Pathology Flashcards
(384 cards)
1
Q
Components of VACTERL syndrome
A
Vertebral Anal atresia Cardiac TE fistula Renal Limb
2
Q
Difference between omphalocoele and gastroschisis
A
Omphalocoele = herniation through the ventral membranes
Gastroschisis = herniation all the way through the skin
3
Q
What percentage of omphalocoeles present with other defects?
A
40%
4
Q
What is the name for the most common site of ectopic gastric mucosa, and where is it typically located?
A
Inlet patches in Upper esophagus
Gastric heterotopia in the colon or SI
5
Q
What are the consequences of inlet patches in the esophagus?
A
Occult blood loss due to ulceration, Barrett’s metaplasia, adenocarcinoma
6
Q
What percentage of Meckel diverticula produce gastric acid and therefore confer high risk of perforation and intestinal bleeding?
A
50%
7
Q
Which pathology is caused by failed involution of the vitelline duct?
A
Meckel diverticulum
8
Q
What is the morphologic difference between a Meckel versus typical diverticulum?
A
Only Meckel has muscle
9
Q
What is the most common location for a typical diverticulum?
A
Sigmoid colon
10
Q
Which pathology is associated with Trisomy 18 and Turner Syndrome?
(because it’s genetic, it’s also more common in twins)
A
Pyloric stenosis
11
Q
Which gender is at higher risk for pyloric stenosis?
A
Males
12
Q
What is the treatment for pyloric stenosis?
A
Myotomy (splitting of the pyloric sphincter)
13
Q
Which congenital disorder is (surprisingly) associated with incomplete penetrance?
A
Hirschsprung (RET gene)
14
Q
What stain can be used to confirm the biopsy diagnsosis for Hirschsprung?
A
Acetylcholinesterase
15
Q
Which part of the colon is typically most enlarged in Hirschsprung?
A
Cecum (because the sigmoid colon and rectum don’t work)
16
Q
Which type of creature causes Chagas disease?
A
A protozoan
17
Q
Which 3 arteries supply the esophagus?
A
upper - inferior thyroid
middle - aorta
lower - left gastric
18
Q
Which condition is associated with loss of coordination between longitudinal and circular esophageal smooth muscle?
A
Nutcracker esophagus
19
Q
Which muscular layers are associated with diffuse esophageal spasm?
A
Both
20
Q
How can you distinguish Hypertensive LES from achalasia?
A
With hypertensive LES you still have normal peristalsis
21
Q
Which muscular layers are associated with Chagas disease?
A
Myenteric only – difference from Hirschsprung!
22
Q
Which pathology is related to diabetic neuropathy, Sarcoidosis, Down syndrome, and Sjogren’s?
A
Achalasia
23
Q
In which part of the esophagus do you normally find diverticula? What is the exception?
A
Lower. Exception: Zenker
24
Q
Which esophageal pathology may be associated with graft vs. host and GERD?
A
Esophageal webs
25
What is the difference between esophageal Schatzki A and B rings?
```
A = squamous
B = columnar
```
BOTH DISTAL
26
GI bleeds are most common where?
Esophagus
27
Desquamative skin diseases like bullous pemphigoid and epidermolysis bullosa may predispose you to these 2 conditions
Esophagitis
| Crohns
28
Which type of esophagitis causes necrosis?
Toxic -- including pill esophagitis
29
Which virus causes esophagitis with cytoplasmic inclusions?
CMV
30
Which pathology is this?
Hyperemic mucosa with eosinophilia and some neutrophils; possibly with basal zone hyperplasia
Esophageal reflux
31
What's special about the presentation of eosinophilic esophagitis?
It presents with dysphagia but NO REFLUX
32
How many cirrhosis cases lead to portal HTN?
50%
33
How are esophageal varices treated?
Beta blockers
34
In which gender is Barrett's more common?
Males
35
Which esophageal pathology presents with velvety salmon-colored mucosa with squamous islands in a sea of columnar cells?
Barretts
36
What is the length that differentiates long segment Barretts from short segment? What is the significance there?
3cm
LONGER = MORE LIKELY TO BECOME DYSPLASTIC
37
Which pathology has pale blue wine goblet shaped cells?
Barrett
38
Most common benign mesenchymal esophageal tumor
leiomyoma
39
Which are more common in the esophagus: benign tumors or malignant?
