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Flashcards in Path Deck (94):
1

The development of what provides older children and adults a relative resistance to rotavirus infection?

Development of IgA antibodies from secretory immunity in the bowel to rotavirus surface antigens

2

What organism causes food poisoning from reheated rice?

Bacillus cereus

3

Mediated by endotoxins--lipopolysaccharide component of the outer cell wall?

Gram-negative sepsis

4

Mediated by release of exotoxins

Gram-positive sepsis

5

Rash and Koplik spots on the buccal mucosa are characteristic findings?

Measles --rubeola

6

Produces parotitis and orchitis

Mumps

7

Cytotoxic CD8 T cell response is required to clear what virus

EBV

8

Results from elaboration of super antigens that stimulate T lymphocytes and generate a marked release of cytokines and an extensive inflammatory response

Staphylococcal toxic shock syndrome

9

What causes granuloma inguinale?

Klebsiella granulomatis
--infection may progress to scarring with urethral and lymphatic obstruction

10

Has neurotoxin protease that cleaves synaptobrevin?

Clostridium tetani

11

Achalasia has a long term risk of development of_______.

Squamous cell carcinoma

12

May follow forceful vomiting, or may occur as a complication of instrumentation--dissection of air from the rupture extends into soft tissue, producing the subq emphysema?

Boerhaave syndrome

13

Associated with anticentromere antibodies?

Scleroderma --CREST syndrome

14

Causes of GERD?

Sliding hiatal hernia
Decreased tone of the lower esophageal sphincter
Delayed gastric emptying

15

Produced by E. coli strains--associated with hemolytic uremic syndrome mediated by endothelial injury?

Verocytotoxin --shiga-like toxin

16

Most common in the antrum of the stomach--are precursors to adenocarcinoma and have intestinal metaplasia with dysplasia?

Gastric adenomas

17

Results from excessive secretion of transforming growth factor alpha (TGF-a) with diffuse enlargement of gastric rugae and protein-losing enteropathy?

Menetrier disease

18

Tumor cells of this carcinoma have a signet ring appearance because the cytoplasmic mucin pushes the nucleus to one side

Diffuse gastric carcinoma

19

Derived from intestinal cell of Cajal--mesenchymal origin ?

Gastrointestinal stromal tumor--GIST

20

Tortuous dilations of mucosal and submucosal vessels--seen most often in the cecum in pts older than 50

Angiodysplasia

21

What antibodies can be present with celiac disease?

Antitransglutaminase
Antigliadin
Antiendomysial

22

What is the mechanism by which celiac disease causes intestinal inflammation?

Exposure to gliadin protein--causes epithelial cells to produce IL-15, which in turn leads to accumulation of activated CD8+ T cells that bear the NK cell receptor NKG2D and damage the enterocytes expressing MIC-A

23

What HLAs are associated with celiac disease?

HLA-DQ2 or DQ8

24

Deep fissure extending into the muscular--extension of fissures into the overlying skin can produce enterocutaneous fistulas?

Crohn disease

25

Inflammatory bowel disease associated with migratory polyarthritis, ankylosing spondylitis, and primary sclerosing cholangitis?

Ulcerative colitis

26

Results from inheritance of one mutant copy of the APC tumor suppressor gene--young pts colon shows hundreds of polyps?

Familial adenomatous polyposis (FAP) syndrome

27

May arise from low-grade mutinous adenocarcinoma of the appendix, which may be so differentiated that it resembles an appendiceal mucocele?

Pseudomyxoma peritonei

28

Elevated _______ suggests extrahepatic or intrahepatic biliary obstruction

Alkaline phosphatase

29

What is seen with chronic HBV infection?

Persistence of HBsAG, HBV DNA and IgG anti-HBcAb

30

The persistence of ______ in serum for 6 months or more denotes a carrier state for HEPB.

HBsAg

31

Cytokeratin inclusions that are characteristic of alcoholic hepatitis?

Mallory-Denk bodies

32

What is the cause of Gilbert syndrome?

