Rapid Review Nichols Path Flashcards
(251 cards)
1
Q
Heartburn
A
GERD
2
Q
Pathogen for acute sialadenitis? Which gland?
A
Staph aureus, parotid
3
Q
Is surgery an option for GERD?
A
Yes
4
Q
Cause of chronic sialadenitis?
A
Sialolith
5
Q
Most common salivary gland tumor?
A
Pleomorphic adenoma – ductal epithelium and mesenchymal elements
6
Q
Rx for a 50 y/o female that presents with rounded, well-circumscribed, painless, motile, firm mass at angle of jaw? Complication?
A
Surgery; CN VII injury (Bell’s)
7
Q
Second MC tumor of parotid?
A
Warthin’s Tumor (Papillary Cystadenoma Lymphomatosum)
8
Q
60 y/o male smoker presents with slow-growing, painless, firm mass?
A
Papillary Cystadenoma Lymphomatosum (Warthin’s)
9
Q
Cystic spaces lined by double layer of oncocytes + prominent lymphoid stroma
A
Papillary Cystadenoma Lymphomatosum
10
Q
Expresses CagA gene and causes degradation of p53 leading to activation of cell proliferation pathways? (Ras, Mek, Erk, NF-kB, B-cat)
A
H pylori
11
Q
Syringe-like Type IV secretion system pilus
A
H Pylori
12
Q
Difference b/w H. pylori gastritis and autoimmune atrophic gastritis?
A
G-cell hyperplasia
13
Q
Is a Warthin’s tumor a true neoplasm?
A
No
14
Q
MC malignant tumor of salivary glands? Prognosis?
A
Mucoepidermoid Carcinoma, pretty good
15
Q
Treatment plan for Mucoepidermoid Carcinoma based upon what three factors?
A
Histologic grade, location, stage
16
Q
Abdominal pain/discomfort + heartburn + N/V + massive hematemesis
A
Acute hemorrhagic gastritis
17
Q
MCC Chronic gastritis?
A
H Pylori
18
Q
What inflammatory cell type seen in chronic H pylori gastritis?
A
Neutrophil
19
Q
Brain injury stress ulcers?
A
Cushing
20
Q
Burn injury stress ulcers?
A
Curling
21
Q
Diagnostic modality for esophageal cancer?
A
Endoscopy
22
Q
Imaging to help stage and det. depth esophageal cancer?
A
CT and Ultrasound
23
Q
MC gastric polyp?
A
Hyperplastic (H pylori)
24
Q
Standard diagnostic modality for gastric cancer? Staging modality? Curative modality?
A
Endoscopy, CT, surgery
25
What two factors make a tumor malignant?
Invasion or malignancy
26
Main/Earliest mutation in esophageal SCC?
p53
27
Majority of esophageal SCC are protruding, flat, or excavated?
Protruding
28
Order of mutations in Esophageal SCC?
p53 --\> FHIT and TOC --\> DLC1, 9p31, Cyclin D1 --\> EGFR, HIST, cMYC; everything from cyclin D1 on in this list is amplification
29
Mutations occurring in Esophageal Adenocarcinoma? Are they all necessary or sufficient?
p53, epigenetic silencing/hypermethylation of p16/INK4 cyclin dependent kinase inhibitor, RB; amplification of cERB-B2, Cyclin D, Cyclin E; no
30
Histologic type of gastric polyp -- Dilated corpus oxyntic type glands?
Fundic gland polyp
31
Type of epithelium in an adenomatous polyp?
Stratified columnar
32
First-line therapy for constipation according to Nichols
Prunes (theoretical candy...?)
33
Together, the RFs obesity, alcohol, and low veggie diet are the three most important in what cancer?
Colon
34
Name that gene (loss of methylation just included for completeness): Chr 5q --\> loss of DNA methylation --\> Chr 12q --\> Chr 17q --\> Chr 18q
APC/B-cat --\> loss of DNA methylation --\> KRAS --\> p53 --\> Smad2/Smad4/DCC
35
MLH1, MSH2, BAX, BRAF mutations -- what pathway?