Benign
40
2 cancers with signet ring cells
Esophageal adenocarcinoma
| Diffuse gastric cancer
41
Which pathology are people with CagA negative H. pylori generally spared from?
Esophageal adenocarcinoma
42
What is tylosis and what does it signify?
Hyperkeratosis of palms and soles
White patch in the mouth
HOWEL EVANS SD (SCC ESOPHAGUS)
43
SOX2
Esophageal SCC
44
Location of adenocarcinoma vs SCC in the esophagus
```
Adeno = distal
SCC = middle
```
45
Which type of esophageal cancer is more likely to metastasize?
SCC
46
2 diseases that cause hypertrophic gastropathy
Menetrier
| Zollinger-Ellison
47
GI consequence of altitude sickness
Acute gastritis
48
Why are the elderly more susceptible to gastritis?
Reduced mucin and bicarb secretion
49
Surface epithelium with corkscrew profiles
Gastritis (mucus is gone so you can see the curvature of the cells)
50
How many critically ill patients develop ulcers in the first 3 days of their illness?
75%
51
What is a Dieulafoy lesion and what causes it?
A dilated artery in the gastric submucosa (in the lesser curvature) that may rupture
Cause: NSAIDS
52
What is GAVE (gastric antral vascular ectasia) and what causes it?
Longitudinal stripes of red mucosa alternating with pale bits ("watermelon stomach"); may rupture and bleed
Cause: Cirrhosis or SCLERODERMA
53
Association with CagA h. pylori and cancer
CagA POSITIVE = high risk
| CagA NEGATIVE = protective
54
Nodular gastric mucosa with thickened rugal folds
H. pylori chronic gastritis
55
Which cause of chronic gastritis presents with elevated SERUM gastrin (hypergastrinemia)?
Autoimmune gastritis
56
What are the antibodies against in AIG?
Parietal cells & IF
| *specifically HK ATPase*
57
Atrophic glossitis = which anemia?
B12
58
Chromogranin A
Autoimmune gastritis or carcinoid tumor
59
Type of tumor that may result from autoimmune gastritis
Carcinoid (may present as "NE hyperplasia")
60
Onset time for autoimmune gastritis
20-30 years
61
Predisposing condition for MALToma
H. pylori chronic gastritis
62
Stomach region affected in eosinophilic gastritis
pylorus
63
Typical cause of eosinophilic gastritis
milk allergy
64
Patient has celiac disease. Their whole stomach is covered in aphthous ulcers. They have increased T cells.
Varioloform gastritis (Also known as lymphocytic gastritis )
65
Primary cause of granulomatous gastritis
Crohns
66
This malformation may predispose to PUD
Meckels
67
Most common location for PUD
proximal duodenum
68
Recurrence rate for H. pylori
20%
69
How can achlorhydria lead to cancer?
Permits the growth of bacteria that secrete carcinogenic nitrosamines
70
Gastritis cystica may present as polyposa (in the submucosa) or profunda (in the deep gastric wall). What causes it?
Trauma! (chronic gastritis and stomach surgery)
71
Multiendocrine neoplasia
Zollinger Ellison
72
Prognosis for gastrinoma: what might they become?
Up to 90% are malignant! May become carcinoid tumors
73
Prognosis for Menetrier disease
Associated with adenocarcinoma
74
Cerebriform rugal folds with enormous overstuffed mucus cells and Anti-TNF-Alpha Ab's
Menetrier's disease
75
Typical cause of a fundic gland polyp (2)
FAP or long term use of PPI's (hypertrophy of oxyntic glands)
76
Gastric antral polyp with intestinal metaplasia
Gastric adenoma
77
CDH1 tumor suppressor
gastric adenocarcinoma
78
Discohesive non-glandular structures with flattening of rugal folds with mucin lakes
Diffuse gastric adenocarcinoma (linitis plastica)
79
Which type of gastric cancer has no precursor lesions: diffuse or intestinal?
Diffuse
80
Chimeric fusion gene: API2-MLT fusion product of Ch 11, 18
MALToma
81
Which type of cancer does MALToma progress to>
DIffuse large B cell lymphoma
82
Lymphoepithelial lesions in the pylorus should raise suspicion of ___
Maltoma
83
Body's most common organ for a carcinoid tumor
Ileum
84
Synaptophysin
Carcinoid tumor
85
Typical progression of an ileal carcinoid tumor -- where does it metastasize?