Decreased levels of uridine diphosphate glucuronosyltransferase (UDPGT)

--Stress may cause transient unconjugated hyperbilirubinemia to a point that scleral icterus is detectable

33

Newborn jaundice that persists more than 2 wks following birth?

Neonatal cholestasis

34

What are the causes of neonatal cholestasis?

-Neonatal hepatitis
-alpha-1 antitrypsin deficiency
-Extrahepatic biliary atresia--pts will have high alkaline phosphatase and require surgery to anastomose extra hepatic ducts and prevent progressive liver damage

35

Autoimmune disorder that causes progressive intrahepatic bile duct destruction--antimitochondrial antibodies in serum

Primary biliary cirrhosis

36

Intrahepatic biliary tree obliteration and a beaded appearance in remaining ducts--concentric onion skin ductular fibrosis and associated with anti-neutrophil cytoplasmic antibodies?

Primary sclerosing cholangitis

37

Levels of what will be low in Wilson disease?

Ceruloplasmin--copper cannot be secreted into plasma because of ATP7B mutation, which is responsible for encoding copper transporting ATPase in the hepatocytes--Therefore no copper to be transported by the ceruloplasmin

38

Severe complication of preeclampsia and when a coagulopathy is apparent from the increasing prothrombin time, emergent delivery must be undertaken to save the life of the mother and fetus.

Maternal HELLP syndrome--Hemolysis, elevated liver enzymes, low platelets

39

May develop in young women who have used oral contraceptives?

Hepatic adenoma--can enlarge and rupture from estrogenic stimulation during pregnancy

40

What 2 mutations carry a greatly increased risk for pancreatic cancer?

SPINK1 and PRSS1 mutations

41

Esophageal web increases the risk of....

Esophageal SCC

42

Characteristics of Plummer-Vinson syndrome?

Severe iron deficiency anemia
Esophageal web
Beefy-red tongue--due to atrophic glossitis

43

What vein backs up into esophageal vein causing dilation--varies in the contexts of portal HTN?

Left gastric vein

44

Achalasia has an increased risk of developing______

SCC

45

5 major risk factors for the development of SCC of the esophagus?

ETOH and tobacco
Very hot tea
Achalasia
Esophageal web-Plummer-Vinson syndrome
Esophageal injury-Lye ingestion

46

Congenital malformation of the anterior abdominal wall leading to exposure of abdominal contents?

Gastroschisis

47

Persistent herniation of bowel into umbilical cord?

Omphalocele--contains covering of peritoneum and amnion of the umbilical cord

48

What causes chronic autoimmune gastritis?

Antibodies against parietal cells and/or intrinsic factor---mediated by T cells type IV HSR

49

Pts with chronic autoimmune gastritis are at an increased risk of developing...

Intestinal type gastric adenocarcinoma

50

Where is the most common site for chronic H pylori gastritis to occur?

Antrum of the stomach

51

Pts with chronic H pylori gastritis are at an increased risk of...

Ulceration
Gastric adenocarcinoma--intestinal type
MALT lymphoma--B-cell lymphoma

52

What risk is involved when a duodenal ulcer presents in the posterior duodenum?

Rupture leading to bleeding from the gastroduodenal artery or acute pancreatitis

53

Rupture of a gastric ulcer carries a risk of bleeding from...

Left gastric artery

54

Gastric carcinoma that presents as a large, irregular ulcer with heaped up margins and most commonly involves the lesser curvature of the antrum?

Intestinal type adenocarcinoma

55

Gastric carcinoma with signet ring cells

Diffuse type of gastric carcinoma

56

What distant metastasis is classic for the intestinal type of gastric carcinoma?

Periumbilical region--Sister mary joseph nodule

57

What distant metastasis is classic for the diffuse type of gastric carcinoma?

Bilateral ovaries--Krukenberg tumor

58

Where are the most common locations for a volvulus to occur?

Sigmoid colon--elderly
Cecum--young adult

59

What is the cause of dermatitis herpetiformis seen with Celiac disease?

IgA deposition at the tips of dermal papillae

60

Where does most of the damage occur in celiac disease?

