Path Flashcards
(118 cards)
1
Q
A 3-year-old boy is brought to the health post in a rural Zimbabwean villager. The child started to have diarrhea 20 hours ago, and the volume has increased rapidly. The mother also reports that several members of her family and others in the village are also ill with a similar illness and that 3 children have already died.
A
Cholera. Cholera toxin
2
Q
Pt has RLQ pain and bloody diarrhea; associated with erythema nodosum, and enlarged lymph nodes. What can kill the pt?
A
Yersinia =
hemorrhagic and ulcerated
if they also have hemochromotosis or hemolytic anemia bc for some reaosn the bacteria takes a bunch of iron
3
Q
Genetics: NOd2--> NFKB activation. Worse prognosis? STK SMAD MSH/MLH DRB1 PIZZ ERBB2 PTCH PRSS/SPINK SOX E cadherin
A
NOD2 = CD IL10/IL10r = worse and earlier onset
STK –> Peutz Jegher’s
SMAD –> Juvenile polyps
MSH/MLH –> Lynch/nonpolyp colorectal cancer via microsatellite instability
DRB –> Autoimmune hepatitis
Pizz–> a1Antitripsin
ERBB2–> gallbladder carcinoma
PTCH –> odontogenic keratocyst// basal cell carcinoma in mouth
PRSS/SPINK - pancreatis trypsin inhibitor
SOX = Esophagus SCC
E cadherin = diffuse gastric cancer [intestinal = H. Pylori APC]
4
Q
3yo pt has clubbing of fingers, hematochezia, with increased TGFb signaling. What is the dz and the genetic mutation?
A
juvenile polpys; smad4
5
Q
APC tumor suppresor gene mutation causes polyps after puberty;
A
familial adenomatous poyposis
6
Q
The genetic variation of all polypsosis
A
AD
7
Q
Signet rings Ddx
A
Mostly Gastric cancer but also sometimes esophageal and colorectal.
8
Q
Serum markers
- CEA
- a-fetoprotein
- ANA )nuclear) , AAA (amino acid), SMA,
- AMA (mitochondrial)
A
- CEA = Colorectal cancer
- a-fetoprotein = hepatocellular carcinoma
- AIH
- Primary biliary cholangitis
9
Q
Neutrophilic infiltration of mthe musclaris propria in the colon!
A
APPENDICITIS
10
Q
fibrosis of retro eritoneal tissues from inflammation
A
Sclerosing retroperitoniits//Ormond disease. SADPUCKER
11
Q
A secondary tumor of the peritoneum comes from what?
Primary peritoneul tumor?
A
Ovarian and pancreatic most common
IF YOU OR A LOVED ONE mesothelioma
12
Q
How does regeneration work?
A
- Kupffer cells –> IL6 –> super reactive to HGF, EGF, TGFa
- (happens if IL6 and GH doesn’t work)
Progenitor cells –> in canals of Hering
13
Q
How does the hepatocytes get rid of that pesky bridged fibrosis?
A
Metalloproteinases
14
Q
pt presents with anorexia, weight loss, weakness, and palmar erythema. What is the MOA of palmar erythema?
What else does this put you at ristk for?
A
This is seen in chronic liver
hyperestrogenemia
Gall stones bc estrogen = increases cholesterol syntheiss
15
Q
Acute liver failure is caused by what?
A
50% of cases in US --> acetaminophen A Hep A; autoimmune hep B Hep B C Hep C; ischaemia D hep D; drugs E Hep E; F
16
Q
Pt presents with fever, arthralgias, rash and ground glass appearance. What mediates damage? What extrahepatic manifestations will occur?
A
Hepatitis B; T cell mediate damage.
Polyateritis odosa, anemia
17
Q
Liver lymphoid aggregates with focal areas of macrovesicular steatosis, what’s u? What extrahepatic manifestations?
A
Hepatitis C, Alcoholic liver disease
Tons.
Vasculitis, porphyria,
18
Q
CLusters of periportal plasma cells
A
AIH
19
Q
Pt on steroids is at risk for what?
