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Flashcards in Midterm Problem Areas Deck (179):
1

Four types of inflammatory lesions of oral cavity

Irritation Fibroma
Pyogenic Granuloma
Peripheral Ossifying Fibroma
Peripheral Giant Cell Granuloma

2

Most common inflammatory lesion of oral cavity

Irritation fibroma

3

Aphthous ulcer cause (2)

Stress
Lack of sleep

4

Most common fungal infection of mouth

Oral thrush

5

Cause of scarlet fever

Group A strep

6

Result in oral cavity of phenytoin/dilantin ingestion

Gingival hyperplasia

7

3 mutations in squamous cell carcinoma in chronological order

Inactivation of P16 --> Hyperplasia
Mutation of p53 --> Dysplasia
Activation of cyclin D1 --> Malignancy

8

3 Odontogenic cysts

Dentigerous
Periapical
Keratocyst

9

Keratocyst location
2 features of the cyst

Posterior mandible

Prominent basal layer palisading + corrugated epithelial surface

10

DM patients get what sinusitis

Mucormycosis

11

If someone is an adolescent male with a tumor of BV's and fibrous tissue what is it?
What to be careful of

Nasopharyngeal angiofibroma
Bleed out during resection

12

A malignant tumor arising in the cribiform plate with lobular growth pattern

Olfactory neuroblastoma

13

A tumor with HPV 6 and 11 found in the septum of the nose with inverted growth pattern and mucin microcysts.

Sinonasal/Schneiderian Papilloma

14

A singer who smokes presents with progressive hoarseness and has bilateral nodules.

Reactive nodules

15

A child comes in with obstructive symptoms and has a neoplasm on the vocal cord that tests positive for HPV 6 and 11

Squamous papilloma

16

A smoker with persistent hoarseness comes in

Carcinoma of larynx

17

Patient comes in with cyst on anterolateral aspect of neck

Branchial cleft cyst

18

patient comes in with cyst in midline of neck

Thyroglossal duct cyst

19

60 year old patient comes in with tumor at birfurcation of common carotid artery and has zell ballen of eosinophilic cells

Paraganglioma

20

Most common lesion of salivary glands
Most common location

Mucoceles
Lower lip

21

Patient comes in with what looks like a mucocele on floor of the mouth

Ranula

22

Most malignant salivary gland

Sublingual

23

Most common tumor of salivary glands

Pleomorphic adenoma

24

Second most common tumor of salivary glands
Patient at risk

Warthin tumor
Smoker

25

Most common malignant salivary gland tumor

Mucoepidermoid carcinoma

26

Parotid gland tumor with cells with clear or granular cytoplasm

Acinic Cell carcinoma

27

Patient with tumor of minor salivary glands in the palate. Tumor has small blue cells in cribriform pattern and has hyaline membrane between cells. There is perineural invasion seen.

Adenoid Cystic Carcinoma

28

Patient with benign enlargement of lacrimal gland and salivary glands with dry eyes and mouth

Mikulicz

29

Patient with granulomas in the orbit that are negative for fungi and bacteria

Sarcoidosis

30

Most common primary orbital neoplasm

Vascular: Hemangiomas

31

Most common malignant neoplasm of lacrimal gland

Adenoid cystic carcinoma

32

Most common benign neoplasm of lacrimal gland

Pleomorphic adenoma

33

Patient comes in with neoplasm of lower eyelid and medial canthus

Basal Cell Carcinoma

34

Elderly patient comes in with tumor of upper eyelid and in Zeis/Meibomian glands and presents with conjunctivitis and blepharitis

Sebaceous carcinoma of eyelids

35

Most common cause of conjunctival scarring

Chronic dry eyes

36

Patient presents with an actinic tissue that is moving medially towards the cornea. Reports astigmatism and visual changes.

Ptyerygium

37

Patient presents with yellowish subconjunctival lesion

Pinguecula

38

Most common neoplasm of conjunctiva
Associated with what (2)

Squamous Cell
HPV 16 and 18

39

What is the precursor to conjunctival melanomas

Primary Acuired melanosis with atypia

40

Baby presents with a blue sclera at birth.
What is diagnosis
What is the problem

Osteogenesis imperfecta
No Type 1 collagen

41

Membrane where Copper is deposited in Wilson's disease

Descemet

42

Patient presents with depositing of calcium in Bowman layer

Calcific band keratopathy

43

Patient presents with solar damage to the Bowman layer

Actinic band keratopathy

44

Patient presents with progressive thinning and ectasia of cornea with no inflammation. Now has irregular astigmatism. Patient also has Marfans and Downs syndrome

Keratoconus

45

Patient has an autosomal recessive dystrophy of the corneal stroma. Deposits of keratin sulfate are found.

