute versus Chronic Gastritis

a. Acute Gastritis:
i. Usually transient (comes and goes)
ii. Heavy use of nonsteroidal anti-inflammatory drugs, excessive alcohol, heavy smoking, drugs, stress, infections

b. Chronic Gastritis:
i. More common disease
ii. Leads eventually to metaplasia and mucosal atrophy
iii. Causes: Helicobacter pylori most important
iv. Many have organism and symptoms but are asymptomatic

Question 23

7. Gastric versus Peptic Ulcers

a. Gastric Ulcers
i. _____ gastric ulcerations – usually _____ ulcers
ii. Seen with severe _____/critical _____, chronic exposure to _____, extensive _____ (_____ ulcers)

b. Peptic Ulcers
i. _____, usually solitary
ii. Found in regions of heavy gastric _____ exposure
iii. 4:1 – first portion of _____ to _____
iv. Causes: _____ and the mucosal exposure to _____

Answer 23

7. Gastric versus Peptic Ulcers

a. Gastric Ulcers
i. Acute gastric ulcerations – usually stress ulcers
ii. Seen with severe trauma/critical illnesses, chronic exposure to irritants, extensive burns (Curlings ulcers)

b. Peptic Ulcers
i. Chronic, usually solitary
ii. Found in regions of heavy gastric acid exposure
iii. 4:1 – first portion of duodenum to stomach
iv. Causes: H. pylori and the mucosal exposure to acid

Question 24

8. Celiac Disease
   a. “_____-sensitive _____”
   b. Results from reduction in _____ _____ for absorption in _____ intestine
   c. Basic problem – _____ sensitivity to gluten
   d. Get lymphocytic infiltrate and blunting of _____
   e. Gluten found in wheat and related grains (oat, barley and rye)

Answer 24

8. Celiac Disease
   a. “Gluten-sensitive enteropathy”
   b. Results from reduction in surface area for absorption in small intestine
   c. Basic problem – immunologic sensitivity to gluten
   d. Get lymphocytic infiltrate and blunting of villi
   e. Gluten found in wheat and related grains (oat, barley and rye)

Question 25

9. Diverticulosis/Diverticulitis a. Diverticulum – blind _____ that communicates with lumen b. Acquired diverticula – have lack of or attenuated _____ _____ c. Most common location – _____ i. Herniations occur around areas of _____ _____ d. Complications i. Diverticulitis - Diverticulosis happens when _____ (diverticula) form in the wall of the colon. If these _____ get inflamed or infected, it is called diverticulitis. ii. Perforations

Answer 25

9. Diverticulosis/Diverticulitis a. Diverticulum – blind pouch that communicates with lumen b. Acquired diverticula – have lack of or attenuated muscularis propria c. Most common location – colon i. Herniations occur around areas of taeniae coli d. Complications i. Diverticulitis - Diverticulosis happens when pouches (diverticula) form in the wall of the colon. If these pouches get inflamed or infected, it is called diverticulitis. ii. Perforations

Question 26

10. Intestinal Obstructions a. Volvulus: i. _____ of the intestines upon themselves ii. Various etiologies (causes) 1. _____ 2. _____ b. Intussusception: i. “_____ of the intestines” ii. Associated with a “_____ edge” 1. Congenital causes – short, malformed _____ 2. Adults - masses

Answer 26

10. Intestinal Obstructions a. Volvulus: i. Twisting of the intestines upon themselves ii. Various etiologies (causes) 1. Adhesions 2. Masses b. Intussusception: i. “Telescoping of the intestines” ii. Associated with a “leading edge” 1. Congenital causes – short, malformed mesentery 2. Adults - masses

Question 27

11. Appendicitis a. Incidence – __% of persons in US b. Peak incidence – _____ and _____ decades c. Cause – most likely _____ d. Pathogenesis – build up of mucous leads to collapse of _____ and eventually _____, then bacterial _____ e. Clinically – mild _____ pain, _____, _____, _____, _____ lower quadrant tenderness, then pain

Answer 27

11. Appendicitis a. Incidence – 10% of persons in US b. Peak incidence – second and third decades c. Cause – most likely obstruction d. Pathogenesis – build up of mucous leads to collapse of veins and eventually ischemia, then bacterial proliferation e. Clinically – mild periumbilical pain, anorexia, nausea, vomiting, right lower quadrant tenderness, then pain