Microsatellite instability pathway to colonic adenocarcinoma
36
BRAF mutation mimics?
KRAS
37
Signet rings?
Linitis plastica/Diffuse type gastric adenocarcinoma
38
Leather Bottle?
Linitis plastica/Diffuse type gastric adenocarcinoma
39
Order of events leading to esophageal adenocarcinoma?
Obesity --\> GERD --\> Barrett --\> Dysplasia --\> Adenocarcinoma (lower esophagus)
40
Definitive therapy for pancreatic carcinoma?
Surgery
41
Villous blunting and intraepithelial CD8 lymphocytes?
Celiac sprue/gluten-sensitive enteropathy
42
Cause for temporary disaccharidase (lactase) deficiency?
Viral gastroenteritis (Norwalk/Rotavirus I'm guessing)
43
PAS+, foamy macrophages in the lamina propria of a white, middle aged male presenting with GI, cardiac, and joint Sx? Cause?
Whipple disease; Tropheryma whipplei/actinomycete
44
What type of worm is Ascaris? How to differentiate from a protozoa like Giardia?
Roundworm; eosinophilia
45
27 y/o man with psychiatric hx admitted to ER in coma, hypothermic, with a hard/distended abdomen and fatal abdominal compartment syndrome related to the absorption of antidepressents and benzodiazepines -- cause of death?
Acquired toxic megacolon
46
Gold standard for definitive Dx of Hirschprung? Treatment?
Rectal Biopsy; Surgical resection
47
Sessile serrated adenoma -- which pathway?
Microsatellite instability
48
MC Symptom of colon cancer?
Abdominal pain
49
KRAS after APC mutation =
Cancer
50
KRAS without APC mutation =
Hyperplastic polyp
51
Color of a carcinoid?
Yellow
52
Small, sessile polyp in the rectum of an adult \>60 y/o with a serrated/star-shaped lumen on histo? Mutation?
Hyperplastic polyp; KRAS
53
Length for progression of an adenoma to carcinoma?
10 yr
54
Highest risk adenomatous polyp?
Sessile villous
55
What are the most important mutations in esophageal adenocarcinoma? (ones he listed in TBL)
p53; EGFR (30% [15% are HER2 -- RX trastuzumab])
56
p16/INK4, EGFR, TP53 together most important in which upper GI cancer?
Esophageal SCC
57
Cleaves E-cadherin, thus releasing B-cat
CagA from H Pylori
58
CDH1 mutation coding for E-cadherin important in which cancer?
Linitis plastica
59
Corkscrew glands (type of polyp)
Hyperplastic
60
Hamartomas in the small intestine (type of polyp)
Peutz-Jeghers
61
MC type of polyp?
Adenomatous
62
Longstanding IBD causes what type of polyp?
Inflammatory/Pseudopolyp
63
Location of colon cancer causing occult bleeding/anemia?
Right side
64
Location of colon cancer causing overt bleeding and obstructive symptoms?
Left side
65
ATG16L1, IRGM, NOD2 seen in Crohn's or UC? Which activates NF-kB and is assoc. w/ epithelial integrity? Which is a/w defective Paneth cell granules and affects intestinal microbiota? (all key points from Robbins)
Crohn's; NOD2; ATG16L1
66
IL23R, Stat3, IL12B -- adaptive or innate immunity genes in IBD?
Adaptive
67
Role of SLC22A5, ZNF365, NKX2-3 in IBD -- Innate or adaptive immunity or cell integrity?
Cell integrity
68
Location of colon cancer causing tenesmus, pain, and bleeding?
Rectum
69
Apple core lesion with barium enema
Left sided colon cancer
70
Th1, Th17, IL23 -- Crohn's or UC?
Crohn's
71
Th1, Th2, Th17, IL13, IL10, IL10R, IL23
Ulcerative colitis
72
Annular, napkin ring lesion
Left sided colon cancer
73
Disease limited to mucosa/submucosa
Ulcerative colitis
74
Polypoid exophytic cancer
Right sided colon cancer
75
Why do a CT before you take someone to surgery to excise a polyp?