Macular Corneal Dystrophy

46

Most common cause of cataract

Age-related opacification of lens

47

Patient presents with loss of vision and no pain. Damage is irreversible

Open angle glaucoma

48

Far-sighted Asian patient comes in. What should you be concerned with

Angle closure glaucoma

49

Most common primary intraocular malignancy in adults
Where does it spread
Which form is the worst

Melanoma of Uveal Tract
Liver
Epitheloid pattern

50

Near sighted people with cotton wool spots are at risk for what

Retinal detachment

51

Number one cause of blindness in US?

Diabetes Mellitus or ARMD

52

Premature infant treated with oxygen has delayed angiogenesis in lateral retina

Retionopathy of Prematurity

53

Patient presents with blindness due to deposits in Bruch membrane and loss of retinal pigmented epithelium

Atrophic Dry ARMD

54

Patient presents with hemorrhage of choroid blood vessels.

Exudative Wet ARMD

55

Most common intraocular tumor of kids

Retinoblastoma

56

Most common tumor of retina

Retinoblastoma

57

Patient presents with leukocoria, dilated fixed pupil heterochromia and strabismus

Retinoblastoma

58

Most common tumor of the optic nerve

Gliomas

59

Teenager patient with benign optic nerve tumor comes in. Patient has neurofibromatosis type 1

Pilocytic astrocytoma

60

3 diseases of optic nerve and cause of each

AION: Vascular injury
Papilledema: Intracranial pressure incrase
Optic neuritic: Demyelination

61

End stage Eye

Phthisis Bulbi

62

Newborn has regurgitation of food with first feeding. Aspiration and suffocates.
What is diagnosis
What is it seen with
What form is most common

Esophageal atresia
Tracheoesophageal fistula
Type C

63

Newborn presents with loops of small bowel outside his abdomen but covered by amniotic membrane.

Ompholocele

64

Newborn presents with a defect to right of umbilicus and has free floating small bowel outside of abdomen

Gastroschisis

65

Patient presents with large defect in which bowel is floating in placental membrane

Body stalk defect

66

Newborn presents with respiratory embarassment and hypoplasia of the lung.

Diaphragmatic hernia or Bochdalek hernia

67

Meckel diverticulum
True or acquired
Rule of 2's

True congenital: all 3 walls

68

First born male presents with muscular vomiting and has a palpable muscular hypertrophy that feels like an olive.

Pyloric stenosis

69

Newborn Male patient fails to pass meconium. He has Down syndrome. There is a colonic dilatation proximally to the rectum. It ruptures and stercoral ulcers are found.

Hirschsprung disease

70

Patient presents with episodic food regurgitation at night.

Esophageal Diverticuli

71

Location of each diverticuli in esophagus

Zenker: Proximal
Traction: Mid
Epiphrenic: Distal

72

Patient has solid food dysphagia. History of GERD and was drinking lye.

Stenosis

73

Women presents with iron deficiency anemia, glossitis, and dysphagia.

Plummer-Vinson syndrome with esophageal webs

74

Young patient presents with dilation of proximal esophagus and constriction in lower esophagus. Birds beak appearance on barium swallow
What are they also at risk for.

Achalasia
Squamous Cell Carcinoma

75

Patient has a hernia with reflux esophagitis

Sliding axial (most common)

76

Patient has a hernia with a volvulus

Paraesophageal rolling hernia

77

Chronic alcoholic presents with severe retching and has longitudinal lacerations of esophagus at GE junction. They are only superficial.

Mallory-Weiss tears

78

A patient with severe bloody vomit presents with deep tears in the distal esophagus.

Boerhaave Syndrome

79

Patient with liver cirrhosis presents with massive hematemesis and bleeds out.

Esophageal varices

80

Patient presents with tiny punched out ulcers and has intranuclear inclusion cells on histo slide.

Herpes simplex esophagitis

81

Patient presents with shallow ulcerations and intranuclear inclusions

CMV

82

40 year old adult presents with heartburn, regurgitation and chest pain. You see eosinophils on histo slide of distal esophagus.

GERD

83

Male Patient has a histo slide prepared of upper/mid esophagus showing corrugated epithelium and many eosinophils after an allergic reaction to a meal.

Eosinophilic Esophagitis

84

Barrett esophagus associated with what cancer
Achalasia associated with what cancer

Adenocarcinoma
Squamous cell carcinoma

85

A patient on NSAID's and Alcohol presents with pinpoint bleeding and hemorrhage and erosions. Curling and Cushing ulcers are also found.