Duodenum

Jejunum and ileum are less involved
(opposite compared to Celiac sprue)--presents in jejunum and ileum with secondary vit B12 deficiency

61

Disease involving the small bowel lamina propria--macrophages compress lacteals not allowing chylomicrons to be transferred from enterocytes to lymphatics leading to fat malabsorption and steatorrhea?

Whipple disease

62

Postive for chromogranin?

Carcinoid tumor

63

Why doesn't carcinoid heart disease involve the left heart?

Presence of MAO in the lungs, which metabolize the serotonin

64

Where is the most common site for Crohn disease to occur?

Terminal ileum--but can occur anywhere from mouth to anus

65

What is the hallmark inflammation seen with UC?

Crypt abscesses with neutrophils

66

What type of inflammation occurs in 1/2 of Crohn disease cases?

Lymphoid aggregates with granulomas

67

Shows lead pipe sign on imaging due to loss of haustrau?

UC

68

Shows string sign on imaging?

Crohn disease

69

Where do colonic diverticula arise?

Where the vasa recta traverse the muscularis propria --weak point in colonic wall

Most common site is sigmoid colon

70

AD disorder resulting in thin-walled blood vessels, especially in the mouth and GI tract--rupture presents as bleeding...

Hereditary hemorrhagic telangiectasia

71

Colonic polyp with serrated appearance on micro?

Hyperplastic

72

What mutation leads to an increased risk for formation of polyp?

APC mutation

73

What mutation leads to formation of polyp?

K-ras mutation

74

What mutation/overexpression allows for progression of polyp to carcinoma?

P53 mutation
COX overexpression

75

AD disorder characterized by 100s to 1000s of adenomatous polyps?

Familial adenomatous polyposis (FAP)

76

FAP with fibromatosis (Proliferation of fibroblasts arising in retroperitoneum) and Osteoma (benign tumor of bone that usually arises in the skull?

Gardner syndrome

77

FAP with CNS tumor?

Turcot syndrome

78

What is the cause of hereditary nonpolyposis colorectal carcinoma (HNPCC)?

Inherited mutations in DNA mismatch repair enzymes

79

What are the most common causes of chronic pancreatitis?

ETOH--adults
CF--children

80

What does biliary atresia lead to in the first 2 months of life?

Biliary obstruction--jaundice with conjugated bilirubin

81

What is a late complication of chronic cholecystitis?

Porcelain gallbladder--Shrunken, hard gallbladder due to chronic inflammation, fibrosis, and dystrophic calcification

82

Adenocarcinoma arising from the glandular epithelium that lines the gallbladder wall?

Gallbladder carcinoma

83

What conjugates bilirubin within the hepatocytes?

Uridine glucuronyl transferase--UGT

84

What converts CB to urobilinogen and where does this take place?

Intestinal flora convert CB to urobilinogen--oxidized to stercobilin (makes stool brown) and urobilin

85

What lab finding is seen with Dubin-Johnson syndrome?

Elevated CB--because the liver conjugates the bilirubin, but it is unable to reach the gallbladder

86

What do the labs show when a pt has a biliary tract obstruction?

Elevated CB
Decreased urine urobilinogen
Elevated alkaline phosphatase

87

What defines a chronic state of HepB?

HBsAG present for >6 months

88

What mediates the damage in alcoholic hepatitis?

Acetaldehyde--metabolite of ETOH

89

What is the classic triad of secondary hemochromatosis?

Cirrhosis
Secondary DM
Bronze skin

90

Inflammation and fibrosis of intrahepatic and extrahepatic bile ducts?

Primary sclerosing cholangitis

91

What is primary sclerosing cholangitis associated with?

UC
p-ANCA

92

What is a hepatic adenoma associated with?

Oral contraceptive use--regresses upon cessation of drug

93

What are the risk factors for the development of hepatocellular carcinoma?

Chronic hepatitis--HBV and HCV
Cirrhosis
Aflatoxins derived from Aspergillus

94

What is the serum tumor marker for hepatocellular carcinoma?

Alpha-fetoprotein