Look for metastasis
76
Flask-shaped ulcer in the submucosa? Geographic prevalence?
Entameoba Histolytica; Mexico
77
Organism that resembles human macrophages; how do you tell it's not a macrophage?
Entamoeba Histolytica; ingests RBCs
78
What amoeba sits atop intestinal ductular cells and is extremely dangerous in immunocompromised patients?
Cryptosporidium
79
Toxic megacolon in which IBD? (big time bad complication)
Ulcerative colitis
80
Most sensitive evaluation of free air in the colon (for Dx of toxic megacolon)? What's a quickie test in case of emergency (Uworld)
CT; flat plain of abdomen
81
Useful test to observe mucosal changes in IBD?
Barium enema
82
IBD with strong monozygotic concordance?
Crohn's
83
MC age range of diagnosis of Crohn's
20-29
84
Transmural involvement
Crohn's
85
Fistula
Crohn's
86
Noncaseating granuloma
Crohn's -- Excellent!!!!
87
Skip lesion
Crohn's
88
Cobblestone mucosa
Crohn's
89
Creeping fat
Crohn's
90
Volcano appearance on H&E?
Pseudomembranous colitis
91
Thickened submucosal collagen layer w/ lymphs in the epithelium? Etiology? Responds to?
Collagenous colitis, decreased MMP1 or increased TIMP, budesonide
92
ANCA + anti-saccharomyces cerevisiae in IBD?
Crohn's
93
Chromogranin stains?
Carcinoid
94
Hypergastrinemia in majority or minority of carcinoids?
Majority
95
Secretin stimulation test is used for dx of what?
Zollinger-Ellison
96
MC symptom and location of intestinal neuroendocrine carcinoid (not ZE)?
Abdominal pain; ileum/appendix
97
MC neoplasm of appendix
Carcinoid
98
CD 117 is also known as? Mutated in what? MC location?
cKIT, GIST, stomach
99
Tumor whose cells differentiate from interstitial cells of Cajal
GIST
100
MC presentations of GIST
overt GI bleed or abdominal mass
101
Detection of GIST? Biopsy method?
CT; FNA
102
Imatinib
GIST
103
Post-transplant lymphoproliferative disorder
EBV
104
MC GI lymphoma location?
Stomach (50% are MALTomas, rest are diffuse large B-cell lymphomas)
105
MC GI lymphoma presenting symptom? Next MC?
Epigastric pain; anorexia
106
Dermatitis herpetiformis associated with?
Celiac
107
Most specific antibody for Dx of Celiac? Other antibodies present?
IgA Anti-endomysium; Anti-gliadin, anti-tissue transaminase
108
Young female with lupus -- think what GI complication?
Necrotizing vasculitis of GI tract (hypercoagulable --\> ischemia)
109
Middle-aged man with polyarteritis nodosa -- think what GI complication?
Necrotizing vasculitis of GI tract
110
Child with Henoch-Schonlein Purpura -- think what GI complication?
Necrotizing vasculitis of GI tract
111
Lymphs in the epithelium without thickened submucosal collagen
Lymphocytic colitis
112
Oral and genital aphthous ulcers + uveitis + gastric ulcers + arthritis
Behcet's (was in Marino's part of Diarrhea lecture -- just in case he gets sneaky!)
113
Embolus to the SMA -- think what GI vascular issue?
Acute mesenteric ischemia
114
Congestive heart failure in the ICU -- think what GI vascular issue?
Ischemic colitis
115
Atherosclerosis with pain after eating -- think what GI vascular issue?
Chronic mesenteric ischemia
116
Middle age woman with autoimmune disorders/hypercoagulability -- think what GI vascular issue?
Venous mesenteric ischemia
117
Upper GI bleed
Melena
118
Lower GI bleed
Hematochezia
119
Active bleeding of ulcer upon endoscopy + visible vessel (risk of rebleed?)