Liver
86
Forgegut vs midgut vs hindgut carcinoid tumors: prognosis
Only midgut is malignant (jejunum and ileum)!
87
Most common mesenchymal tumor of the abdomen
GIST
88
KIT
GIST
89
Prognosis for a GIST
benign, especially in the stomach (may be worse in intestine)
90
Carney Triad
1- GIST
2- paraganglioma
2- pulmonary chondroma
91
Best guess for a tumor that's larger than 30 cm
GIST
92
Typical presentation of a GIST
Mass effect + anemia
93
Most common cause of intestinal obstruction worldwide
Hernia
94
Which type of hernia is most likely to lead to obstruction?
Inguinal
95
Biggest negative consequence of a hernia
Bowel infarction
96
Typical location for a volvulus
Sigmoid colon (LLQ)
97
Which childhood GI complication is associated with rotavirus and its vaccine?
Intussusception
98
This vessel has the worst prognosis in bowel ischema
SMA
99
Mortality rate in bowel ischemia
10%
100
Pathogen that can cause bowel ischemia
CMV
101
Presentation for bowel ischemia
bloody diarrhea with LLQ pain
102
What are the diagnostic criteria for angiodysplasia?
Exclusionary diagnosis for bloody diarrhea with no polyps or mucosal changes, and with ectatic nests
Commonly in cecum/RLQ
May be associated with Meckel
103
2 vitamin deficiencies that can cause peripheral neuropathy
B12; A
104
Gliadin
The wheat protein that triggers Celiac disease
105
Part of the GI tract most sensitive to gluten
duodenum, jejunum
106
Prognosis for Celiac
Mucosa returns to normal within 6-24 months of new diet
107
Dermatitis herpetiformis
Celiac
108
Small intestine is atrophic and flat, with no visibile villi
Celiac
109
Which cancer is associated with Celiac?
Enteropathy Associated T Cell Lymphoma (EATL)
also
Small intestinal adenocarcinoma
110
IPEX syndrome/FOXP3 mutation
Autoimmune enteropathy
111
Diffuse antibodies to every type of intestinal cell, some stomach cells, and some pancreatic cells, with mixed amounts of lymphocytic infiltrate
IPEX syndrome
112
Which organism can cause transient lactose intolerance?
Giardia
113
MTP protein (microsomal triglyceride transfer protein)
Abetalipoproteinemia
114
Intracellular lipid accumulations --> acanthocytic red cells
Abetalipoproteinemia
115
Hemagglutinin
Cholera
116
CFTR channel (infectious)
Cholera
117
What is the most common enteric pathogen in the US?
Campylobacter
118
This pathogen causes arthritis in patients who are HLA-B27+
Campylobacter
119
Guillain-Barre syndrome
Campylobacter
120
Cryptitis with abscess (but crypts are still preserved)
Campylobacter
121
How many cases of campylobacter progress to dysentery?
15% (but 50% of children)
122
What is the most common worldwide cause of dysentery?
Shigella
123
This organism has an intracellular tropism for APC's (specifically M cells)
Shigella
124
This pathogen is non-motile
Shigella
125
This pathogen has a tropism for the left colon and ileum
Shigella
126
Pseudomembranes with aphthous ulcers
Shigella
127
May cause triad of reactive arthritis, urethritis, conjuctivitis
Shigella
128
May cause HUS
Shigella, EHEC
129
This intestinal bug has a surprising vaccine
Salmonella
130
May cause severe dissemninated disease in asplenic patients
Salmonella
131
This pathogen can cause gallstones
Salmonella typhi or paratyphi
132
Which type of salmonella can cause lymphatic hyerplasia?
Typhi (not dysenteriae)
133
Infection that causes grossly enlarged Peyers patches with mesenteric lymph node involvement
Salmonella
134
Infection that may cause osteomyelitis in sickle cell patients
Salmonella
135
Infection associated with rose spots on the chest and abdomen
Salmonella
136
This pathogen causes a worse infection in people with increased free iron, ie anemia
Yersinia
137
This pathogen may lead to protein loss and hypoalbuminemia
C. diff
138
Presents with the classic triad of diarrhea, weight loss, and joint pain
Whipple's disease
139
The only pathogen that causes prolonged malabsorption syndromes
Whipple's disease
140
The most common cause of acute gastroenteritis in the SU
Norovirus
141
The most common cause of severe childhood diarrhea
Rotavirus
142
This type of worm infection may persist for life because the worms can have their larval stage inside the body
Strongyloides
143
This type of worm also invades the lungs as part of its life cycle
Ascaris lumbricoides
144
Eterobius vermicularis
Pinworms
145
This worm causes anemia and significant mortality
Necator duodenale (hookworm)
146
This worm is famous for causing B 12 anemia
D. latum
147
This protozoan is an obligate glucose fermenter
Entamoeba
148
What are the path findings in IBS?
