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USMLE Step 1: GI > GI Pathology > Flashcards

GI Pathology Flashcards

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USMLE® Step 1 flashcards
1
Q

T/F: Salivary gland tumors are usually malignant and occur in the parotid gland.

A

FALSE: usually benign, not malignant

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2
Q

Name 3 types of salivary gland tumors.

A

Pleomorphic adenoma, Warthin’s tumor, mucoepidermoid carcinoma

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3
Q

T/F: Pleomorphic adenoma presents as a painful, mobile mass.

A

FALSE: painless, not painful

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4
Q

T/F: Warthin’s tumor is a benign cystic tumor with germinal centers.

A

TRUE

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5
Q

Mucoepidermoid carcinoma is the most common malignant tumor, presents as a painful/painless mass.

A

Painful (due to common involvement of facial nerve)

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6
Q

Achalasia is the failure of relaxation of the lower esophageal sphincter due to _____.

A

Loss of myenteric (Auerbach’s) plexus

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7
Q

T/F: Achalasia presents as progressive dysphagia to solids only.

A

FALSE: solids AND liquids (obstruction presents as solids only)

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8
Q

Patient with achalasia undergoes a barium swallow. What would be seen on barium swallow?

A

Dilated esophagus with area of distal stenosis (“bird’s beak”)

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9
Q

T/F: Achalasia is associated with an increased risk of esophageal squamous cell carcinoma.

A

TRUE

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10
Q

Name 2 conditions associated with secondary achalasia.

A

Chagas’ disease, scleroderma (CREST syndrome)

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11
Q

Patient presents with heartburn, regurgitation upon lying down, nocturnal cough, dyspnea. He was also recently diagnosed with adult-onset asthma. Name the disorder.

A

GERD

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12
Q

Esophageal varices presents as painless bleeding of dilated submocosal veins in upper/lower _____ of esophagus secondary to _____.

A

Lower 1/3; portal hypertension

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13
Q

Match the type of esophagitis with the description: white pseudomembrane; punched-out ulcers; linear ulcers

A

Candida; HSV-1; CMV

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14
Q

What is Mallory-Weiss syndrome?

A

Mucosal lacerations at the GE junction due to severe vomiting, leads to hematemesis, usually found in alcoholics/bulimics

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15
Q

Boerhaave syndrome is a _____ esophageal rupture due to _____.

A

Transmural; violent retching (*Remember Been-Heaving Syndrome!)

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16
Q

T/F: Esophageal strictures are associated with lye ingestion and acid reflux.

A

TRUE

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17
Q

Name the triad of Plummer-Vinson syndrome.

A

Dysphagia (due to esophageal webs), glossitis, iron deficiency anemia

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18
Q

Describe the metaplasia associated with Barrett’s esophagus.

A

Replacement of nonkeratinized (stratified) squamous epithelium with intestinal (nonciliated columnar) epithelium in the distal esophagus.

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19
Q

Name 10 risk factors for esophageal cancer.

A

Achalasia, Alcohol (squamous), Barrett’s esophagus (adeno), Cigarettes (both), Diverticula (eg. Zenker’s) (squamous), Esophageal web (squamous), Familial, Fat (obesity) (adeno), GERD (adeno), Hot liquids (squamous) (*Remember AABCDEFFGH mnemonic!)

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20
Q

T/F: Worldwide, adenocarcinoma is more common, though in the United States, squamous cell carcinoma is more common.

A

FALSE: Worldwide, squamous cell carcinoma is more common, though in the United States, adenocarcinoma is more common.

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21
Q

T/F: Squamous cell cancer carcinoma is localized to the upper 2/3 of the esophagus, while adenocarcinoma is localized to the lower 1/3.

A

TRUE

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22
Q

65 year old man presents with cardiac symptoms, arthralgias, and neuro symptoms. PAS+, foamy macrophages are seen in intestinal lamina propria. What is the organism associated with this disease?

A

Tropheryma whipplei (Whipple’s disease)

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23
Q

A patient with celiac sprue develops autoantibodies to _____.

A

Gluten (gliadin)

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24
Q

T/F: Celiac sprue primarily affects the distal ileum.

A

FALSE: distal duodenum or proximal jejunum

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25
Q

What is the most common disaccharidase deficiency? What type of diarrhea does it cause?

A

Lactase deficiency; osmotic diarrhea

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26
Q

Lactose tolerance test is positive for lactase deficiency if the administration of lactose produces symptoms and _____ rises <20mg/dL.

A

Glucose

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27
Q

Abetalipoproteinemia is the dec in synthesis of _____ which ultimately leads to fat accumulation in _____.