High
120
Completely white base of ulcer (risk of rebleed?)
Low
121
Ulcer in the posterior wall of the duodenum or lesser curvature of the stomach?
Rebleed
122
3 predictive factors of esophageal varices?
Pressure, size, color
123
Decreased risk by smoking and appendectomy
Ulcerative colitis
124
Increased risk by smoking, appendectomy, high childhood sanitation level, high carbohydrate miles
Crohn's
125
Begins in rectum, no skip lesions
Ulcerative colitis
126
Rectum only; rectal bleed and tenesmus
Proctitis
127
Rectum + sigmoid colon; bloody diarrhea, tenesumus, abdominal cramps and pain
Proctosigmoiditis
128
Rectum + Sigmoid + Descending colon to flexure; bloody diarrhea, abdominal cramping, pain on left side, and unintended wt loss
Left-sided colitis
129
Entire colon; severe bouts of bloody diarrhea, abdominal cramps/pain, fatigue, and significant weight loss
Pancolitis
130
Is fulminant colitis common with IBD?
No
131
Sclerosing cholangitis
Ulcerative colitis
132
ANCA alone in IBD?
Usually ulcerative colitis
133
MALToma treatment
Antibiotics
134
MALToma prognosis with treatment
Good (other GI lymphoma prognoses bad)
135
Watershed infarct
Splenic flexure
136
Early severe abdominal pain without ileus but not actually tender on physical exam; doesn't bleed
Acute mesenteric ischemia (medical or surgical emergency, poor prognosis)
137
Key diagnostic test of acute mesenteric ischemia?
Angiography
138
Dusky =
Small bowel infarct = dead = surgical excision
139
Key diagnostic test of ischemic colitis?
Colonoscopy
140
Pill-induced esophageal ulcer
Bisphosphonates
141
Ischemic esophageal ulcers (AIDS)
CMV
142
Punched out ulcers right above GEJ
Herpes
143
MCCs of acute lower GI bleed
Diverticulosis + angiodysplasia
144
MCCs of chronic lower GI bleed
Hemorrhoids + neoplasia
145
Degenerative change in blood vessels in cecum (dilated, tortuous) with mucosal telangiectasias; A/w advanced age (\>70), chronic renal failure, Osler-Weber-Rendu, prior radiation, and watermelon stomach
Angiodysplasia
146
Intrahepatic cholangiocarcinoma -- MCC?
Alcoholic
147
Rate limiting enzyme for cholesterol metabolism
7alfa-hydroxylase
148
Three factors in pathophys of gallstone formation
Cholesterol supersat, accelerated nucleation, gallbladder hypomotility
149
Hemolysis, advancing age, long-term TPN, cirrhosis -- type of stone?
Black
150
Decreasing biliary secretory IgA, high B-glucuronidase activity, bacterial infection -- type of stone?
Brown
151
MC gallbladder disease?
Cholelith
152
Diagnostic modality for gallstone?
Ultrasound
153
Extraction method for stone?
ERCP
154
Post-cholecystitis abdominal pain, melena, and jaundice and find a clot in the bile duct
Hemobilia
155
Cancer from PSC?
Cholangiocarcinoma
156
Cancer Sometimes Penetrates Benign Liver
Colon, stomach, pancreas, breast, lung
157
MCC of HCC
Chronic viral hepatitis
158
Four presenting Sx of HCC
Jaundice, encephalopathy, ascites, bleeding
159
Four predictors of prognosis in HCC
Size, differentiation, invasion and mets
160
HCC tumor marker
a-fetoprotein
161
Mainstay Rx of HCC? Are patients usually eligible?
Surgery; no
162
Central stellate scar grossly (liver tumor)
Focal nodular hyperplasia
163
Anabolic steroids or OCPs?
Hepatic adenoma
164
Complication of hepatic adenoma?
Rupture/massive peritoneal hemorrhage
165
MC benign liver tumor
Hemangioma
166
Liver tumor usually \<2cm, commonly subcapsular, composed of blood-filled vascular spaces?
