Pathology Flashcards
(176 cards)
1
Q
Facial pain or paralysis with a salivary gland tumor usually indicates what?
A
Malignant involvement of CN VII
2
Q
Which salivary gland is most commonly affected by benign tumors?
A
Parotid gland
3
Q
Malignant tumors of salivary glands are most commonly found in what size glands?
A
Small glands
4
Q
Typical presentation of salivary gland tumors
A
Painless mass or swelling
5
Q
Most common salivary gland tumor
A
Pleomorphic adenoma
6
Q
Where are pleomorphic adenoma tumors most commonly located?
A
At angle of jaw
7
Q
What happens if pleomorphic adenoma tumor is not completely excised or ruptures?
A
Recurs
8
Q
A benign mixed tumor composed of chondromyxoid stroma and epithelium
A
Pleomorphic adenoma
9
Q
Most common malignant salivary gland tumor
A
Mucoepidermoid carcinoma
10
Q
Malignant salivary tumor that can present with facial nerve damage and has mucinous squamous components
A
Mucoepidermoid carcinoma
11
Q
Benign cystic tumor with germinal centers and lymphoid tissue that is the 2nd most common tumor of salivary glands typically found in smokers
A
Warthin tumor
12
Q
What population group is commonly affected by Warthin tumors?
A
Smokers
13
Q
Esophageal manometry will have what type of LES pressures
A
Increased LES pressures
14
Q
Infection in someone from South America that causes achalasia
A
T cruzi infection causing Chagas disease
15
Q
What is the cause of achalasia
A
Destruction of Auerbach plexus causing esophageal dysmotility
16
Q
Presents with “bird’s beak” on barium swallow and progressive dysphagia to solids and liquids
A
Achalasia
17
Q
What is a complication of achalasia
A
Esophageal cancer
18
Q
What neurons are affected in achalasia
A
Postganglionic inhibitory neurons
19
Q
Loss of what regulatory substances can cause achalasia
A
NO and VIP
20
Q
Transmural esophageal rupture, usually in the distal esophagus, with pneumomediastinum due to violent retching that is considered a surgical emergency
A
Boerhaave syndrome
21
Q
Typical sign of Boerhaave syndrome
A
Crepitus in neck or chest region
22
Q
Type of infiltrates seen in esophagus with esophageal rings and linear furrows on endoscopy caused by food allergens and common in atopic patients
A
Eosinophils
23
Q
Esophageal pathology caused by food allergens leading to dysphagia and food impaction and unresponsive to GERD therapy
A
Eosinophilic esophagitis
24
Q
Individual with caustic ingestion or acid reflux is at risk for what esophageal pathology
A
Esophageal strictures
25
Painless dilated submucosal veins that are 2ndary to portal HTN and commonly seen in cirrhotics which may cause life-threatening hemorrhage
Esophageal varices
26
Pill esophagitis is associated with what drugs?
```
PINT Bis:
Potassium chloride
Iron
NSAIDs
Tetracycline
Bisphosphonates
```
27
Esophagitis caused by Candida infection will have what type of gross finding?
White pseudomembrane
28
Esophagitis caused by HSV-1 infection will have what type of gross finding?
Punched-out ulcers
29
Esophagitis caused by CMV infection will have what type of gross finding?
Linear ulcers
30
Esophagitis is commonly associated with what?
Reflux
31
Commonly presents with heartburn, regurgitation, dysphagia, cough or hoarseness
GERD
32
GERD is associated with what atopic condition?
Asthma
33
What is considered the cause of GERD
Transient decrease in LES tone
34
Partial thickness mucosal laceration at GE junction due to severe vomiting
Mallory-Weiss tear
35
Clinical presentation of Mallory-Weiss tear
Painful hematemesis in alcoholics or bulimics
36
Mallory-Weiss tear can lead to what more serious condition
Boerhaave syndrome
37
Mallory-Weiss tear is commonly misdiagnosed with what other condition
Ruptured esophageal varices
38
Presents with Dysphagia, Iron deficiency anemia, and Esophageal webs with associated glossitis and beefy red tongue
Plumber-Vinson syndrome
39
Classic triad of Plumber-Vinson syndrome
Dysphagia, Iron deficiency anemia, Esophageal webs
| Plumbers DIE
40
Part of CREST syndrome caused by esophageal smooth muscle atrophy leading to decreased LES pressure and dysmotility and acid reflux
Sclerodermal esophageal dysmotility
41
Complication of sclerodermal esophageal dysmotility
Barret esophagus, Aspiration, Strictures (BAS)
42
CREST syndrome
Calcinosis, Raynaud's, Esophageal dysmotility, Telangiectasias
43
Replacement of Nonkeratinized stratified squamous epithelium with intestinal epithelium in distal esophagus
Barret esophagus
44
Type of epithelium seen on pathology in Barret esophagus
Non-ciliated columnar intestinal epithelium with goblet cells
45
What is Barret esophagus associated with?
