Flashcards in Spring Exam 4 Deck (433):
1
describe the spirometry findings associated w/ obstructive disease
-FVC: Decreased or normal
-FEV1: Decreased
-FEV1/FVC Ratio: DECREASED
-TLC: NORMAL OR INCREASED
2
Histology: TTF-1 (+), CK5/6 (-)
adenocarcinoma of the lung
3
Adult Respiratory distress syndrome is due to
-Shock
-Infections
-Toxic gas inhalation
-Ionizing radiation
-Oxygen toxicity
4
what type of CAs are associated with Lynch Syndrome
**R-sided colon CA more common
**Mucinous adenocarcinoma more common
-its a type of Hereditary Nonpolyposis Colorectal Cancer Syndrome
5
Follows contact with birds after inhalation of dried bird excretion and/or handling contaminated birds
chlamydia caused atypical pneumonia
6
Histology: Curschmann’s Spirals, mucous plugs
asthma
7
-Granuloma with central caseous necrosis
-Organizes leaving a fibrocalcific nodule often with persisting viable tuberculosis
Ghon complex
*focus of primary TB infection
8
anatomic features of cirrhosis
1. fibrous septa
2. parenchymal nodularity
3. diffuse process
9
Serologic findings
-Anti-mitochondrial antibody (AMA)
-Elevated alkaline phosphatase
Primary Biliary Cirrhosis
10
describe how and where gastric adenocarcinoma spreads
-Local infiltration (through wall of stomach)
-Lymphatic – regional and distant lymph nodes
-Blood – liver and lungs commonly
-Transcoelomic (across peritoneal cavity)- Often involves both ovaries (signet ring carcinoma) – Krukenberg tumour.
11
complications of biliary atresia
-neonatal cholestasis
-rapidly progresses to cirrhosis if untreated
12
3 Non-Hepatotropic Viruses that Infect the Liver
HSV
CMV
Adenovirus
*usually seen in association w/ immunosuppression
13
pathogenesis:
-inhaled and taken up by alveolar macrophages
-Resulting inflammation causes variable (minimal to extensive) lung fibrosis
coal-worker’s Pneumoconiosis
-coal dust inhaled
14
Helicobacter pylori Gastritis can lead to what? (5)
-cell damage and inflammatory cell infiltration
-Affects the antrum preferentially
-Metaplasia
-atrophy
-dysplasia
15
Klebsiella pneumonia is most common in who
-elderly men,
-alcoholics,
-patients with diabetes mellitus,
-malignancies
-heart disease
16
describe the shake test
-used to determine if surfactant/lung is mature
-Take amniotic fluid sample of equal amounts --> add increasing amounts of EtOH--> shake the tubes--> if bubbles develop= sufficient lecithin (mature), if no/less bubbles/foam = immaturity
17
Histology:
-Granulomatous and lymphocytic destruction of bile ducts (florid duct lesion) --> progressive loss of bile ducts (ductopenia)
Primary Biliary Cirrhosis
18
Histology:
-When blood vessels are affected hemorrhage gross red appearance
-Larges/distended alveolar space
-leukocytic alveolitis
Bronchopneumonia
19
-Virus reactivated --> recurrent herpetic stomatitis (cold sore)
-Trauma, allergies, UV light, stress, immunosuppression
-Small vesicles
-Lips, nasal orifices, buccal mucosa, gingiva, hard palate most common locations
-Typically resolves 7-10 days (can persist in immunocompromised- necessitate antiviral therapy)
HSV
20
routes of pulmonary infection
inhalation
aspiration
bloodstream
puncture
21
in acute HepB infection:
-____ appears before the onset of symptoms, peaks during overt disease
-___ and ___Signify active disease and viral replication
-____ antibody does not rise until the acute disease is over and is usually not detectable for a few weeks to several months after the disappearance of ____
HBsAg appears before the onset of symptoms, peaks during overt disease
BHeAG and HBV-DNA Signify active disease and viral replication
Anti-HBs antibody does not rise until the acute disease is over and is usually not detectable for a few weeks to several months after the disappearance of HBsAg
22
Benign, non-neoplastic proliferation of hepatocytes that occurs in response to a local abnormality in blood flow through the liver
**central scar (the abnormal blood vessel)
Focal nodular hyperplasia
23
MECL t (11;19)(q12;p13) --> CRTC1-MAML2 fusion transcript --> may be useful diagnostically
Mucoepidermoid carcinoma
*malignant salivary tumor
24
causes of viral pneumonia
1. influenza virus,
2. respiratory syncytial virus (RSV),
3. common cold viruses (parainfluenza, adenovirus)
4. human metapneumovirus
5. herpes or varicella viruses
25
-20-30% become symptomatic
-Excruciating colicky pain
-Gallstone ileus
-Pancreatitis
cholelithiasis
*very prevalent in US (10-20% of adults)
26
Sx: cough, dyspnea, tachypnea, sputum
acute bronchitis
27
What part of spirometry?