THERE ARE NONE!
149
Which disease is classified by the Rome Criteria?
IBS
150
This disease may be related to over-secretion of 5HT3
IBS
151
Malignant potential: Crohns & UC
Both are high!
152
Which can lead to toxic megacolon: Crohns or UC?
UC
153
Which has a higher recurrence rate: Crohns or UC?
Crohns
154
Helminths may be protective for this disease
IBD
155
Which is more likely to cause strictures: Crohns or UC?
Crohns
156
Which presents with finger clubbing: UC or Crohns?
Crohns
157
Which can be treated with Anti-TNF antibodies: Crohns or UC?
Crohns
158
Which biliary pathology is associated with UC?
PSC
159
Middle aged woman with colitis (diarrhea but no blood or weight loss); biopsy reveals dense subepithelial fibrous tissue with lymphocytes
Collagenous collitis
160
Patient with a history of UC had a colostomy and now has non-bloody diarrhea. Biopsy reveals mucosal lymphoid follicles, increased macrophages, and increased plasma cells.
Diversion colitis
161
Epithelial apoptosis of crypt cells
graft vs host
162
How may patients with diverticulae are symptomatic?
20%
163
Most common location for a colon polyp
Left colon
164
Etiology of a colon polyp
decreased epithelial turnover & shedding
165
Colon lesion with mature goblet and absorptive cells
hyperplastic polyp
166
SMAD4+
Juvenile polyps
167
How many patients with juvenile polyposis get colon cancer
50%
168
Retention polyps
Single juvenile polyps
169
Typical age of a patient with juvenile polyps who presents with rectal bleeding
<5
170
STK11
Peutz Jeghers
171
These juvenile polyp syndromes confer an increased risk of pancreatic cancer
Peutz Jeghers; Juvenile Polyps
172
Typical location for a Peutz Jeghers polyp
Small intestine
173
Rectal polyp in a child with digital clubbing and increased risk of ANY Gi cancer
Juvenile polyposis
174
Ileal polyp in a child with mouth freckles and increased risk of colon cancer
Peutz Jeghers
175
Which polyp presents with Congenital RPE hypertrophy?
Classic FAP
176
Colon polyp with a serrated surface
Hyperplastic polyp
177
Cowden syndrome, Cronkhite-Canada syndrome, and TSC all cause this type of polyp
Hamartomatous
178
Outcome of most colon adenomas
Nothing -- rare to become cancerous (30% of adults in the US have them)
179
FAP has an association with this condition, taught by Dr. Galbraith
Nasopharyngeal angiofibroma
180
Primary syndromic cause of colon cancer (though still only 3%)
HNPCC (Lynch Syndrome)
181
Patients with colon polyps whose first degree relatives died of breast or pancreatic cancer may tip you off to this syndrome
HNPCC (Lynch Syndrome)
182
MSH2 or MLH1 (microsatellite instability/mismatch repair error)
HNPCC (Lynch Syndrome)
183
Patients with this syndrome present with colon cancer at a relatively young age, often located in the cecum
HNPCC (Lynch Syndrome)
184
Effect of aspirin and NSAIDS on colon cancer
Protective!
185
Most common mutation in colon cancer
APC (WNT/B catenin)
186
Location differences!
| Polypoid exophytic colon cancer vs. napkin ring/apple core lesions
Exophytic = right colon (as in Lynch syndrome/HNPCC)
Napkin ring = left colon
187
Anemia in the elderly is this type of colon cancer until proven otherwise
Right sided (Exophytic)
188
This gross pathogen can cause appendicitis
Pinworms (vermicularis)
189
Prognosis for a carcinoid tumor of the appendix
Benign!