A
Steroids attack vascualture so =
- SOS Sinusoidal Obstruction Syndrome (obliteratino of central veins)
- Budd Chiari
Hepatic adenomas
20
Q
What is peliosis hepatitis?
What does it cost
A
Bood filled caviites; seen in pts taking steroids, with TB, or Bartonella with AIDS.
Steroids attack vasculature.
Causes impaired blood flow through the liver
21
Q
Microvesicular steatosis
A
Aspirin and
fatty liver of pregnancy
22
Q
if you hav e NAFLD, what are you at risk for?
A
NOT cirrhosis; but yes HCC
23
Q
what do hemochromatosis guys die from
A
HCC or cirhosis
24
Q
Name 3 hereditary conditions that predispose a pt for cirrhossis
A
Hemachromtosis, Wilson’s, alpha ntitrypsin
25
MRP2 is deficient in what
Dubin Johnson. carrie out the conjugated bilirubin
26
Itching, hepatmegaly, jaundice xanthomas. non caseating granulomas, what labs will you find
Primary biliary cholangitis
Increased ALP, AMA
27
Gall bladder anomalies in kids
CHoledochal cysts
- dilation of bie duct
Fibropolycstic disease
--> ductal plate malformations
- Von Meyerberg complex (hamartomas in bile duct)
- includes Caroli disease or syndrome. biliary cysts
28
There are 3 diseases under fibropolycystic disease. I'l lname something about them, you name the dz
1. Ascending cholangitis with intrahepatic biliary cysts
2. clusters of dilated bile ducts in fibrous stroma
3. Incomplete involution of embryonic ductal structures
1. Caroli dz
2. Von Meyenberg complex "bile duct hamartomas"
3. Congenital hepatic fibrosis
29
A pt receiving chemotherapy gets ascities, weight gain, jaundice and tender hepatomegaly; morph you see patchy obliteratino of sall hepatic veins.
Sinusoidal obstructino syndrome
30
2yopresents w/ mixed epithelial and mesenchymal cell types, activation of wnt b catenin pathway
Hepatoblastoma
31
Conditions for pigment stones
- infection
- chronic hemolytic conditions
- E coli, lumbricoides, sinensis
32
Alcohol does NOT put you at risk for
Pancreatic carcinoma
33
Give me definition:
- Cholesterolosis
- Rokitasnky Aschoff sinus
- Porcelain gallbladder
- Xanthogranulomatous cholecystitis
What disease are thse found in
Cholesterolosis: CHolesterol laden macrophages
- Muscosal outpouchings
- Dystrophic calcification
- Nodular stuff
This is all with chronic cholecystitis.
34
Physical exam shows balloon cells with hyperkeratosis and acanthosis in mouth. Dx? what is this associate dwith
Hairy cell leukoplakia
| EBV
35
Pt presents with epigastric pain, anorexia, weight loss and vomiting.. Endoscopy shows hypertrophy of thh fundus/ body of stomach rugae. What is the cause and MOA of this? Risk?
Menetrier's disesase.
| TGF beta overexpression --> Hypertrophy = too much mucus = protein used up = parietal atrophy = Adenocarcinoma
36
Endoscopy shows fundic gland polyps, what is the cause of these
use of H+ inhibitors
37
pt has gastric adenocarcinoma. What type of junctions are lost?
E-cadherin gene = loss of adherence
38
Micromorphology shows (+) chromogramin and synaptophysin; with islands of cohesive cells without nuclei.
Carcinoid = serotonin syndrome
39
A pt presents with paragangliomas, pulmonary chondromas, and what other tumor completes the Carney triad?
Where do they arise from?
GIST Gastrointestinal Stroma tumor
= intersitial cells of cajal; GOF in cKIT
40
What are main causes of intestinal obstruction?
| Lesser causes?
- Hernia, adhesion, Voluvulus ,intusussuception
| - Strictures, tumor, infracts
41
Most common causes of Malabsorption?