-Moving air is not enough, oxygen must diffuse from alveoli into blood
-Inhale known concentration of CO and He
DLCO
28
-Ex. Chronic bronchitis, emphysema,
-Usually due to cigarette smoking
COPD
29
-Symptoms: Otitis media, pressure
-Squamous cell carcinoma
-carcinoma
nasopharyngeal carcinoma
30
-Relapsing disease marked by attacks of bloody mucoid diarrhea
-Ulceroinflammatory disease limited to the colon and affecting only the mucosa and submucosa** in a CONTINUOUS manner beginning in the rectum
Ulcerative colitis
31
6th most common neoplasm worldwide, 3rd leading cause of cancer death (600,000 annually)
hepatocellular carcinoma
32
High exhaled NO suggests ____
(significant) ongoing inflammation
33
-Very limited info on acute/early infection, maybe some nausea and vomiting
-Chronic infection is mostly asymptomatic
- OR peptic ulcers, abdominal pain, eructation (burping), bloating
-No specific diagnostic endoscopic finding
Helicobacter pylori Gastritis
34
-Etiology: Tobacco, alcohol, immunosuppression
-May be multiple (field effect/cancerization)
-Tongue (lateral and ventral) over 50% cases
SCC- oral cavity
35
-Accounts for 15-20% of lung CA
-1% (or less) occur in non-smokers
-Arise from neuroendocrine cells
small cell Lung CA
36
Vector-borne (usually tick bite) obligate intracellular bacteria; causes widespread vasculitis
rickettsia caused atypical pneumonia
37
how do you dx hepatocellular carcinoma and where does it typically metastasize too?
-Contrast enhanced CT screening in cirrhotic patients
-Metastasizes to lung, bone, and abdominal lymph nodes (already at late intrahepatic stage usually)
38
what organism causes herpangina (pharyngeal vesicles and ulcers)
Coxsackievirus A
39
what organisms cause lobar pneumonia
-Streptococcus pneumoniae most common
-Except Klebsiella pneumonia in elderly, diabetics, alcoholics
40
what are the different type of emphysema?
1. centriolobular (centriacinar)
2. panlobular
3. paraseptal (bullous)
4. irregular emphysema
41
-Often small and clinically/radiographically occult, may present as metastatic cancer to a cervical neck lymph node from an unknown primary site
-Nonkeratinizing carcinomas
-Prognosis: ASSOCIATED WITH BETTER OUTCOME
SCC-oropharynx
42
lung abscess can arise from what?
-Pneumonia (Staphylococcus, coliforms, anaerobes)
-Aspiration
-Bronchial obstruction proximal to abscess
-Infected pulmonary infarct
-Septic embolus from another site
-complication of bacterial pneumonia
43
Sx: cough, fever, rigors, pleuritic chest pain, difficulty breathing, purulent (green/yellow) sputum; may contain flecks of blood
-Demonstrated by dullness to percussion with bronchial breathing
lobar pneumonia
44
definition of chronic bronchitis
-Productive cough more than 3 consecutive months for more than 2 yrs
45
pathogenesis:
-Smoking irritates the lungs --> more inflammation --> more neutrophils (and macrophages)--> more elastase (and other proteases)
α-1 Antitrypsin Deficiency
46
-most common lung cancer in never-smokers
-accounts for 30-40% of Lung CA
adenocarcinoma
*associated w/ smoking, but to a lesser degree
47
Histology: Asbestos/Ferruginous bodies
malignant mesothelioma
48
-Triggered by (viral) infection, exercise, etc.
-Drug-induced (aspirin)
-No demonstrable “allergy”
non-atopic asthma
49
-Associated with a small inflammatory lesion and hilar lymphadenitis
-Ghon complex
-Usually asymptomatic and becomes latent
primary TB
50
-Usually asymptomatic; may present with pain
-Risk of bleeding in pregnancy and with large tumors
-Very extremely rare transformation into carcinoma
-Surgical removal if large or at risk for transformation
hepatocellular adenoma
51
Seen:
Nodular aggregates of lymphocytes in portal areas
Histology:
-pattern with scattered necroinflammatory activity and slowly progressive fibrosis
Chronic HepC
52
risk factors for cholelithiasis
"Fat, female, forty, fertile”
53
what laboratory things are used to assess liver function?