Acute Gastritis

86

Patient presents with H. pylori infection with mucosal atrophy and metaplasia. Lymphocytes have infiltrated the lamina propria and glands.

Chronic active gastritis

87

Cancer associated with chronic gastritis caused by H. pylori? (2)

1. Gastric adenocarinoma
2. MALToma

88

60 year old Scandinavian presents with pernicious anemia and atrophy of mucosa.

Auto-immune gastritis

89

Patient who has been using NSAID's and alcohol presents with little to no inflammation but there is foveolar hyperchromasia and hyperplasia.

Reactive gastropathy

90

Patient presents with epigastric burning pain. A solitary punched out lesion is found in duodenum. Patient has H. pylori infection and uses NSAID's.

Peptic Ulcer disease

91

Patient has a gastrinoma and multiple peptic ulcers. What is cause

Zollinger-Ellison

92

Male patient with hyperplasia of mucosa and thickened gastric folds presents.

Menetrier Disease

93

Patient has cystic dilation of fundic glands.

Fundic polyp

94

Older Patient has pedunculated and sessile polyps. Patient also has Familial adenomatous polyposis.

Adenoma

95

Patient has round polyp that looks to be part of repair process

Inflammatory/Fibroid polyp

96

Male patient who eats nitrites, smoked foods, and not enough fruits and veggies presents with chronic gastritis. What is he at risk for

Intestinal type Adenocarcinoma

97

Patient with poorly differentiated cancer of stomach.

Diffuse Adenocarcinoma

98

Patient has a tumor develop from enterchromaffin like cells and is in a hypergastrinemic state. He has the CD markers of CD56, synaptophysin, and chromogranin

Carcinoid Tumor

99

Patient has a tumor develop from interstitial cells of Cajal and is CKIT/CD117 and CD34 positive. Tumor responds to Gleevec.

GIST

100

Elderly female presents with herniation of jejunum through only two layers.

Jejunal Diverticuli

101

Most common cause of bowel obstruction

Adhesion

102

Patient presents with cyclic bowel obstruction symptoms.

Endometriosis - bowel obstruction

103

Patient presents with pain out of proportion to physical exam. Displays rigid rebound tenderness. Blood levels show lactic acidosis. Patient dies from peritonitis and sepsis.

Ischemic bowel disease at splenic flexure or rectum

104

Patient with lower GI bleed and CREST & Osler-Weber-Rendu presents. Venous dilations are seen in right colon and cecum.

Angiodysplasia

105

Patient with lower GI bleed has one large solitary venous dilation.

Arteriovenous Malformation

106

A pregnant patient who complains of chronic constipation and history of cirrhosis presents with painful bowel movements.

External Hemorrhoid

107

Premature newborn started on formula presents with problem with first oral feeding. Radiograph shows pneumatosis intestinalis (gas in bowel).

Necrotizing Enterocolitis

108

Scandinavian patient presents with inflammation of small intestine. Histology shows a blunting of villi with lengthening of glands. Patient tests positive for IgA transglutaminase and IgA Endomysial Ab. Also has dermatitis herpetiformis.
What is diagnosis
What are two associated cancers.

HLA-DQ2 Celiac disease/Sprue
T cell lymphoma and adenocarcinoma

109

How to test igA tTG in sprue?
How to test IgA EMA in sprue?
What should you do first

tTG: Elisa
EMA: Immunofluoresence
IgA serum test

110

Person visits the tropics and comes back with macrophages in their distal small bowel. Treatment with Antibiotics gives full recovery

Tropical Sprue

111

Patient with luminal stasis, hypochlorhydria and immunocompromised has diarrhea.

Bacterial Overgrowth syndrome

112

Hospitalized Patient comes in with a membrane of neutrophils, fibrin, and necrosis in his colon. He reports using broad-spectrum antibiotics. Patient dies of toxic megacolon.
How to treat

Pseudomembranous colitis caused by C. dif
Oral vancomycin

113

Female patient presents with cramping and diarrhea. No inflammation is seen and physical exam is normal. Patient reports diet of fatty foods and sugary foods. Patient reports stress.

Irritable bowel syndrome

114

Twenty year old Jewish patient presents with full thickness inflammation, luminal narrowing, skip lesions, and aphthous ulcers. Fistulas and sinus tract formation occurs as well as fat wrapping. Noncaseating granulomas are in bowel wall lymph nodes. Serology shows P-ANCA positive

Crohn's disease

115

Patient presents with ulceration of mucosa and submucosa only. Continuous inflammatory process involving the rectum. Pseudopolyp formation is seen. No granulomas present. Primary sclerosing cholangitis is seen. Serology shows antibodies to Yeast

Ulcerative colitis

116

Elderly female with chronic watery diarrhea and thickened subepithelial collagen

Collagenous colitis

117

Patient presents with lymphocytosis of mucosa and inflammation. No thickened subepithelial collagen

Lymphocytic colitis

118

Patient presents with heavy pigmentation of colon during cholonoscopy. Reports heavy laxative use.