Hemangioma
167
Malignant epithelial neoplasm of liver in kids
Hepatoblastoma
168
What's another name for a cholangiocarcinoma at the bifurcation of the common bile duct?
Klatskin tumor
169
MC mutations in cholangiocarcinomas?
KRAS (50% intra, 15% extra) and p53 (33% in all)
170
Mode of metastasis for cholangiocarcinoma?
Lymphatics
171
Mode of metastasis for HCC?
Hematogenous
172
Differentiate Extrahepatic Cholangiocarcinoma from intrahepatic.
EH has pruritis, fever, jaundice, and high bilirubin
173
Prognosis for cholangiocarcinoma?
Bad
174
Obstruction, hepatitis, Dubin-Johnson
Conjugated hyperbilirubinemia
175
Hemolysis, hepatitis, Gilbert
Unconjugated hyperbilirubinemia
176
Rx for severe hyperbilirubinemia damaging brain?
UV light
177
MCCOD from liver disease in childhood?
Biliary atresia
178
Jaundiced 3-6 weeks of age, conjugated hyperbilirubinemia, disproportionately high GGT, mild-moderately high ALT and AST -- Dx?
Biliary atresia
179
Congenital lack of intrahepatic bile ducts?
Alagille syndrome (arteriohepatic dysplasia)
180
Mutation in JAGGED1 gene for ligand for NOTCH1 receptor? Inheritance?
Alagille, AD
181
Trichrome stain of portal triad shows blood vessels but no bile ducts
Alagille
182
Prognosis for Alagille?
Good
183
Defective excretion of bilirubin conjugates and other organic anions across hepatocyte canalicular membrane?
Dubin-Johnson
184
Brown-black liver pigment
Dubin-Johnson
185
Lysosomes containing polymers of epinephrine metabolites?
Dubin-Johnson (causes the pigmentation)
186
Recurring or fluctuating jaundice (general, but just for association with this disease)
Dubin-Johnson
187
Autosomal recessive deficiency of UGT?
Gilbert
188
Young adult with mild, primarily unconjugated hyperbilirubinemia brought on by febrile illness, exertion, fasting, or hemolysis and no other manifestations of disease?
Gilbert
189
Disease that causes hyperbilirubinemia but also decreased incidence of colon cancer and heart disease?
Gilbert
190
Dense lymphocytic infiltrate in and around interlobular bile ducts with granulomas and bile duct destruction and loss, and progressive portal fibrosis
Primary biliary cirrhosis
191
Anti-mitochondrial antibody
Primary biliary cirrhosis
192
Onion-skinning fibrosis of bile ducts
Primary sclerosing cholangitis
193
PSC presenting Sx
Fatigue, pruritis, jaundice
194
Beading of bile ducts
Primary sclerosing cholangitis
195
Portal hypertension due to thrombosis of hepatic veins
Budd-Chiari
196
MCC Budd-Chiari
Polycythemia vera (or myeloproliferative disease -- he seemed to harp on that)
197
Hypertrophy of caudate lobe
Budd-Chiari
198
Patients lie still because pain is aggravated by movement. Usually have voluntary and involuntary guarding.
Acute Cholecystitis
199
Acute acalculous cholecystitis -- 4 associations?
Postoperative state after major surgery, severe trauma, severe burns, or sepsis
200
Skin vesicles and bullae with sun exposure? Etiology?
Porphyria cutanea tarda; ROS from uroporphyrinogen
201
Porphobilinogen-deaminase deficiency
Acute Intermittent Porphyria; AD
202
Gallstones in the bile ducts
Choledocolithiasis
203
Infection of the intrahepatic biliary ducts
Ascending cholangitis
204
Bacterial ascending cholangitis -- acute or chronic?
Acute (Gram negative intestinal anaerobes
205
Olive-like mass
Congenital pyloric stenosis
206
Parasitic ascending cholangitis -- acute or chronic?