190
Bacteria with this type of metabolism predominate in periodontitis
Anaerobes
191
People with a variety of systemic and auto-immune diseases present with this dental complication
Periodontitis
192
This vascular disease is characterized by oral ulcers, genital ulcers, and uveitis
Behcet disease
193
"Pregnancy tumors" that often regress
Pyogenic granuloma
194
This type of herpes causes cold sores
HSV-1
195
This part of the mouth is most affected in a primary acute oral herpes infection
gingiva (acute herpetic gingivostomatitis)
196
Acantholysis with intracellular and extracellular edema
Oral HSV-1
197
How many people have candida as part of their normal oral flora?
50%
198
Raspberry/strawberry tongue
Strep A pharyngitis
199
Warthin Finkeldey giant cells
Measles
200
This infectious disease causes palatal petechiae
Mono
201
Most common cause of erythema multiforme
Stevens Johnson syndrome
202
Ludwig's angina cellulitis is a consequence of this group of disorders
Pancytopenias
203
Leukoplakia or erythroplakia -- which is raised? Which is depressed?
Raised -- leukoplakia
| Depressed -- erythroplakia
204
Location of erythroplakia
Anywhere in the mouth
205
What percentage of HEENT cancers are SCC?
95%
206
70% of oropharyngeal cancers are caused by this
HPV-16
207
Which malignancy has the highest rate of secondary tumor growth, at 7%?
SCC of the oropharynx
208
What effect does HPV positivity have on prognosis of SCC?
Improves it!
209
Primary gene involved: classic (tobacco) oral SCC
p53 (53 cigarettes)
210
Primary gene involved: HPV oral SCC
p16 (for HPV16)
211
Which type of oral SCC has no precancerous lesions associated with it?
HPV+
212
This type of oral SCC presents with tumor cells hiding in tonsillar cryps or the base of the tongue, and may present as a sore throat
HPV+
213
This cancer is characterized by plaques with indurated (rolled) borders
Oral SCC
214
Extension and metastasis of oral SCC:
Extension: submandibular and cervical nodes
Mets: mediastinal nodes, lung, liver, bone
215
This very aggressive cyst is found in the posterior mandible of young males. It is lined by keratinized stratified SCC and has a very high recurrence rate.
Odontogenic Keratocyst
216
If a patient has more than 1 Odontogenic Keratocyst, they should be evaluated for this syndrome and gene.
Gorlin Syndrome (PTCH+)
217
The most common salivary gland lesion
Mucocele
218
Primary cause of a mucocele
Trauma
219
Fluctuant oral pseudocyst filled with inflammatory granulation tissue
Mucocele
220
Regression rate, mucocele
High
221
Large sublingual epithelial-lined lesion penetrating the myelohyoid muscle
Ranula
222
2 most common bacterial causes of sialadenitis
Staph and strep viridans
223
Typical patient with a salivary gland tumor (except Warthin tumors)
60 year old female
224
PLAG1
pleomorphic adenoma
225
How many pleomorphic adenomas will become malignant?
2%
226
Which 2 salivary gland tumors can be bilateral?
```
Warthin (benign)
Acinic cell (malignant)
```
227
Oncocytic tumors
Warthin
228
Benign or malignant: Warthin tumor
Benign & unlikely to recur
229
MECT/MAML fusion gene and prognosis
Mucoepidermoid carcinoma -- malignant!
230
Which malignant salivary gland tumor tends to be perineural?
adenoid cystic carcinoma
231
CD14+ cell
Kupffer cell
232
What is the function of Endothelin?
It is a vasoconstrictor that also causes scar contraction
233
Range of time for acute hepatitis
6 months
234
Two diseases that present with diffuse microvesicular steatosis
Fatty liver of pregnancy
| Tetracycline toxicity
235
Which clotting factors are produced in the liver?
5, 7, 9, 10
236
Friable, hard, small liver with obliteration of the central vein
Cirrhosis
237
Why would you measure pulmonary venous wedge pressure in a patient with liver disease?
To determine the progression of cirrhosis
238
"Compaction of scars" in the liver indicataes this
Imminent regression
239
What percentage of people with chronic liver disease are asymptomatic?
40%
240
The risk of these 2 conditions continues to be elevated even if the patient's cirrhosis is reversed.
HCC
| Portal HTN
241
Spider angioma indicates this, which causes this
Chronic liver failure; hyperestrogenemia
242
Portal hypertension and ascites are almost always (>90%) indicative of this condition
Cirrhosis
243
What percentage of cirrhosis patients develop esophageal varices? What percentage will die as a result?
40%; 20%
244
Thrombocytopenia and pancytopenia indicate this complication of cirrhosis.