AST/ALT
ALP and GGT
Direct and indirect bilirubin
Total protein
INR
Albumin
54
4 stages of acute inflammation in lobar pneumonia
1. edema and congestion (12-14 hrs)
2. red hepatization (1-3 days)
3. gray hepatization (3-4 days)
4. resolution (8-10 days: untreated)
55
congenital anomalies of the esophagus
-Ectopic tissue (e.g. inlet patch)
-Atresia and tracheoesophageal fistula
56
what organism causes acute bacterial epiglottis (abrupt onset- pain and airway obstruction)
H. influenza
57
4 serologic findings associated w/ autoimmune hepatitis
-Elevated serum IgG
-High anti-nuclear antibody titers (ANA)
-Anti-smooth muscle antibodies (SMA)
-Anti-liver/kidney microsome antibodies
58
-Most common salivary gland tumor to arise in gnathic bones
Mucoepidermoid carcinoma
*malignant salivary tumor
59
what lab values would you expect to find in Cirrhotic liver disease?
-Decreased albumin, protein, platelets, increased INR, decreased platelets, thrombopoietin (TPO) level
60
for HepE, describe the
virus type:
Transmission:
frequency of chronic hep:
vaccine?
virus type: ssRNA
Transmission: fecal-oral
frequency of chronic hep: acute ONLY!
vaccine? no
*high mortality in pregnant women
61
Viral cytopathic effect: multinucleation, margination, nuclear molding
HSV
62
what type of emphysema?
enlargement of distal alveoli --> some kind of fibrosis/scarring
paraseptal (bullous)
63
-Red patch or plaque that cannot be given another specific diagnosis
-Associated with greater risk of malignancy (over 50%)
-tobacco risk factor
Erythroplakia
64
types of choleliths
-cholesterol stones (80% of US gallstone)
-pigment stones
65
Histology is typical interstitial pneumonia
-Intranuclear inclusion may be found in alveolar lining cells
varicella zoster caused pneumonia
66
Sx:
-Projectile vomiting and regurgitation
pyloric stenosis
67
-“regional enteritis” and/or “granulomatous colitis”
Crohn's disease
68
Endoscopy:
-Small caliber esophagus
-Corrugated (ringed) esophagus**
-Proximal esophageal stenosis
eosinophilic esophagitis
69
New onset (less than 6 months) of symptomatic disease and/or laboratory evidence of liver injury (AST and ALT)
acute hepatitis
70
-Very rare malignant neoplasm of immature hepatocytes that occurs predominately in the first two years of life and most by age five
-Presents as an enlarging abdominal mass
hepatoblastoma
71
Overgrowth of fungal organisms that are often component of normal oral flora (broad spectrum abx, immunosuppression, strain)
oral candidiasis
72
types of esophagitis
1. GERD
2. Barrett Esophagitis
3. Eosinophilic esophagitis
4. Infectious eosphagitis
73
-superficial mucosal ulceration
-painful, recurrent
-spontaneous resolution, but can recur
aphthous ulcers
aka canker sores
74
__ is caused by inflammation of the small airways of the lungs. It is also known as cryptogenic organizing pneumonitis (COP).
BOOP
75
-tumors are often benign
-But they can metastasize
-Metastatic potential is difficult to determine
carcinoid lung CA
*therefore pts w/ a hx of carcinoid are followed
76
Palatine tonsil, lingual tonsils, base of tongue (associated NOT as strong for ____ or ____)
oral cavity or laryngeal carcinoma
77
when is indirect (unconjugated) bilirubin elevated? (3)
-hemolysis
-impaired bilrubin bilirubin conjugation (congenital syndromes)
-reduced hepatic bilirubin uptake due to decreased liver blood flow (heart failure or portosystemic shunt)
78
-Massively enlarged hilar lymph nodes
-Alveolar fibrosis with noncaseating granulomas
sarcoidosis
79
-High IgG-anti-HAV positive ___
Hight IgM-anti-HAV positive ____
-High IgG-anti-HAV positive months out
-Hight IgM-anti-HAV positive weeks out
*start fecal shedding the virus prior to IgM
80
-Multiple squamous papillomas
-Classically described in children, can also occur in adults
recurrent respiratory papillamatosis (RRP) of larynx
81
a spread of gastric adenomcarinoma that often involves both ovaries (signet ring carcinoma)
Krukenberg tumor
82
nonkeratinizing nasopharyngeal carcinoma is typically ___ driven
EBV
83
leading cause of death in the elderly and the chronically and terminally ill
pneumonia
84
____ is the major producer of serum proteins
-Most abundant serum protein is ____
liver
albumin
85
-More common esophageal cancer in the US but not worldwide
-US Incidence is rising (more common than SCC in US)
adenocarcinoma esophageal cancer
86
what lung cancers are not associated w/ smoking?