Question 28

12. Inflammatory Bowel Disease including basic differences between Crohns and Ulcerative Colitis: a. Chronic _____ inflammatory disorders b. Result from abnormal local immune response against normal _____ of the gut and self _____ c. Appears to be _____ predisposition d. Exists in two forms: Crohns + Ulcerative Colitis: e. Crohns Disease: i. Can affect _____ portion of GI tract ii. Most commonly – _____ _____ iii. Is also a systemic disease – extraintestinal inflammations as well iv. Gross features – Skip lesions, transmural involvement, fistula formation, v. Microscopically - presence of ____ inflammation vi. Variable course – episodes of diarrhea, crampy abdominal pain, fever, sometimes melena vii. Complications – fistulas, abdominal abscesses, intestinal strictures f. Ulcerative Colitis: i. Affects only the _____ ii. Also a systemic disorder- extraintestinal inflammations iii. Grossly – continuous involvement, superficial – mucosa and submucosa only iv. Microscopically – no ____, dysplasia sometimes present v. Clinically – chronic relapsing attacks of ____ diarrhea, cramps, some individuals fever and weight loss vi. Complications – blood loss, associated with development of colon carcinoma

Answer 28

12. Inflammatory Bowel Disease including basic differences between Crohns and Ulcerative Colitis: a. Chronic relapsing inflammatory disorders b. Result from abnormal local immune response against normal flora of the gut and self antigens c. Appears to be genetic predisposition d. Exists in two forms: Crohns + Ulcerative Colitis: e. Crohns Disease: i. Can affect any portion of GI tract ii. Most commonly – terminal ileum iii. Is also a systemic disease – extraintestinal inflammations as well iv. Gross features – Skip lesions, transmural involvement, fistula formation, v. Microscopically - presence of granulomatous inflammation vi. Variable course – episodes of diarrhea, crampy abdominal pain, fever, sometimes melena vii. Complications – fistulas, abdominal abscesses, intestinal strictures f. Ulcerative Colitis: i. Affects only the colon ii. Also a systemic disorder- extraintestinal inflammations iii. Grossly – continuous involvement, superficial – mucosa and submucosa only iv. Microscopically – no granulomas, dysplasia sometimes present v. Clinically – chronic relapsing attacks of bloody diarrhea, cramps, some individuals fever and weight loss vi. Complications – blood loss, associated with development of colon carcinoma

Question 29

13. Non-neoplastic versus Adenomatous Polyps Polyps - A small clump of cells that forms on the _____ of the colon or rectum. a. Non-neoplastic: i. Majority of _____ ii. Are _____ iii. Most – hyperplastic iv. Some – juvenile – are _____ b. Adenomas: i. Are _____ _____ ii. Result from epithelial _____ and _____ iii. Patterns: 1. Tubular 2. Villous 3. Tubulovillous iv. Malignant risk: 1. size – rare in less than __ cm 2. histologic type likelihood high in sessile villous lesions 3. severity of dysplasia – most often found in villous areas

Answer 29

13. Non-neoplastic versus Adenomatous Polyps Polyps - A small clump of cells that forms on the lining of the colon or rectum. a. Non-neoplastic: i. Majority of polyps ii. Are sporadic iii. Most – hyperplastic iv. Some – juvenile – are hamartomas b. Adenomas: i. Are neoplastic polyps ii. Result from epithelial proliferation and dysplasia iii. Patterns: 1. Tubular 2. Villous 3. Tubulovillous iv. Malignant risk: 1. size – rare in less than 1 cm 2. histologic type likelihood high in sessile villous lesions 3. severity of dysplasia – most often found in villous areas

Question 30

14. Colorectal Carcinoma a. Carcinoma represents __% of cancers b. Peak incidence – __-__ years c. Carcinogenesis – 2 patterns: i. _____ sequence 1. Cumulative genetic abnormalities 2. Follows dysplasia sequence ii. _____ _____ pathway 1. Arise from defective DNA repair 2. May not see precursor lesions d. Proximal versus Distal Lesions i. _____ – tend to be polypoid/exophytic, obstruction uncommon ii. _____ – tend to be annular “napkin-ring”, tend to obstruct e. Microscopic Type – adenocarcinoma of varying degrees of differentiation

Answer 30

14. Colorectal Carcinoma a. Carcinoma represents 98% of cancers b. Peak incidence – 60-70 years c. Carcinogenesis – 2 patterns: i. Adenoma-carcinoma sequence 1. Cumulative genetic abnormalities 2. Follows dysplasia sequence ii. Microsatellite instability pathway 1. Arise from defective DNA repair 2. May not see precursor lesions d. Proximal versus Distal Lesions i. Proximal – tend to be polypoid/exophytic, obstruction uncommon ii. Distal – tend to be annular “napkin-ring”, tend to obstruct e. Microscopic Type – adenocarcinoma of varying degrees of differentiation