Congestive splenomegaly ("hypersplenism") 2ry to portal HTN
245
If a patient with chronic liver failure has hepatopulmonary syndrome, in what position are they most comfortable and able to breathe?
Lying supine -- standing = bad
246
How many cirrhosis patients get hepatopulmonary syndrome?
30%
247
Extreme over-dilation of pulmonary capillaries due to over-production of NO indicates this complication of cirrhosis and portal HTN
Hepatopulmonary syndrome
248
Patient has chronic liver failure, dyspnea, and digital clubbing. Dyspnea is NOT improved in the supine position.
Portopulmonary HTN (unknown physiology)
249
What is the mortality rate for patients with acute on chronic liver failure?
>50%
250
During which period of viral infection is someone with hepatitis most contagious?
Incubation period (asymptomatic)
251
Which 2 types of hepatitis may lead to immune complex glomerulonephritis?
B, C
252
What is the most common symptom of chronic hepatitis?
FATIGUE *not jaundice*
253
Which antigen is elevated in HBV carriers?
HBsAg
254
Patient has elevated HBsAg and moderately elevated AST/ALT. They are asymptomatic. What type of HBV do they have?
ACTIVE! If it's anything other than just HBsAg -- even with no symptoms -- it's not a carrier state.
255
Mottled infiltrate with spotty necrosis (lobular hepatitis), hepatic dropout, pyknosis and *no portal inflammation*
Acute viral hepatitis
256
Presents with an extremely high plasma cell count in hepatic fluid
Acute Hep A
257
Extensive fibrosis and ductular reactions with inflammatory cells and interface hepatitis (inflammation of the junctions between hepatocytes and vessels)
Chronic viral hepatitis
258
This disease presents with hepatocytes filled with lipids and increased lymphoid follicles
Chronic Hep C
259
What causes the ground glass appearance of chronic Hep B?
Accumulation of HBsAg
260
50% of Americans are seropositive for this type of hepatitis
A
261
What is the most common disease course for HBV?
Acute hepatitis followed by full recovery
262
How many HBV patients develop cirrhosis? How many developing chronic disease without cirrhosis?
10% each
263
What is the most common mode of transmission for HBV worldwide?
Childbirth
264
Which hepatitis has an incubation period of 2-6 months?
B
265
Which Hep B protein confers increased risk to HCC? What is its function?
HBx; controls viral replication
266
Which cell marker is the only one you'll see in the "window phase" of HBV infection
IgM
267
Continually elevated HBeAg indicates this
Progression to chronic liver disease
268
Which HBV protein confers resistance to drugs?
HBsAg
269
Which hepatitis presents 30% of the time in someone with no risk factors?
HCV
270
Which hepatitis can cause metabolic syndrome?
C (genotype 3)
271
E2 envelope protein
Confers HCV resistance to our antibodies
272
How does co-infection of HBV/HDV affect prognosis?
Prognosis is actually better if you get them both at once
273
In patient with HBV-HDV coinfection who has very elevated AST/ALT, which infection is predominating?
HDV
274
Which presents with an elevated T cell count -- acute or chronic hepatitis?
BOTH
275
Which forms of hepatitis confer increased risk for HCC?
B, C
276
Which unpleasant GI bacteria can cause direct infection of the liver?
Salmonella typhi
277
PBC and PSC are both associated with this liver disease
Auto-immune hepatitis
278
Identify the patient and prognosis for each type of autoimmune hepatitis:
I (ANA/ASMA+)
II (LKM/CYP2D6+)
```
I = patients > 40 with better prognosis
II = patients <20 with worse prognosis
```
279
Patient has high plasma cell count in hepatic fluid but is HAV negative
Autoimmune hepatitis
280
Hepatocyte rosettes
Autoimmune hepatitis
281
How many patients with autoimmune hepatitis will die on their first attack?
40%! It's much worse than viral hepatitis
282
Which liver disease is associated with elevated NADH levels?
Alcoholic fatty liver
283
Which liver cell type is Keratin 8+ and Keratin 18+?
Mallory Denk bodies
284
In what conditions would you expect to see Mallory Denk bodies?
Alcoholic fatty liver, NAFLD, Wilson, Biliary tract disease
285
Micronodular perisinusoidal cirrhosis
Alcoholic steatofibrosis (Laennec cirrhosis)
286
What is the primary cause of chronic liver disease in the US?