Chronic (Cryptosporidium, Fasciola hepatica, Schistosoma, Clonorchis)
207
N-acetylcysteine
Acetaminophen OD
208
Boiled cabbage? Inheritance?
Tyrosinemia, AR
209
Mousy/musty
Phenylketonuria
210
Rotting Fish
Trimethylaminuria
211
Sweaty feet
Isovalaric acidemia
212
Maple syrup
Maple syrup disease
213
Fumaryl-aceto-acetase deficiency
Tyrosinemia Type I
214
French Canadian baby presenting with failure to thrive in first few months of life, then vomiting, diarrhea, jaundice, lethargy, coma, and then death; high urine succinylacetone -- Dx?
Tyrosinemia
215
Acetaminophen OD
Centrilobular necrosis
216
Yellow fever or mushrooms
Midzone necrosis
217
Phosphorous compounds
Periportal necrosis
218
Most common urea cycle disorder? Inheritance?
Ornithine transcarbamylase deficiency, X-linked
219
Beta-glucocerebrosidase deficiency? Inheritance?
Gaucher's disease, AR
220
Most common lysosomal storage disease?
Gaucher's
221
Kupffer cells and macrophages expanded with crinkled cytoplasm
Gaucher's
222
Most common initial sign of Gaucher's? Other main manifestations (2)?
Splenomegaly; Pancytopenia and bone pain
223
Glucose-6-phosphatase deficiency
Von Gierke's Disease/Glycogen Storage Disease Type I
224
Marked hepatomegaly with hypoglycemia in the first year of life
Von Gierke
225
3 big Sx in Von Gierke?
Hyperlipidemia, Hyperuricemia, Lactic Acidosis
226
Most common porphyria?
Porphyria cutanea tarda
227
Urine becomes dark, even purple during an attack of this disease
Acute intermittent porphyria
228
Dx for Acute Intermittent Porphyria?
Urine test for porphobilinogen
229
Rx for Acute Intermittent Porphyria?
IV heme
230
Anchovy-paste
Amebiasis
231
Canalicular bile plugs
Canalicular cholestasis
232
Accumulation of bile in hepatocytes
Hepatocellular cholestasis
233
Epiallopregnanolone sulfate inhibition of farnesoid X receptor-mediated bile acid efflux
Intrahepatic cholestasis of pregnancy
234
Rx for intrahepatic cholestasis of pregnancy?
Ursodeoxycholic acid
235
Second MC drug class to cause liver injury in a hepatocellular/cholestatic pattern?
Psychoactive meds
236
What is NAPQI?
Toxic metabolite of acetaminophen that is conjugated with glutathione
237
First region of hepatocytes to run out of glutathione?
Centrilobular
238
ANCA + anti-smooth muscle
Autoimmune hepatitis
239
Subtle histologic difference between autoimmune hepatitis and viral hepatitis?
Plasma cells are more prominent in autoimmune hepatitis
240
MCC acute liver injury?
Alcohol
241
Failure of Na-K Pump in hepatocytes due to injury that causes depletion of ATP, leading to influx of Na and H2O -- what histologic finding does this describe? Is it reversible?
Ballooning degeneration; yes
242
What do acute fatty liver of pregnancy, Reye syndrome, and multiple hornet stings all have in common?
Microvesicular steatosis
243
Mega-mitochondria
Microvesicular steatosis
244
Aggregates of intermediate filaments
Mallory bodies
245
Steatosis, Mallory Bodies and Neutrophils are triad for what?
Alcoholic Hepatitis
246
Severe hepatocyte damage leading to swelling of hepatocyte cytoplasm and wispy appearance
Feathery degeneration
247
How does NASH differ from alcoholic hepatitis? (2 ways)
Milder and lacks cholestasis
248
Key cytokines in Alcoholic Liver Disease?
TNFa, IL1, IL6, and L8
249
Key cytokines in NASH/NAFLD?
TNF, IL6, MCP-1
250
Type IV collagen in the space of Disse?
Normal
251
Type I and III collagen in the space of Disse?
Cirrhosis