GERD
46
Complication of Barret esophagus
Esophageal adenocarcinoma
47
Typical presentation of esophageal cancer
Progressive dysphagia (first solids then liquids) and weight loss
48
Adenocarcinoma is seen in what part of the esophagus?
Lower 1/3
49
Risk factors for adenocarcinoma of the esophagus
GERD, Barrett esophagus, obesity, smoking, achalasia
50
Adenocarcinoma of the esophagus is more prevalent in what part of the world?
America (west)
51
Squamous cell carcinoma is seen in what part of the esophagus
Upper 2/3
52
Risk factors for squamous cell carcinoma of the esophagus
Alcohol, hot liquids, caustic strictures, smoking, achalasia
53
Plumber-Vinson syndrome is associated with what risk factor?
Alcohol
54
Type of intestinal metaplasia caused by GERD or irritation to lower esophagus
Barret esophagus
55
Lymph nodes that drain the lower 1/3 of the esophagus
Celiac and gastric nodes
56
Lymph nodes that drain the middle 1/3 of the esophagus
Mediastinal or tracheobronchial nodes
57
Lymph nodes that drain the upper 1/3 of the esophagus
Cervical lymph nodes
58
How do NSAIDs cause acute gastritis?
NSAIDs decrease PGE2 decreasing gastric mucosa protection
59
How doe burns cause acute gastritis?
Hypovolemia causes intestinal ischemia
60
Type of ulcers caused by burns in acute gastritis
Curling ulcers
61
How does brain injury cause acute gastritis?
Increased vagal stimulation increases ACh which increases acid production
62
Type of ulcers caused by brain injury in acute gastritis
Cushing ulcers
63
Complication of chronic gastritis
Gastric cancers
64
H pylori infection affects what part of the stomach
Affects antrum first then spreads to body
65
Complications seen in H pylori infection
Peptic ulcer disease and MALT lymphoma
66
Treatment for H pylori infection
PPIs, Clarithromycin, Amoxicillin or Metronidazole
67
Most common cause of chronic gastritis
H pylori infection
68
Autoantibodies to parietal cells and intrinsic factor with increased risk of pernicious anemia is seen in what type of chronic gastritis
Autoimmune gastritis
69
What causes pernicious anemia in autoimmune gastritis
Parietal cells destroyed, cannot make intrinsic factor, vitamin B12 cannot be absorbed
70
What type of lymphocytes are involved in autoimmune gastritis?
T-cell mediated damage (type IV)
71
Precancerous condition caused by hyperplasia of the gastric mucosa leading to hypertrophied rugae that look like brain gyri, excess mucus production with resultant protein loss and parietal cell atrophy with decreased acid production
Ménétrier's disease
72
Bilateral metastases to ovaries with abundant mucin-secreting, signet ring cells
Krukenberg tumor
73
Krukenberg tumor is associated with which type of cancer?
Diffuse type gastric cancer
74
Virchow node is associated with what condition?
Metastasis from stomach
75
Left supraventricular node by metastasis from stomach cancer
Virchow node
76
Subcutaneous periumbilical metastasis
Sister-Mary-Joseph nodule
77
Sister-Mary-Joseph nodule is associated with which type of cancer?
Intestinal type gastric cancer
78
Type of stomach cancer not associated with H. pylori infection
Diffuse type
79
Stomach cancer with signet ring cells and stomach wall that is grossly thickened and leathery
Diffuse type
80
Mucin-filled cells with peripheral nuclei seen in diffuse type gastric cancer and Krukenberg tumor
Signet ring cells
81
Gastric cancer associated with H. pylori infection, dietary nitrosamines, tobacco, achlorhydria and chronic gastritis
Intestinal type
82
Most common type of gastric cancer
Adenocarcinoma
83
Acute onset of multiple eruptive seborrheic keratoses common in gastric cancer
Leser-Trelat sign
84
Which type of peptic ulcer is seen most commonly with H. pylori infections?