NAFLD
287
>5% of hepatocytes are triglyceride +
NAFLD
288
Which type of metabolic liver disease is more likely to lead to cirrhosis: AFLD or NAFLD?
NAFLD -- but it's still super uncommon
289
C282Y vs H63D mutation in Hemochromatosis
```
C282Y = more severe; more common in whites
H63D = less severe
```
290
Causes pseudogout
Hemochromatosis
291
Which metabolic liver disease presents with absolutely 0 evidence of inflammation?
Hemochromatosis
292
Which metabolic liver disease causes cardiomyopathy?
Hemochromatosis
293
Which condition increases risk of HCC by 200x regardless of treatment?
Hemochromatosis
294
This liver condition is diagnosed via buccal biopsy
Secondary (fetal) Hemochromatosis
295
ATP7B
Wilson disease
296
Which metabolic disease cannot be diagnosed based on a blood test?
Wilson -- serum copper is unreliable
297
Rhodamine-Orceine stain
Wilson disease
298
Cutaneous necrotizing panniculitis (SQ fat)
A1AT
299
The most commonly diagnosed inherited liver disease in children
A1AT
300
Cytoplasmic globular inclusions in hepatocytes that are PAS+
A1AT
301
Feathery degeneration
Kuppfer cells filled with bile
302
Charcot triad for ascending cholangitis
RUQ pain, fever, jaundice
303
Jigsaw-shaped liver nodules
Biliary cirrhosis
304
2 conditions that cause periportal accumulation of Mallory Denk bodies
Wilson; biliary cirrhosis
305
Which is caused by sepsis: canalicular cholestasis, or ductular cholestasis?
Ductular
306
Which people are at highest risk for intrahepatic gallstone formation?
Asians
307
Chemical composition of an intrahepatic gallstone?
Calcium
308
Which liver disease is the primary cause of liver-related death in children under age 2?
Biliary atresia
309
This LIVER disease is related to a rotavirus, reovirus, or CMV infection in infancy
Perinatal biliary atresia
310
This autoimmune cholangiopathy is AMA+
Primary biliary cirrosis
311
This autoimmune cholangiopathy is ANCA+
Primary sclerosing cholangitis
312
This autoimmune cholangiopathy confers an increased risk of cancer
PSC
313
This autoimmune cholangiopathy has a strong association with Sjogrens syndrome
PBC
314
This liver disease presents with an enlarged cirrhotic liver with florid duct lesions. What is its prognosis
PBC -- treatable with oral ursodeoxycholic acid!
315
Which disease is treataed with oral ursodeoxycholic acid?
PBC
316
String of beads morphology
PSC
317
Onion skin fibrosis with tombstone scars
PSC
318
8 year old female with PCKD or Caroli disease presents with RUQ pain and jaundice
Choledochal cyst (dilation of common bile duct)
319
Caroli syndrome
a baby liver absolutely riddled with cysts
320
Von Meyenberg complexes
bile duct hamartomas
321
Peliosis hepatitis
Dilation of sinusoids due to impaired efflux of hepatic blood; related to bartonella in AIDS patients
322
Vanishing bile duct syndrome is associated with
host-versus-graft disease
323
Single hepatic mass lesion with a stellate central scar (fibromuscular hyperplasia) in a healthy adult
Focal nodular hyperplasia
324
Liver covered in nodules but no evidence of fibrosis; associated with transplants and systemic disease
Nodular regenerative hyperplasia
325
Which has a worse prognosis (and what is the prognosis): focal nodular hyperplasia vs nodular regenerative hyperplasia
Nodular regenerative hyperplasia --> portal HTN
326
Most common benign neoplasm of the liver
Cavernous hemangioma
327
HNF-1A
Hepatocellular adenoma from birth control
328
Null levels of LFABP
Hepatocellular adenoma from birth control (HNF-1A)
329
Related to MODY-3 diabetes
Hepatocellular adenoma from birth control (HNF-1A)
330
Rank the hepatocellular adenomas in terms of their risk of malignant transformation
B-catenin > inflammatory > HNF-1A birth control
331
hepatocellular adenoma with telangiectasia
Inflammatory
332
Glutamine synthetase + indicates this genetic mutation
B catenin
333
FAP and Beckwith Wiedemann predispose to this liver disease
Hepatoblastoma
334
2 most common genes associated with HCC
```
B-catenin activation
P53 inactivation (esp with aflatoxin)
```
335
Which is more highly correlated with aflatoxin: p53 or B catenin?
p53
336
HNF4-alpha
inflammatory HCC
337
AFP+
HCC
338
Primary metastasis site from the liver
lung
339
Oncocytic tumor
HCC
| Warthin
340
Klatskin tumor
Cholangiocarcinoma arising in the perihilar region -- the most common CCA!