Celiac, pancreatic insufficiency
42
Blood tests reveal autoantibodies to enterocytes and goblet cells. What is the method of inheritance and the MOA?
X linked,
| FOXp3 mutation decresaing Tregs.
43
Blood tests reveal acanthocytes (burr cells) instead of lipid membranes. What is deficient?
Abetalipproteinemia
MTP is deficient, not apolipoB
44
Pt presents with PAS (+) and whpped macrophages. What ist he malapsoptive class?
Lymphatic transport
45
What mal absorptive dz have intraluminal digestino deficiency
Chronic pacnreatitis, cystic fibrosis, primary bile acid malabospriton, IBD
46
Tight junction permeability is messed up in what disease?
IBD
47
A mutation in IL 10 makes for a worse case in what?
CD
48
What is prone to staph aureus and viridans ??
Sialolithiasis
49
What type o frectal cancer is associated with HPV?
Condyloma acuminatum - squamous carcinoma of lower anus
50
Which is acute liver and which is chronic?
- Cirrhosis
- Hepatomegaly
- Nutmeg
- Weight loss
- Ascites
- Palmar erythema/spider angiomata
- Hepatorenal syndrome
- Encephalopathy
Chronic:
- Cirrhosis, weight loss, Palmar erythema, spider angiomata, encephalopathy
Acute:
- Nutmeg, hepatomegaly, ascites, hepatorenal syndrome, encephalopathy (asterixis, LOC)
51
Mallory bodies are seen where?
Liver Damage only
Alcoholic hepatitis
Wilson
Large bile duct obstrutcion
52
HCC is cauesd by
- Hemochromatossi
- NAFLD
- HCV
- AIH
- A1 antitrypsin
53
Hemolytic anemia is is associated with
Wilson
54
PAS (+)
a1 antitrypsin; whipple.
55
Pizz
a1 antitrypsin
| causes ER stress response --> NFkB inflammation --> hepatocyte dagage
56
Hepatomegaly
- Acute liver (alcoholic hepatitis)
- 1 biliary cirrhosis
- Neonate cholestsis
- SOS
57
These extremely common hamartomas in the bile duct are called what?
Von Meyerberg complexes, nothing to worrya bout
58
Pt presents with hepatomegaly ascietes adn weight gain with some jaundice. pertinent hx is GI cancer for which he was succesffully treated. What is mortph
Chemotherapy = sinusoidal obstruction syndrome
MOrph: patchy obliteration of small hepatic veins
59
pt is pregnant with jaundice. What ist he most common casue of this?
Viral heptatis.
60
3 yo pt presents with a mass on liver. bx shows mixed epithelial and emsenchymal tissue. What is hte cuase?
wnt b-catenin
61
Klatskin tumors are what type of cancer? What causes it?
Perihilar in biliary tree of cholangiocarcinoma!
- Opisthorchis viverrini & clonorchis sinensis
62
What is spink
it's a trypsin inhibitor, if mutated = no inhibitoion
63
Acute pancreatitis is casued by gall stones nd ethanol. What is the MOA?
Lipase = fat necrosis
EThanol shuts down the ampulla of vater while simultaneously inrceasing protein secretion
64
Proelastase
prophsoplipase
kallikrein
does what
Pro- damages blood vessel
Prophsopholipase - adipose tissue
kallikrien - kinin and factor XII
65
left side adenocarcioma gastric cancer
right side
Napkin ring obstruction = adenoma carcinoma sequence
right side hemorrhage; microsatellite insufficiency
66
What causes periodontitis? What are you at risk for with this?
Gram (-) anaerobic/microaerophilic bacteria
Endocaridts and brain abscess
Gram (+) is gingivitis
67
A pt presents with gastrointestinal problems. On bx you discover cystic masses with a bunch of smooth muscle layers. What's the deal?
Congenital DUplication cysts!
68
Pt presesnts with tylosis. What is this and what is the dz?