Question 31

1. Gastrointestinal Stromal Tumors a. Considered smooth muscle tumors in _____ b. Appear now to have different _____ c. Can occur anywhere – most commonly in _____ d. Types: i. _____ _____ derivation ii. _____ derivation iii. Tumors with _____ derivation iv. Tumors _____ differentiation

Answer 31

1. Gastrointestinal Stromal Tumors a. Considered smooth muscle tumors in past b. Appear now to have different differentiation c. Can occur anywhere – most commonly in stomach d. Types: i. Smooth muscle derivation ii. Neural derivation iii. Tumors with dual derivation iv. Tumors lacking differentiation

Question 32

2. Carcinoid Tumors a. Arise from _____ cells of gut b. Less than __% of colorectal lesions c. __% of small intestine lesions d. All are potentially _____ e. Potential depends on: i. Size ii. Site of origin iii. Depth of penetration

Answer 32

2. Carcinoid Tumors a. Arise from endocrine cells of gut b. Less than 2% of colorectal lesions c. 50% of small intestine lesions d. All are potentially malignant e. Potential depends on: i. Size ii. Site of origin iii. Depth of penetration

Question 33

3. _____ a. Failure of development of the intestinal lumen b. Stenosis and obstruction

Answer 33

3. Atresia a. Failure of development of the intestinal lumen b. Stenosis and obstruction

Question 34

4. Meckel Diverticulum a. Failure of involution of the _____ duct b. Leaves long diverticulum, usually in the _____ c. Complications: i. Bacterial overgrowth depleting Vitamin _____ – pernicious anemia ii. Heterotopic tissue – pancreas/gastric mucosa with ulceration

Answer 34

4. Meckel Diverticulum a. Failure of involution (shrinkage of of the omphalomesenteric duct b. Leaves long diverticulum, usually in the ileum c. Complications: i. Bacterial overgrowth depleting Vitamin B12 – pernicious anemia ii. Heterotopic tissue – pancreas/gastric mucosa with ulceration

Question 35

5. _____ a. Defect of per umbilical musculature b. Creates sac into which intestines herniate

Answer 35

5. Omphalocele a. Defect of per umbilical musculature b. Creates sac into which intestines herniate

Question 36

6. _____ _____ a. Caused by arrest of migration of neural crest cells b. Do not distribute distal to anus c. Creates aganglionic segment d. Leads to marked dilatation of that segment

Answer 36

6. Hirschsprung Disease a. Caused by arrest of migration of neural crest cells b. Do not distribute distal to anus c. Creates aganglionic segment d. Leads to marked dilatation of that segment

Question 37

7. Hepatitis A a. Course: benign, self-limited disease b. Incubation period: __-__ days c. Mode of transmission: _____/_____ d. Clinically: i. Rarely fulminant disease ii. Does it lead to chronic liver disease?????

Answer 37

7. Hepatitis A a. Course: benign, self-limited disease b. Incubation period: 15-50 days c. Mode of transmission: fecal/oral d. Clinically: i. Rarely fulminant disease ii. Does not lead to chronic liver disease

Question 38

8. Hepatitis B a. Incubation period – __-__ days b. Transmission: _____ blood and body fluids c. Prevalence: High world wide d. Clinically – 5 scenarios: i. _____ hepatitis with recovery and clearance of virus ii. _____ chronic hepatitis iii. _____ chronic disease ending in liver failure iv. _____ hepatitis with liver necrosis v. _____ carrier state

Answer 38

8. Hepatitis B a. Incubation period – 45 – 160 days b. Transmission: Infected blood and body fluids c. Prevalence: High world wide d. Clinically – 5 scenarios: i. Acute hepatitis with recovery and clearance of virus ii. Nonprogressive chronic hepatitis iii. Progressive chronic disease ending in liver failure iv. Fulminant hepatitis with liver necrosis v. Asymptomatic carrier state

Question 39

9. Hepatitis C a. Incubation period: __-__ days b. Transmission: most via _____ i. IV Drug abuse accounts for >__% ii. Blood _____ were major cause in past c. Clinically: i. _____ phase often asymptomatic ii. Much higher rate of progression to chronic liver disease than _____ iii. Most common cause of liver _____ in US iv. Most have _____ infection v. Approximately __% go on to liver failure