A

Apolipoprotein B; enterocytes

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28
Q

Name 3 causes of pancreatic insufficiency.

A

Cystic fibrosis, obstructing cancer, and chronic pancreatitis

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29
Q

What are the 4 fat-soluble vitamins?

A

Vitamins A, D, E, K

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30
Q

Celiac sprue findings include anti _____, anti _____ and anti _____ antibodies.

A

Endomysial; tissue transglutaminase; gliadin

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31
Q

What is the dermatologic finding associated with celiac sprue?

A

Dermatitis herpetiformis

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32
Q

T/F: Celiac sprue is associated with a moderate increased risk of T-cell lymphoma.

A

TRUE

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33
Q

_____ ulcer is associated with burns, which inc/dec plasma volume, leading to sloughing of gastric mucosa and acute gastritis.

A

Curling’s; inc

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34
Q

_____ ulcer is associated with brain injury, which inc/dec vagal stimulation, inc/dec ACh, and inc/dec H+ production, leading to acute gastritis.

A

Cushing’s; inc; inc; inc

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35
Q

Type A chronic gastritis is an autoimmune disorder characterized by autoantibodies to _____, _____ anemia, and achlorhydria, and affects the gastric _____.

A

Parietal cells; pernicious; body

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36
Q

Type B chronic gastritis is caused by _____ infection, is associated with an increased risk of _____, and affects the gastric _____.

A

H. pylori; MALT lymphoma; fundus

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37
Q

What is the name of a precancerous condition characterized by gastric hypertrophy with protein loss, parietal cell atrophy, and inc mucous cells?

A

Menetrier’s disease

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38
Q

T/F: Stomach cancer is almost always adenocarcinoma.

A

TRUE

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39
Q

Intestinal stomach cancer is/is not associated with H.pylori; diffuse stomach cancer is/is not associated with H. pylori.

A

Is; is not

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40
Q

What is Virchow’s node?

A

Involvement of L supraclavicular node by metastasis from stomach

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41
Q

What is Krukenberg’s tumor?

A

Bilateral metastases to ovaries (abundant mucus, signet ring cells)

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42
Q

What is Sister Mary Joseph’s nodule?

A

Subcutaneous periumbilical metastasis

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43
Q

Compare the presentations of gastric ulcers vs. duodenal ulcers (in terms of pain).

A

Gastric ulcers: pain greater with meals (results in weight loss); duodenal ulcers: pain decreases with meals (results in weight gain)

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44
Q

T/F: The risk of carcinoma is increased in gastric ulcers, but not in duodenal ulcers.

A

TRUE

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45
Q

Name 2 complications of ulcers.

A

Hemorrhage (gastric, duodenal- posterior>anterior), perforation (duodenal- anterior>posterior)

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46
Q

Crohn’s or ulcerative colitis? Rectal involvement; transmural inflammation; noncaseating granulomas; strictures and fistulas.

A

Ulcerative colitis; Crohn’s; Crohn’s; Crohn’s

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47
Q

Name 5 extraintestinal manifestations of Crohn’s disease.

A

Migratory polyarthritis, erythema nodosum, ankylosing spondylitis, uveitis, kidney stones

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48
Q

Name 4 extraintestinal manifestations of ulcerative colitis.

A

Pyoderma gangrenosum, primary sclerosing cholangitis, ankylosing spondylitis, uveitis

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49
Q

Name 5 treatment options for Crohn’s disease.

A

Corticosteroids, azathioprine, methotrexate, infliximab, adalimumab

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50
Q

Name 4 treatment options for ulcerative colitis.

A

ASA preparations (sulfasalazine), 6-mercaptopurine, infliximab, colectomy

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51
Q

IBS is defined as recurrent abdominal pain associated with at least 2 of which 3 symptoms?

A

1) Pain that improves with defecation 2) Change in stool frequency 3) Change in appearance of stool

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52
Q

Patient presents with initial diffuse periumbilical pain that migrates to McBurney’s point, nausea, fever. Obstruction by fecalith seen on imaging. What is the most likely diagnosis?

A

Appendicitis

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53
Q

Diverticulum are most often located in the _____.

A

Sigmoid colon

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54
Q

What is the difference between “true” and “false” diverticulum?

A

“True” diverticulum: all 3 gut wall layers outpouch; “false” diverticulum: only mucosa and submucosa outpouch

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55
Q

60yo patient presents with painless hematochezia, eats a low-fiber diet, has many false diverticula in the sigmoid colon. What are some complications of his condition?

A

Diverticulitis, fistulas (patient has diverticulosis)

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56
Q

Patient with history of diverticulosis presents with LLQ pain, fever, leukocytosis. What is the most likely diagnosis?