341
ABCG8 gene (ATP cassette transporter)
hereditary gallstones
342
Ascending cholangitis causes this kind of stone
pigment
343
Bouveret syndrome
gallstone ileus
344
Bacteria most commonly implicated in acute cholecystitis
Salmonella typhi
345
Rokitansky-Aschoff sinus
pocket of gallbladder poking through muscular wall; caused by reactive hyperplasia secondary to chronic cholecystitis
346
Xanthoma cell
foamy bilious macrophage
347
Which is more common: extrahepatic CCA or gallbladder CA?
Gallbladder CA
348
ERBB2 (Her-2/neu) mutation
Gallbladder cancer
349
Most common metastasis site for gallbladder CA
liver
350
PDX1
pancreatic agenesis
351
SPINK1
protein that prevents the healthy pancreas from digesting itself; mutated in AR pancreatitis
352
2 most common causes of pancreatitis
Alcohol; gallstones
353
Gender preference; pancreatitis
male
354
pathology made worse by hypercalcemia
pancreatitis
355
which is the only pancreatic enzyme that is normally activated inside the pancreas?
lipase
356
Which virus can randomly cause pancreatitis?
mumps (paramyxo)
357
PRSS1
AD pancreatitis; gain of function in trypsinogen gene ("press the on button")
358
How many patients with hereditary pancreatitis will develop pancreatic CA?
40%
359
Morphologic difference between acute interstitial & acute necrotizing pancreatitis
```
Interstitial = necrosis of fats
Necrotizing = necrosis of pancreatic cells
```
360
Which is elevated first in pancreatitis: amylase or lipase?
amylase
361
How many cases of chronic pancreatitis are hereditary?
25%
362
Acinar cell dropout indicates
chronic pancreatitis
363
Chronic pancreatitis with large numbers of protein plugs indicates this etiology
Alcoholism
364
Why can opiate abuse lead to pancreatitis?
increased tone of sphincter of Oddi
365
Severe chronic pain is a consequence of this disease
chronic pancreatitis
366
AD-PCKD and VHL predispose to this condition
congenital pancreatic cyst
367
Which pancreatic cystic neoplasm is located at the head of the pancreas and commonly involves the pancreatic duct?
IPMN (intraductal papillary mucinous neoplasm)
368
Which pancreatic cystic neoplasm is more common in males?
IPMN (intraductal papillary mucinous neoplasm)
369
Which pancreatic cystic neoplasm is common in young women?
solid pseudopapillary neoplasm
370
Rank the cystic pancreatic neoplasms by malignant potential
1. solid pseudopapillary neoplasm
2. mucinous cystic = IPMN
4. serous cystic
371
This pancreatic cystic neoplasm is associated with a VHL mutation
serous cystic
372
These pancreatic cystic neoplasms are associated with a KRAS mutation
mucinous cystic; IPMN
373
This pancreatic cystic neoplasm is associated with a WNT mutation
solid pseudopapillary neoplasm
374
A precursor lesion to which cancer is delineated by marked telomere shortening?
PanIN (pancreatic CA)
375
This cancer is differentiated by:
1) tumor suppressor mutation - CDKN2A
2) oncogene activation -- KRAS
Pancreatic CA
376
CDKN2A methylation has been linked to both this GI cancer and melanoma
Pancreatic CA
377
Most common site for pancreatic CA metastasis
liver
378
Cancer of which organ is famous for having a very thick, dense fibrous capsule (large desmoplastic reaction)?
Pancreas
379
+ Carcinoembryonic Ag
Pancreatic CA
380
This rare cancer presents with secretion of active pancreatic enzymes and metastatic fat necrosis
Acinar cell carcinoma
381
This rare cancer has a good prognosis, occurs in children, and has mixed acinar/squamous cells
Pancreatoblastoma
382
Where are curling ulcers located?
Stomach
383
Lesions related to PPI's and FAP
Fundic gland polyps
384
Stomach polyps made of intestinal cells
Gastric adenoma
PRE MALIGNANT IF LARGE