Answer 39

9. Hepatitis C a. Incubation period: 14 – 84 days b. Transmission: most via blood i. IV Drug abuse accounts for >40% ii. Blood transfusions were major cause in past c. Clinically: i. Acute phase often asymptomatic ii. Much higher rate of progression to chronic liver disease than HBV iii. Most common cause of liver transplants in US iv. Most have persistent infection v. Approximately 20% go on to liver failure

Question 40

10. Alcoholic Liver Damage a. Responsible for >__% of chronic liver disease b. Changes i. Hepatic steatosis: 1. Progressive accumulation of _____ 2. Starts in centrilobular areas 3. Progresses to larger accumulations 4. Reversible until _____ occurs 5. Grossly presents as enlarged “_____ liver”

Answer 40

10. Alcoholic Liver Damage a. Responsible for >60% of chronic liver disease b. Changes i. Hepatic steatosis: 1. Progressive accumulation of lipids 2. Starts in centrilobular areas 3. Progresses to larger accumulations 4. Reversible until scarring occurs 5. Grossly presents as enlarged “fatty liver”

Question 41

11. Cirrhosis a. “Diffuse process characterized by fibrosis and the conversion of normal liver architecture into structurally abnormal nodules” b. Characteristics: i. Bridging fibrosis ii. Parenchymal nodules iii. Disruption of architecture of entire liver c. Causes: _____ abuse, chronic _____, _____ disease, _____ overload d. Severe complications: i. Progressive liver _____ ii. Portal _____ iii. Development of hepatocelluar _____

Answer 41

11. Cirrhosis a. “Diffuse process characterized by fibrosis and the conversion of normal liver architecture into structurally abnormal nodules” b. Characteristics: i. Bridging fibrosis ii. Parenchymal nodules iii. Disruption of architecture of entire liver c. Causes: alcohol abuse, chronic infections, biliary disease, iron overload d. Severe complications: i. Progressive liver failure ii. Portal hypertension iii. Development of hepatocelluar carcinoma

Question 42

12. _____ | a. Accumulation of peritoneal fluid

Answer 42

12. Ascites | a. Accumulation of peritoneal fluid

Question 43

13. _____ _____ | a. distended and engorged superficial epigastric veins, which are seen radiating from the umbilicus across the abdomen.

Answer 43

13. Caput Medusae | a. distended and engorged superficial epigastric veins, which are seen radiating from the umbilicus across the abdomen.

Question 44

14. _____ | a. tremors of head and extremities

Answer 44

14. Asterixis | a. tremors of head and extremities

Question 45

15. _____ a. Genetic disorder b. Results in excessive accumulation of iron – deposited in parenchymal organs including liver and pancreas c. Develop pigmentation and iron deposition in other organs as well

Answer 45

15. Hemochromatosis a. Genetic disorder b. Results in excessive accumulation of iron – deposited in parenchymal organs including liver and pancreas c. Develop pigmentation and iron deposition in other organs as well

Question 46

16. _____ _____ a. Genetic disorder b. Defect in copper metabolism c. Can proceed to brain involvement

Answer 46

16. Wilson Disease a. Genetic disorder b. Defect in copper metabolism c. Can proceed to brain involvement

Question 47

17. Hepatocellular Carcinoma a. World wide occurs most in countries with high _____ rates b. Three major associations i. _____ or _____ infection ii. Chronic _____ iii. _____ exposure 1. Are toxins from fungus _____ flavus – dietary exposure c. Most develop in _____ livers d. Pathology of Tumors i. Grossly : 1. Unifocal 2. Multifocal 3. Diffuse ii. Microscopically: 1. Degree of differentiation can vary iii. Clinically: 1. Often occur in individuals with liver symptoms anyway 2. New symptoms: sudden increase in liver size, worsening ascites, pain 3. Prognostically – _____ a. Mean survival – __ months

Answer 47

17. Hepatocellular Carcinoma a. World wide occurs most in countries with high HBV rates b. Three major associations i. HBV or HCV infection ii. Chronic alcoholism iii. Aflatoxin exposure 1. Are toxins from fungus Aspergillus flavus – dietary exposure c. Most develop in cirrhotic livers d. Pathology of Tumors i. Grossly : 1. Unifocal 2. Multifocal 3. Diffuse ii. Microscopically: 1. Degree of differentiation can vary iii. Clinically: 1. Often occur in individuals with liver symptoms anyway 2. New symptoms: sudden increase in liver size, worsening ascites, pain 3. Prognostically – grim a. Mean survival – 7 months