Melanosis Coli

119

Patient has a mass in colon from straining during bowel movements

Mucosal prolapse

120

Patient presents with a GI tumor of spindle and stellate cells with inflammation. Cells are CD34 positive. inflammation only through submucosa, not transmural.

Inflammatory fibroid polyp

121

Toddler presents with rectal bleeding

Juvenile polyposis

122

Young kid presents with tree like polyps and pigmentation on lips and oral cavity. Mutation at STK11/LKB1 on choromosome 19

Peutz-Jegher syndrome

123

Patient presents with macrocephaly, benign skin and mucosal tumors and dysplastic gangliocytoma of cerebellum. Loss of PTEN gene function and activation of MTOR

Cowden

124

Most common polyps of bowel
Location
Size

Hyperplastic
Left colon
Less than 5 mm

125

Polyps are found in the right colon. Associated with defective mismatch repair genes

Sessile serrated adenoma

126

3 mutations for colorectal carcinoma

Loss of APC gene
Turn on KRAS
Lose DCC

127

Most common primary malignancy of Small intestine

Carcinoids

128

Most common type of GI lymphoma

Large B-cell

129

Patient presents with apple core apearing tumor in the duodenum

Small intestine adenocarcinoma

130

Most common neoplasm of appendix

Carcinoid

131

Appendix tumor that makes mucin

Pseudomyxoma peritonei

132

Most common thing we see in peritoneum

Secondary neoplasms

133

Two genetic causes of acute pancreatitis

PRSSI: AD
SPINK1: AR

134

Two lab tests for pancreatitis
Which is better

Lipase and amylase
Lipase is more specific and sensitive

135

Main thing confused with acute pancreatitis?
How to differentiate

Occlusion of mesenteric vessels --> Ischemic bowel

Do blood gases and look for lactic acidosis

136

Primary progression of chronic pancreatitis

Secondary diabetes mellitus due to eventual destruction of islet cells

137

Most common cyst in pancreas

Pseudocysts

138

Tumor of pancreas in adolescent girls and young women with mild abdominal discomfort.

Solid pseudopapillary tumor

139

Female patient with cystic neoplasm. Ovarian-like stroma in cyst wall

Mucinous Cystic neoplasm

140

Male patient with cystic neoplasm in pancreatic head

Intraductal papillary mucinous neoplasm

141

Most common type of pancreatic malignancy

Pancreatic adenocarcinoma

142

Two mutations in pancreatic adenocarcinoma

KRAS activated
p16 inactivated

143

Patient presents with obstructive jaundice, weight loss, and migratory thrombophlebitis. Patient dies within a year.

Pancreatic adenocarcinoma

144

Best tumor marker for pancreatic cancer

CA19-9

145

Young female Northern European presents with hepatitis. Plasma cells are found at portal tract lobule interface. There is an absence of viral markers and it is negative for anti-mitochondrial antibodies. There is an elevation in autoantibodies.
Type 1 of this has what genetic association?

Autoimmune Hepatitis

HLA-DR3

146

Child presents with liver disease after taking aspirin during a viral infection.

Reye's syndrome

147

African american woman presents with hepatitis. There are mallory bodies, hepatocyte swelling and necrosis, neutrophilic infiltrates, fibrosis, and steatosis. Elevated liver enzymes and neutrophils are found.

Alcoholic hepatitis

148

An obese patient with diabetes mellitus type 2 presents with elevated liver functions and hepatitis.

Metabolic liver disease such as NASH

149

Older male patient presents with hepatomegaly, pancreatic pigementation, diabetes mellitus, and skin pigmentation of a bronze color. Cardiomegaly is also present.
What is diagnosis
What is the mutation
What is the chromosome

Hereditary hemochromatosis
HFE gene
Chromosome 6

150

Patient presents with liver disease. There is also basal gnaglia atrophy, kayser-fleischer rings.
How to diagnose? (2)
What is diagnosis

Check serum ceruloplasmin and urine copper levels

Wilson's Disease

151

Middle aged woman with celiac disease had her first symptom as pruritis. She developed jaundice, xanthomas, dark urine and light colored stools later. Blood levels show elevated alkaline phosphatase and cholesterol. Antimitochondrial antibodies are found. Duct injury and plasma cells are found on histo slide.