SCC of the esophagus, SOX mutation
| tylosis is thick palms and soles, RHBDF2 mutation
69
What is a dieulafoy lesion?
Big dialted artery that is at risk of rupture in lesser curvature
70
What is Gastric Antral Vascular Ectasia?
GAVE: Gave a watermelon. Red streaks like a watermelon
71
pt presents with B12 deficiency and hypothyroidism. Endoscope shows no rugae in the stomach. What is the deal? Where is this most likely to be located?f
Autoimmune grastritis;
fundus/body
ANtibodies to H/K ATPase and IF
72
What is lymphocytic gastritis?
Women with Celiac disease have accumulation of CD8. Called Variola bc the ulcerations and small nodules on the skin look like small pox
73
What happens with longstanding gastritis?
- Gastric adenocarcinoma (maybe in carcinoma)
- Parietal cell deficiency --> no acid --> bacterial overgrowth
- Gastritis cystica (cyst of inflammation wrapped in epithelial cells)
74
A patient has a gastric adenoma. What is this associated with? Risk of?
+FAP or chronic gastritis with atrophy.
| Risk of carcinoma if over 2cm
75
a pt with hx of autoimmune atrophic gastritis presents with flushing, bronchospasm and diarrhea. What is the blood marker for this dz and embryonic derivation? Where are these tumors most aggresive?
Carcinoid tumors,
Chomogranin, NCC
Aggressive in midgut.
Most common in small intestine
76
Pt presents with dyspepsia, epigastric pain, hematemesis, melan, weight loss. What is teh cause of this tumor, and what allows it to continue? Diagnostic marker?
MALT lymphoma (AKA extranodal)
- Cause = H. Pylori.
- 11,18 translocation means bad news. BCL and MLT expressed and more B cells grow
Marker: lymphoepithelial lesions
77
A pt presents with ischemic bowel. If the pt is experiencing hemorrhage, what layer of the bowel has it gone through? Hemorrhage and serositis? Hemorrhage and necrosis?
What ist eh view microscopically
Hemorrhage: mucosal
Hem & Necrossi: mural
Hem, Nec, and serositis: Transmural
Bacterail pseudomembranes
78
Angiodysplasia is associated with what?
Aortic stenosis and vW disease
79
What isthe immunology of Celiac disease?
How do you tell between Celiac and Tropical sprue?
Type IV T cell mediated --> IL15 --> CD8 --> enterocyte apoptosis
```
Celiac = proximal duodenum and jejunum
Tropical = jejunum and ileum
```
80
40 yo woman presents with watery diarrhea and abdominal pain. Pertinent hx of celiac disease. Endoscopy shows nothing. Bx shows a bandlike collagen with inflammation in lamina propria.
Collageouns MIcropspic colitis
| also: Lymphocytic: prominent intraepitheilal infiltrate
81
Stellate cells are activated by what?
Inflammatory cytokines (IL1)
ECM disruption,
Toxins
82
What drugs increase cahnces of CD or IBD
Contraceptives
| NSAIDS --> Knock out IL10
83
The microflora induces immune tolerance with which substances?
MAMP, SCFA, PSA, IAP
84
Bacteroides lpays waht role?
inhibits salmonella flagellin from binding to TLRF and activating NFKB; when it is there, the PPRP which gets die of NFKB
85
Tx of IBD
TNF blockers; Leukocyte adhesion blockers;
86
I GET SMASHED
| Caclium's role
Calcium activates the guys; so hypercalcemia is bad
87
Compications of pancreatitis, acute and chronic
Acute: - PSEUDOCYSTS, Hemorrhage, hypocalcemia, ARDS, renal failure, Shock, abscess, infection, necrosis
Chronic: Insufficiency and pseudocysts
Pseudocysts are liquefactive necrosis of enzymes lined by granulation NOT epithelium
88
What's included int he morphology of acute pancreatits?