A

Diverticulitis

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57
Q

Patient presents with halitosis, dysphagia, obstruction; there is herniation of mucosal tissue at Killian’s triangle. What is the diagnosis?

A

Zenker’s diverticulum

58
Q

Zenker’s diverticulum is a true/false diverticulum; Meckel’s diverticulum is a true/false diverticulum.

A

False; true

59
Q

What are the 5 2’s of Meckel’s diverticulum?

A

2 inches long, 2 feet from the ileocecal valve, 2% of the population, commonly presents in the first 2 years of life, may have 2 types of epithelia (gastric/pancreatic)

60
Q

Meckel’s diverticulum is the persistence of the _____; it is diagnosed by _____.

A

Vitelline duct; pertechnetate study for ectopic uptake

61
Q

Child with currant jelly stool- name the abdominal emergency.

A

Intussusception

62
Q

Intussusception commonly occurs at the _____ junction; volvulus common occurs at the _____ and _____.

A

Ileocecal; cecum; sigmoid

63
Q

Child with Down’s syndrome presents with chronic constipation, failure to pass meconium. What is the likely diagnosis, how is it diagnosed, and what is the treatment?

A

Hirschsprung’s disease; rectal suction biopsy; resection

64
Q

Child presents with bilious vomiting with proximal stomach distention, “double bubble” seen on X-ray. Name the disorder.

A

Duodenal atresia

65
Q

Child with cystic fibrosis, cannot pass stool at birth. Name the disorder.

A

Meconium ileus

66
Q

T/F: Necrotizing enterocolitis is more common in older children.

A

FALSE: more common in preemies due to decreased immunity

67
Q

Elderly patient presents with severe pain after eating; abdominal exam is non-significant. Name the disorder and where it commonly occurs.

A

Ischemic colitis; splenic flexure and distal colon

68
Q

Patient with history of multiple abdominal surgeries now presents with small bowel obstruction. Name the disorder.

A

Adhesions

69
Q

Name the 3 most common locations where angiodysplasia occurs.

A

Cecum, terminal ileum, ascending colon

70
Q

Adenomatous polyps are precancerous; malignant risk is associated with _____, _____, and _____.

A

Increased size, villous histology, and increased epithelial dysplasia.

71
Q

What is the most common non-neoplastic polyp in the colon?

A

Hyperplastic

72
Q

In juvenile polyposis syndrome, 80% of polyps are located in the _____.

A

Rectum

73
Q

Patient presents with multiple nonmalignant hamartomas throughout the GI tract, hyperpigmentation of the mouth, lips, hands, and genitalia. Name the syndrome.

A

Peutz-Jeghers

74
Q

Name 4 syndromes that progress to CRC.

A

1) Familial adenomatous polyposis 2) Gardner’s syndrome 3) Turcot’s syndrome 4) Hereditary nonpolyposis CRC/Lynch syndrome

75
Q

Patient with FAP and osseous and soft tissue tumors, congenital hypertrophy of retinal pigment epithelium. Name the syndrome.

A

Gardner’s syndrome

76
Q

Patient with FAP and malignant CNS tumor. Name the syndrome.

A

Turcot’s syndrome (*Remember Turcot=Turban mnemonic!)

77
Q

Iron deficiency anemia in males >50 years old and postmenopausal females should raise your suspicion for _____.

A

CRC

78
Q

T/F: CEA tumor marker is a useful tool for CRC screening.

A

FALSE: Good for monitoring recurrence, NOT useful for screening

79
Q

The molecular pathway that lead to CRC is as follows: loss of _____ gene; _____ mutation; _____ loss of p53.

A

APC; K-Ras; p53

80
Q

What are the 3 most common sites of carcinoid tumor?

A

Appendix, ileum, rectum

81
Q

Classic symptoms of _____ include wheezing, R sided heart murmurs, diarrhea, flushing.

A

Carcinoid syndrome

82
Q

What is the difference between carcinoid tumor that is confined to the GI system vs. tumor that exists outside the GI system?

A

Confined to the GI system: no carcinoid syndrome is observed since liver metabolizes 5-HT; outside the GI system: carcinoid syndrome

83
Q

What are 3 treatment options for carcinoid tumor?

A

Resection, octreotide, somatostatin

84
Q

T/F: Cirrhosis increases the risk for hepatocellular carcinoma.

A

TRUE

85
Q

What is the most common etiology of cirrhosis?

A

Alcohol

86
Q

ALT>AST in _____ hepatitis; AST>ALT in _____ hepatitis.