Primary Biliary Cirrhosis

152

Middle aged male with ulcerative colitis presents with biliary cirrhosis. Histo shows a segmental fibrous obliteration of bile ducts.
Diagnosis and increased risk of what

Primary Sclerosing Cholangitis

Cholangiocarcinoma

153

Tan clusters of dilated bile ducts in a fibrous stroma are found. They are free of bile and are remnant of biliary duct micro hamartomas

Von Meyenburg Complex

154

Female with autosomal dominant polycystic kidney disease presents with diffuse cystic lesions in the liver. These lesions do not communicate with biliary tree.

Polycystic liver disease

155

Patient presents with irregular fibrous widening of portal tracts. Patient also has autosomal recessive polycystic kidney disease

Congenitla hepatis fibrosis

156

Patient presents with dilation of large bile ducts. Stones and stasis is seen. Associated with both forms of polycystic disease.

Caroli Disease

157

Three things that increase risk of cholangiocarcinoma

Primary sclerosing cholangitis
Caroli's
Congenital hepatic fibrosis

158

Patient presents with peculiar facies, vertebral anomalies, CV defects. Histo discovers there are no liver bile ducts. Mutation of JAG 1 gene on Chromosome 20

Alagille Syndrome

159

Patient comes in with liver failure. They admit to steroid, oral contraceptive, and danazol use. They report a Bartonella infection recently.

Peliosis hepatitis

160

Patient presents with hepatomegaly and ascites. Two or more major hepatic veins are obstructed

Budd-Chiari Syndrome

161

Jamaican bush tea drinker presents with oblieration of hepatic veins. He recovers spontaneously.

Veno-occlusive disease

162

First time Pregnant mother presents with hypertension and proteinuria. Also displays signs of HELLP syndrome.

Pre-eclampsia

163

First time pregnant mother prsents with hypertension and proteinuria. Also displays hyperreflexia and convulsions.

Eclampsia

164

Pregnant mother in third trimester presents with liver disease. Microvesicular steatosis is seen on the biopsy.

Acute fatty liver of pregnancy

165

Pregnant mother presents with pruritis, jaundice, dark urine, light colored stools. Cholestasis but no necrosis. Conjugated bilirubin detected.

Intrahepatic cholestasis of pregnancy

166

Middle aged woman comes in with a nodule on her liver. It is well demarcated, and has a central scar. It is lighter colored and contains large arterial vessels.

Focal nodular hyperplasia

167

Elderly patient comes in with multiple spherical nodules in absence of fibrosis. Develops portal hypertension after other stressor. Reticular stain used to accentuate the nodules.

Nodular regenerative hyperplasia.

168

Number one cause of non-cirrhotic portal hypertension in the world

Nodular Regenerative Hyperplasia

169

You find a benign vascular neoplasm less than 2 cm in size on the liver. Should you biopsy?

No, hemangiomas can bleed out

170

Young female patient on oral contraceptives presents with a benign proliferation of hepatocytes without portal triads. They are pale and yellow-tan in color. It is 30 cm large.

Hepatic adenoma

171

Young child comes in with FAP. He has a liver tumor. There is a mutation in beta-catenin.

Hepatoblastoma

172

Patient comes in after exposure to vinyl chloride with an aggressive tumor

Angiosarcoma

173

Elderly black patient comes in with cirrhosis after a mass was found. Patient has a history of viral liver infections and alcohol use. Elevated serum alpha-fetoprotein is found. The tumor is paler than surrounding tissue.

Hepatocellular carcinoma

174

Younger patient comes in with what is believed to be a hepatocellular carcinoma. However it is solitary and very fibrosed and well demaracated. Patient has no history of cirrhosis or chronic liver disease.

Fibrolamellar hepatocellular carcinoma

175

Hispanic patient comes in with PSC. He has a well differentiated tumor of bile duct with no bile within it. It is found at bifurcation of right and left hepatic ducts. Desmoplastic response is seen.

Cholangiocarcinoma: Specifically a Klatskin tumor based on location

176

Obese White female presents with biliary colic

Cholelithiasis

177

Child comes in with acholic stools, symptoms of cholestasis and eventual biliary cirrhosis. There is an obstruction found above the porta hepatis that is uncorrectable.

Biliary atresia

178

Elderly woman presents with long standing stones and chronic cholecystitis.

Carcinoma of the gall bladder

179

Elderly man presents with painless jaundice, hepatomegaly and a palpable gall bladder. Bilirubinemia and elevated alkaline phosphatase are also found.

Carcinoma of the extrahepatic ducts