```
Acute pancreatitis (edema, inflammation, fat necrosis)
Acute Necrotizing pancreatitis ^^ + protease destruction + White-grey hemorrhage
Acute Hemorrhagic necrosis = Red black hemorrhage
```
89
A pt has (+) Trousseau sign and (+) Coursevier sign with epigastric pain radiating to the back. Dx?
Metz?
Pancreatic adenocarcinoma
| Metz to liver
90
Down SYndrome
Duodenal atresia and hirschsprungs
91
Metabolic syndrome is defined as
fat accumulation without aclohol consumption
92
Most common cause of liver disesae?
NAFLD. Just fat people disease. with metabolic syndrome in US
93
What dz is the bronze diabetes dz? What is the hereditary pattern? What protein is messed up?
AR: Hemocrhomatosis
Hepcidin
DM, skin pigmkent, cirrhosis
94
Neonatal pt presents with fever, jaundice, and Respiratory distress; what gene is deficient
a1 antitrypsin
| PIZZ
95
What hyperbilirubin genetic syndrom eis AD
Crigler Najjar II
96
What hyperbilirubin genetic syndrom eis AD
Crigler Najjar II
97
What are the most common causes of cholestasis 1 and 2
1. Gallstones
| 2. Shit hepatocytes
98
Most common cause of large bile duct obstructino in adults? Children?
Adults: 1. gallstones 2. tumors. 3. strictures
| Children 1. atresia 2. CF 3. Choledochal cyst
99
Pt presents with pruritis, jaudice, dark urine, hepatosplenomegaly, and light colored stool. You know this is a ....
Distinguish between them.
Biliary tract disease.
Primary sclerosing = dilation and stricture --> beading!
Primary biliary = lymphocytic infiltrates --> granulomas; intrahepatic!!
100
Von Meyenburg complexes are found in what?
FIbropolycystic disease
101
Nutmeg liver is seen in
Acetampinophen poisining
Acute hepatitis
Budd CHiari syndrome (congestion of the liver)
102
What is a single scirrhous tumor in the liver
Fibrolamellar tumor
103
A hepatic lymphoma is associated with
Viral Hepatitis
104
2 types of cholecystitis
Calculous: with stone
| Acaclculous without stone. ssociated with CMV
105
What does it mean to have multiple dilated bowels?
Adhesions.
106
Intussuspection is commonly caused by what in children?
Viruses - rotavirus/adenovirus most commonly bc they enlarge the peyer's patches, which acts as a lead point.
107
What is exudative diarrhea?
Bloody purulent from inflammation
108
Water or shellfish
Chicken
fecal oral
Pork, milk
Cholera, Hep A, ETEC
Campylobacter, salmonella
Shigella
Yersinia, EHEC
109
A 40 yo female pt presents with water diarrhea and abdonimal pain. There is nothing to show on endoscopy.. bx shows dense mucosal bandlike collagen with mixed inflammation in lamina propria.
What if there was no band? What would be seen?
Collageonous microscopic colitis.
Lymphocytic: prominent intraepithelial infiltrate of lymphocytes with no band collagen
110
Lynch syndrome where do you bx
HNPCC proximal colon
111
What part of the stomach is chronic gastritis located. What inflammatory factors are involved?
pit abscesses Antrum;
| IL5 & TNF
112
which bacteria has CagA toxin?
H. pylori
113
complications of ulcers?
anemia, hemorrhage, perforation, obstruction(acquired pyloric stenosis), malignancy associated with underlying gastritis
114
A pt presents with weight loss, abdominal pain, early satiety and acanthosis nigricans. Bx reveals signet rings. What ype of cancer is this? What genetically is messed up?
Diffuse gastric cancer. not associated with H. Pylori like intestinal.
Diffuse = E-cadherin
[Intestinal = APC, b catening, Wnt
115
If a patient presents with esophageal atresia with fistula, what should you also check?
Heart, GU, neuro.
116
Double bubble
Duodenal atresia
117
What 4 bacteria can cause esophagitis?
HSV, Candida, CMV, Mucor
118
bx of mouth shows cribriform patterns. Dz?
Adenoid cystic gland