A

Viral; alcoholic

87
Q

When is ALP elevated?

A

Obstructive liver disease (hepatocellular carcinoma), bone disease, bile duct disease

88
Q

T/F: GGT is increased in various liver, biliary, and bone disease.

A

FALSE: only elevated in liver and biliary diseases

89
Q

T/F: Amylase and lipase are elevated in acute pancreatitis.

A

TRUE

90
Q

Ceruloplasmin is inc/dec in Wilson’s disease.

A

Dec

91
Q

Child with a viral infection was treated with aspirin. He then presents with fatty liver, hypoglycemia, vomiting, hepatomegaly, and coma. What is the diagnosis?

A

Reye’s syndrome

92
Q

T/F: Hepatic steatosis is not reversible with alcohol cessation.

A

FALSE: It may be reversible

93
Q

Mallory bodies is associated with which alcoholic liver disease?

A

Alcoholic hepatitis

94
Q

T/F: Alcoholic cirrhosis is reversible with alcohol cessation.

A

FALSE: This is the final and irreversible form

95
Q

The AST/ALT ratio in alcoholic hepatitis is usually greater than _____.

A

1.5

96
Q

What is the most common primary malignant tumor of the liver in adults?

A

Hepatocellular carcinoma/hepatoma

97
Q

What tumor marker is elevated in hepatocellular carcinoma?

A

Alpha-fetoprotein

98
Q

Name some risk factors for hepatocellular carcinoma.

A

Hepatitis B and C, Wilson’s disease, hemochromatosis, alpha1-antitrypsin deficiency, alcoholic cirrhosis, carcinogens (aflatoxin from Aspergillus)

99
Q

State whether the following liver tumors are benign or malignant: cavernous hemangioma, hepatic adenoma, angiosarcoma.

A

Benign; benign; malignant

100
Q

What is nutmeg liver?

A

Mottled liver (like a nutmeg) due to backup of blood into liver; commonly caused by right-sided heart failure and Budd-Chiari syndrome.

101
Q

Budd-Chiari syndrome is the occlusion of ___ or ___, leading to congestive liver disease.

A

IVC; hepatic veins

102
Q

Patient with cirrhosis with PAS-positive globules in liver and panacinar emphysema. What is the diagnosis?

A

Alpha1-antitrypsin deficiency

103
Q

In hepatocellular jaundice, hyperbilirubinemia is direct/indirect/both; urine bilirubin is inc/dec/absent; urine urobilinogen is inc/dec/normal.

A

Direct or indirect; inc; normal or dec

104
Q

In obstructive jaundice, hyperbilirubinemia is direct/indirect/both; urine bilirubin is inc/dec/absent; urine urobilinogen is inc/dec/normal.

A

Direct; inc; dec

105
Q

In hemolytic jaundice, hyperbilirubinemia is direct/indirect/both; urine bilirubin is inc/dec/absent; urine urobilinogen is inc/dec/normal.

A

Indirect; absent; inc

106
Q

What is the treatment for physiologic neonatal jaundice?

A

Phototherapy (converts UCB to water-soluble form)

107
Q

Patient who has been fasting and under stress with elevated unconjugated bilirubin, but is asymptomatic. What is the diagnosis?

A

Gilbert’s syndrome

108
Q

In Crigler-Najjar syndrome, type I, unconjugated bilirubin is inc/dec while UDP-glucuronyl transferase is inc/dec/absent.

A

Inc; absent

109
Q

What are 2 treatment options for Crigler-Najjar syndrome, type I? Type II also responds to what?

A

Plasmapheresis and phototherapy; phenobarbital

110
Q

Name the syndrome associated with conjugated hyperbilirubinemia due to defective liver excretion, grossly black liver.

A

Dubin-Johnson syndrome

111
Q

T/F: Rotor’s syndrome causes grossly black liver.

A

FALSE: Does not cause black liver

112
Q

Name the syndrome associated with a problem with 1) bilirubin uptake 2) bilirubin conjugation 3) excretion of conjugated bilirubin.

A

1) Gilbert’s 2) Crigler-Najjar 3) Dubin-Johnson

113
Q

Name 5 areas where copper accumulates in Wilson’s disease.

A

Liver, brain, cornea, kidney, joints

114
Q

What is the treatment for Wilson’s disease?

A

Penicillamine

115
Q

Patient presents with cirrhosis, golden brown corneal rings, hemolytic anemia, parkinsonian symptoms, asterixis, dementia, dyskinesia, and dysarthria. What is the most likely diagnosis?

A

Wilson’s disease

116
Q

What is the classic triad seen in hemochromatosis?

