Path Exam

Question 1

plummer vinson syndrome involves iron deficient anemia, glossitis, and cheilosis (cracking at corners of the mouth) as well as what GI problem

Answer 1

esophageal webs

Question 2

which esophageal problem can occur secondary to chagas disease (infection by trypanosome cruzi)

Answer 2

achalasia

Question 3

while alcoholic cirrhosis is most often the cause of portal HTN that leads to esophageal varices in the western world, what can cause this complication elsewhere

Answer 3

schistosomiasis

Question 4

cancer that results after chronic GERD –> Barrett esophagus –>

Answer 4

adenocarcinoma of the lower 1/3 esophagus

Question 5

what is mutated in adenocarcinoma of the esophagus

Answer 5

p16 and Rb

Question 6

what kind of cancer is likely in the upper 2/3 of the esophagus

Answer 6

squamous cell carcinoma

Question 7

what is this patient at risk for? black man over 45 who uses alcohol, tobacco, hot liquids, achalasia, and from iran or central china or hong kong

Answer 7

squamous cell carcinoma: esophagus

Question 8

these ulcers are likely to perforate and they occur in patients with intracranial disease which increases vagus firing –> increase acid release in stomach (esophagus, gastric, or duodenal)

Answer 8

cushing ulcer

Question 9

these ulcers are found in proximal duodenum and are associated with burns and trauma

Answer 9

curling ulcer

Question 10

most common cause of chronic gastritis

Answer 10

h pylori

Question 11

this type of gastritis typically spares the antrum and involves excess gastrin production and loss of rugal folds

Answer 11

autoimmune gastritis

Question 12

whats the major consequence of autoimmune chronic gastritis (and the reason these patients come to see doc)

Answer 12

impaired intrinsic factor production –> no b12 gets absorbed –> pernicious (macrocytic) anemia

Question 13

foveolar cell hyperplasia that causes protein losing enteropathy (hypoproteinemia) after TGFalpha is overexpressed

Answer 13

menetrier disease

Question 14

most gastric cancer is adenocarcinoma and germ line mutations in what gene precede many cases

Answer 14

CDH1 (a cadherin- loss of cell adhesion leads to carcinoma)

Question 15

diffuse gastric tumors often contain ___ cells which are cells with peripheral nucleus that was pushed aside by intracellular mucin vacuoles

Answer 15

signet ring cells

Question 16

most common place for a lymphoma to metastasize (extra nodal location)

Answer 16

GI tract esp stomach

Question 17

MALTomas typically have what genetic marker

Answer 17

11:18 translocation (promote B cell survival)

Question 18

Usually associated with bulky hepatic metastesis, ___ involves ileal tumors which cause cutaneous flushing, bronchospasm, increased bowel motility, right sided cardiac valve thickening

Answer 18

Carcinoid syndrome

Question 19

Most common GI mesenchymal tumor and where its found

Answer 19

GIST (GI stromal tumor), stomach

Question 20

GIST has a high association with what condition

Answer 20

Neurofibromatosis type I

Question 21

GIST arises from what cells

Answer 21

Cells of cajal

Question 22

Gain of function mutation in cKIT or PDGFRA are associated with what clinical manifestation

Answer 22

GIST

Question 23

Most common location for volvulus of bowel

Answer 23

Sigmoid colon

Question 24

Cause of intussusception in children

Answer 24

Spontaneous

Question 25

Cause of intussusception in adults

Answer 25

Tumor

Question 26

Common cause for ischemic bowel disease at the splenic flexure (watershed area between SMA and IMA)

Answer 26

Atherosclerosis, AAA, hypercoagulability, embolism, vasculitis, cardiac failure, shock, dehydration, vasoconstrictive drugs

Question 27

What MHC type is associated with celiac disease

Answer 27

HLA DQ 2 / 8

Question 28

What kind of T cell is involved in celiac disease damage

Answer 28

CD8 (IL15)

Question 29

We see flattened villi and elongated crypts in this disease

Answer 29

Celiac

Question 30

IPEX syndrome is due to germline mutation in the ___ gene and it can lead to autoimmune driven diarrhea (autoimmune enteropathy)

Answer 30

FOXP3

Question 31

What microorganism causes travelers. Diarrhea

Answer 31

Campylobacter jejuni (gram neg)

Question 32

Extra intestinal manifestations of travelers diarrhea (campylobacter)

Answer 32

Reactive arthritis, erythema nodosum, guillain barre

Question 33

Humans are the only reservoir for this bacteria which causes bloody diarrhea after invading the m cells

Answer 33

Shigellosis

Question 34

Worry. About this infection in people traveling to india, mexico, philipines who present with dysentery followed by bacteremia, fever, abdominal pain

Answer 34

Typhoid fever (salmonella typhii)

Question 35

This organism prefers. Ileum, appendix, R. Colon (can mimic appendicitis)

Answer 35

Yersinia

Question 36

Cause of pseudomembranous colitis (after normal flora is eliminated by antibiotics)

Answer 36

C diff

Question 37

Tropheryma whippelii causes __ to accumulate in small intestine villi lamina propria and lymph nodes in whipple disease

Answer 37

Foamy macrophages

Question 38

Viral causes of gastroenteritis

Answer 38

Norovirus, rotavirus, adenovirus

Question 39

Most common parasite to cause pathology in humans: causes microvilli brush border damage and malabsorption

Answer 39

Giardia lamblia

Question 40

Skip lesions (sharply delineated areas with granular and inflamed serosa and adherent creeping mesenteric fat) are associted with what condition

Answer 40

Crohns disease

Question 41

Aphthous ulcers are associated with which inflammatory bowel disease

Answer 41

Crohn disease

Question 42

Extra intestinal manifestations of. Crohns disease and ulcerative collitis include (as if increased risk of colon adenocarccinoma isn't enough):

Answer 42

Migratory polyarthritis, sacroiliitis, ankylosing spondylitis, uveitis, cholangitis, amyloidosis Erythema nodosum- crohns only

Question 43

This inflammatory bowel disease begins. In the rectum and advances retrograde to involve the entire colon

Answer 43

Ulcerative colitis

Question 44

this abnormality often occurs where vasculature penetrates inner circular layer of muscularis propria at taeniae coli when there is increased intralumenal pressure

Answer 44

sigmoid diverticulitis

Question 45

this rare autosomal dominant disorder involves hamartomatous (tumor like) polyps, mucocutaneous hperpigmentation, and often loss of function of the gene LKB/STK

Answer 45

peutz-jeghers syndrome

Question 46

most common tumor of the appendix

Answer 46

benign carcinoid

Question 47

in a damaged liver, stellate cells (which normally store ____) up regulate ___ genes to produce scar tissue

Answer 47

vitA, PDGFRbeta

Question 48

what stimulates a stellate cell to begin the process of scar formation

Answer 48

TNF, IL1 (chronic inflammation), kupffer cell cytokines, toxins

Question 49

histocompatibility complex associated with extra intestinal manifestation of IBD

Answer 49

HLA B 27

Question 50

dermatologic extraintestinal manifestation of crohns disease

Answer 50

erythema nodosum

Question 51

dermatologic extraintestinal manifestation of ulcerative collitis

Answer 51

pyodermic gangrenosum

Question 52

Ground glass hepatocytes (swollen ER) indicates what

Answer 52

Hep B

Question 53

Lymphoid aggregates or fully formed lymphoid follicles within hepatocytes indicates what

Answer 53

Chronic Hep C