Duodenal > Gastric ulcer
85
Which type of peptic ulcer has pain that is greater with meals and weight gain is seen?
Gastric ulcer
86
What are common causes of gastric ulcers?
H. pylori, NSAIDs
87
What are common causes of duodenal ulcers
Zollinger-Ellison syndrome
88
Which type of peptic ulcer has a greater risk of carcinoma?
Gastric ulcer
89
Type of peptic ulcer that has hypertrophy of Brunner glands on biopsy?
Duodenal ulcer
90
Type of peptic ulcer in which biopsy of margins needs to be done to rule out malignancy?
Gastric ulcer
91
Type of peptic ulcer in which weight loss is seen and pain is increased with meals?
Gastric ulcer
92
Which artery is at risk of bleeding from a ruptured gastric ulcer on the lesser curvature of the stomach?
Left gastric artery
93
What is the most common complication of peptic ulcers
Posterior hemorrhage
94
Which artery is at risk of bleeding from an ulcer on the posterior wall of duodenum?
Gastroduodenal artery
95
Which area, anterior or posterior duodenal, when ruptured, will cause free air under diaphragm with referred pain to the shoulder?
Anterior > posterior
96
What nerve, when irritated, will have referred pain to the shoulder?
Phrenic nerve
97
Celiac disease is an autoimmune-mediated intolerance to what product found in wheat products
Gliadin
98
What HLA subtypes are associated with Celiac disease?
HLA-DQ2 and HLA-DQ8
99
Which group of people are commonly affected by Celiac disease?
Northern Europeans
100
Disease seen in Celiac disease that is caused by IgA deposits on dermal papillae?
Dermatitis herpetiformis
101
What will a biopsy in Celiac disease show?
Villi atrophy and crypt hyperplasia
102
What section of the GI tract is mostly affected by Celiac disease?
Mostly distal duodenum and/or proximal jejunum
103
What is the treatment for Celiac disease?
Gluten-free diet
104
A d-xylose test that shows decreased blood and urine levels is indicative of what type of disease?
Mucosal defects or bacterial overgrowth
105
In what disease is a d-xylose test normal
Pancreatic insufficiency
106
What type of immune cells mediate Celiac disease?
T-cell mediated
107
What antibodies are seen in Celiac disease?
IgA anti-tissue transglutimase, anti-endomysial, and anti-deaminated gliadin peptide antibodies
108
What test is done to test for lactose intolerance?
Lactose hydrogen breath test
109
What level is necessary to diagnose lactose intolerance in a lactose hydrogen breath test?
> 20 ppm compared with baseline
110
What is a common finding in lactose intolerance?
Osmotic diarrhea with decreased stool pH
111
What are biopsy findings in lactose intolerance?
Normal-appearing villi
112
What vitamins are commonly deficient in pancreatic insufficiency?
Fat-soluble vitamins and vitamin B12
113
What are common findings in pancreatic insufficiency?
Decreased pH and fecal elastase
114
Type of malabsorption syndrome that is responsive to antibiotics and seen in recent visitors to tropics?
Tropical sprue
115
What vitamin deficiencies are seen in tropical sprue?
Vitamin B9 and B12
116
What area of the GI tract is commonly affected in tropical sprue?
Jejunum and ileum > duodenum
117
What is the cause of Whipple disease?
Tropheryma whipplei
118
Disease more commonly seen in older man and causes cardiac symptoms, arthralgias, and neurologic symptoms that is PAS positive and has foamy macrophages in intestinal lamina propria?
Whipple disease
119
Refractory cases of Celiac disease can lead to what complication?
Small bowel carcinoma and T-cell lymphoma
120
Which group of individuals are commonly affected with IBS?
Middle-aged women
121
What are the symptoms in IBS?
Diarrhea predominant, Constipation predominant or Mixed
122
Symptoms in change in stool frequency with increased diarrhea in middle-aged women points to what disease?
IBS
123
What is the most common cause of appendicitis in children?
Lymphoid hyperplasia
124
What is the most common cause of appendicitis in adults
Fecalith obstruction
125
What is the treatment for appendicitis
Appendectomy
126
Abdominal pain with psoas, obturator and Rovsing sings with guarding and rebound tenderness indicated what disease?
Appendicitis
127
Where is the initial pain in appendicitis usually felt?