A

Cirrhosis, DM, skin pigmentation (“bronze” diabetes”)

117
Q

In hemochromatosis, ferritin inc/dec, iron inc/dec, TIBC inc/dec, transferrin saturation inc/dec.

A

Inc; inc; dec; inc

118
Q

What are 3 treatment options for hereditary hemochromatosis?

A

Repeated phlebotomy, deferasirox, deferoxamine

119
Q

Patient presents with pruritus, jaundice, dark urine, light stools, hepatosplenomegaly. Labs show inc conjugated bilirubin, cholesterol, and ALP. Name 3 differential diagnoses.

A

Primary biliary cirrhosis, secondary biliary cirrhosis, primary sclerosing cholangitis

120
Q

Match the biliary tract disease with the description: increased pressure in intrahepatic ducts leading to injury/fibrosis and bile stasis; autoimmune reaction with increased serum mitochondrial antibodies leading to lymphocytic infiltrate and granulomas; hypergammaglobulinemia and “onion skin” bile duct fibrosis leading to strictures and dilation with “beading” of intra- and extrahepatic bile ducts on ERCP.

A

Secondary biliary cirrhosis; primary biliary cirrhosis; primary sclerosing cholangitis

121
Q

T/F: Primary sclerosis cholangitis is associated with other autoimmune conditions like CREST, RA, celiac disease.

A

FALSE: Primary biliary cirrhosis is associated with other autoimmune diseases. Primary sclerosing cholangitis is associated with ulcerative colitis.

122
Q

What are the 2 types of gallstones?

A

1) Cholesterol stones 2) Pigment stones

123
Q

T/F: Cholesterol stones are radiopaque while pigment stones are radiolucent.

A

FALSE: Cholesterol stones are radioLUCENT while pigment stones are radiOPAQUE

124
Q

What are the 4 risk factors for cholelithiasis?

A

1) Female 2) Fat 3) Fertile (pregnant) 4) Forty (*Remember 4F’s mnemonic!)

125
Q

What makes up Charcot’s triad of cholangitis?

A

Jaundice, ever, and RUQ pain

126
Q

A patient has a positive Murphy’s sign. What does this mean?

A

Inspiratory arrest on deep RUQ palpation due to pain; high suspicion for cholelithiasis

127
Q

How does cholelithiasis lead to biliary colic?

A

Neurohormonal activation (eg. CCK after a fatty meal) triggers contraction of the gallbladder, forcing a stone into the cystic duct

128
Q

A fistula between the gallbladder and small intestine or gallstone ileus, what is seen on imaging?

A

Air in the biliary tree

129
Q

How is cholelithiasis diagnosed and treated?

A

Diagnose with ultrasound, radionuclide biliary (HIDA) scan.; treat with cholecystectomy

130
Q

Cholecystitis is usually from _____.

A

Gallstones

131
Q

Patient with history of alcoholism and gallstone presents with epigastric abdominal pain that radiates to back, anorexia, nausea. Labs show elevated amylase and lipase. What is the most likely diagnosis?

A

Acute pancreatitis

132
Q

What are 10 causes of acute pancreatitis?

A

Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune disease, Scorpion sting, Hypercalcemia/Hypertriglyceridemia (>1000), ERCP, Drugs (eg. Sulfa drugs) (*Remember GETSMASHED mnemonic!)

133
Q

Which has higher specificity for diagnosing acute pancreatitis, amylase or lipase?

A

Lipase

134
Q

Describe a pancreatic pseudocyst.

A

Lined by granulation tissue, not epithelium, can rupture and hemorrhage

135
Q

Patient with long history of alcohol abuse presents with steatorrhea, fat-soluble vitamin deficiency, DM. What is the diagnosis that puts this patient at increased risk of pancreatic adenocarcinoma?

A

Chronic pancreatitis

136
Q

T/F: Amylase and lipase are LESS elevated in chronic pancreatitis compared to acute pancreatitis.

A

TRUE

137
Q

Pancreatic adenocarcinoma is more common in which part of the pancreas?

A

Pancreatic head

138
Q

What is the tumor marker associated with pancreatic adenocarcinoma?

A

CEA 19-9

139
Q

What is Trousseau’s syndrome?

A

In pancreatic adenocarcinoma, migratory thrombophlebitis- redness and tenderness on palpation of extremities

140
Q

What is Courvoisier’s sign?

A

In pancreatic adenocarcinoma, obstructive jaundice with palpable, nontender gallbladder

141
Q

What is the name of the surgical treatment for pancreatic adenocarcinoma?

A

Whipple procedure

USMLE Step 1: GI (5 decks)

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