Periumbilical
128
What disease in elderly can mimic appendicitis?
Diverticulitis
129
What pregnancy condition can mimic appendicitis?
Ectopic pregnancy
130
What test is done to exclude ectopic pregnancy in a women of child-bearing age?
B-hCG
131
What layers of the gut are found in a false or pseudo diverticulum?
Mucosa and submucosa
132
What type of diet is associated with diverticulosis?
Low-fiber diets
133
What is the most common location of diverticulum?
Mostly in sigmoid colon
134
Pain caused by diverticulitis is typically felt in what abdominal quadrant?
LLQ
135
What signs and symptoms are seen in diverticulitis?
LLQ pain, fever, leukocytosis
136
What are complications of diverticulitis?
Abscess, fistula, obstruction or perforation
137
What is a complication of fistulas seen in diverticulitis?
Colovesical fistula causing pneumaturia
138
What is a complication of obstruction seen in diverticulitis?
Inflammatory stenosis
139
What is a complication of perforation seen in diverticulitis?
Peritonitis
140
Obstruction, dysphagia and halitosis in an elderly male points to what disease?
Zenker's diverticulum
141
What type of diverticulum is Zenker's diverticulum, true or false diverticulum?
False diverticulum
142
Where is the common location of Zenker's diverticulum?
Killian triangle
143
Where is Killian's triangle located in the GI tract?
Between thyropharyngeal and cricopharyngeal parts of the inferior pharyngeal constrictor
144
What is the cause of Zenker's diverticulum?
Esophageal dysmotility
145
What is considered a true diverticulum?
Meckel diverticulum
146
What is the cause of Meckel diverticulum?
Persistence of vitelline duct
147
What is the most common congenital anomaly of the GI tract?
Meckel diverticulum
148
What are common findings in Meckel diverticulum?
RLQ pain, intussusception, volvulus or obstruction near terminal ileum with bleeding
149
Cystic dilation of the vitelline duct?
Omphalomesenteric cyst
150
What are the rule of 2's in Meckel diverticulum?
```
2 times as likely in males
2 inches long
2 feet from ileocecal valve
2% of the population
2 years of life
2 types of epithelia (gastric/pancreatic)
```
151
Congenital megacolon characterized by lack of ganglion cells/enteric nervous plexuses in distal segment of colon?
Hirschsprung disease
152
What gene mutation is associated with Hirschsprung disease?
RET mutation
153
What is the cause of Hirschsprung disease?
Failure of neural crest cell migration
154
What chromosomal trisomy is associated with Hirschsprung disease?
Down syndrome
155
What is a common finding in Hirschsprung disease?
Dilation of normal colon proximal to aganglionic segment
156
Patient presents with bilious emesis, abdominal distention, and failure to pass meconium within 48 hours points to what disease?
Hirschsprung disease
157
Where is Meckel diverticulum usually located?
Near terminal ileum
158
How is Hirschsprung disease diagnosed?
Absence of ganglionic cells on rectal suction biopsy
159
Squirt sign is a common finding in what disease?
Hirschsprung disease
160
What is the treatment for Hirschsprung disease?
Resection of aganglionic segment
161
Complication of malrotation of bowel
Volvulus or duodenal obstruction
162
What is the cause of malrotation?
Anomaly of midgut rotation during fetal development
163
What are common findings in malrotation?
Improper position of bowel and Ladd bands
164
Fibrous bands from liver to colon caused by malrotation
Ladd bands
165
Volvulus affects what area of gut in infants and children?
Midgut
166
What are of colon is affected most in elderly?
Sigmoid colon
167
Coffee bean sign on X-ray in an elderly person points to what disease?
Sigmoid volvulus
168
What is a complication of volvulus?
Obstruction and infarction of colon
169
Twisting of portion of bowel around its mesentery
Volvulus
170
Telescoping of proximal bowel segment into distal segment commonly at ileocecal junction
Intussusception
171
Who is mainly affected by intussusception?
Children
172
What are common causes of intussusception in children?
Recent viral infection
173
Mechanism of viral infection causing intussusception
Adenovirus causes Peyer path hypertrophy leading to a lead point for intussusception
174
What vaccine is associated with intussusception?
Rotavirus vaccine
175
What is the most common cause of intussusception in adults
Mass or tumor causing lead point
176
What is the most common pathologic lead point causing intussusception?
Meckel diverticulum