-Carcinoid tumors**
-Malignant Mesothelioma
-adenocarcinoma (most lung CA in non-smoking ppl)
-(1% or less of Small cell Carcinoma occur in non-smokers)
87
-Starts later (50-70)
-Severe dyspnea, early
-Late cough, dry
-Rare infections
-Rare cor pulmonale
-“pink puffer”
Emphysema
88
"oat cell carcinoma"
small cell lung CA
89
-Most of the inflammatory cells are eosinophils
-Significant bronchospasm (smooth muscle)
asthma
90
Hospital-acquired
Rare
Associated with instrumentation (intubation, bronchoscopy) and COPD
Gram-negative rod
Serratia marcescens pneumonia
91
-Strongly associated with smoking**
-Accounts for 20-30% of lung cancer
Squamous cell lung cancer
92
-the lungs and other organs contain numerous small granulomas
-Can cause death
Miliary TB
93
-the lesions are usually apical and bilateral
-reactivation of dormant primary lesions many decades later
-Apices of one or both upper lobes
secondary TB
*Risk of reactivation increases with immunosuppression and age
94
sx:
Fatigue, nausea/vomiting, fever, jaundice of limited duration (weeks)
HepA
95
steatohepatitis is defined by a histologic triad of what?
-Steatosis
-Inflammation
-Hepatocyte ballooning degeneration (injury)
96
what are esophageal varices caused by?
-portal HTN
-develop in 90% of cirrhotics
**may rupture leading to massive hemorrhage
97
List 4 diseases classified as chronic interstitial diseases
-Idiopathic pulmonary fibrosis
-Pneumoconiosis
-Hypersensitivity pneumonitis
-Sarcodiosis
98
what is portal HTN most commonly caused by?
cirrhosis
99
what organism causes pseudomembranous colitis?
C. difficle
100
what organisms cause infectious mononucleosis (pharyngitis)
EBV
101
transmural infarct (type of ischemic bowel disease) is usually caused by what?
-mechanical compromise of the major mesenteric blood vessels
-mucosal or mural infarction usually results from acute or chronic hypoperfusion
102
hepatocellular carcinoma is associated with what?
**chronic liver disease
-HepB and Hep C
-Aflatoxins
-Cirrhosis
-Alcohol
-Anabolic steroids
-Hemochromatosis
103
what organisms can cause infectious esophagitis?
1. Candida albicans
2. HSV
3. CMV
*commonly occur in immunocompromised people (elderly, iatrogenic, etc) but can occur in otherwise healthy people too
104
Mycobacterium tuberculosis is usually spread _
as airborne droplets and usually implants in the lower lung fields
105
Most are _____ on left side of the colon; 50% by age 60 in the U.S.
acquired pseudodiverticuli
106
associated with nevoid basal cell carcinoma syndrome known as Gorlin Syndrome
Odontogenic Keratocyst
107
______ plays pathogenic role in subset of head and neck cancers (ie. SCC)
HPV (HPV-16)
108
-a.k.a Gluten Sensitive Enteropathy
-A Malabsorption Syndrome
Celiac Disease
109
a.k.a. congenital aganglionic megacolon
Hirschsprung disease
110
-associated with ‘early’ metastasis, thus often presents in advanced stage
adenocarcinoma
111
What type of disease?
-FVC: Decreased or normal
-FEV1: Decreased
-FEV1/FVC Ratio: DECREASED
-TLC: NORMAL OR INCREASED
Obstructive Disease
112
-Often presents with fatigue, weight loss, arthralgia, SOB, dry cough
-Multisystem disease with prominent findings in the lung
Sarcoidosis
113
what organisms cause acute laryngitis
-Mycobacterium tuberculosis
-Corynebacterium diptheriae
114
what organisms cause atypical pneumonia
-viruses (Parainfluenza, espiratory syncytial virus, adenovirus, Epstein-Barr virus)
-myocplasma
-legionella pneumophila
-chlamydia
-Rickettsia
115
histology:
-Mallory hyaline
-Prominent neutrophilic infiltrates
steatohepatitis secondary to alcohol
116
What part of spirometry?
The patient takes in the deepest possible breath then forcibly exhales until no more can be expired
FVC
117
4 complications associated with acute appendicitis
1. Obstruction
2. Loss of blood flow and ischemia
3. Cell injury and inflammation
4. Necrosis and possible perforation
118
Most common fungemic and invasive fungus
candida albicans pneumonia
119
sx:
-Pain, weight loss, malaise, and jaundice, often diagnosed at later stage
-Most present at a late stage with low survival (5 year survival rate is zero if not resectable)
intrahepatic cholangiocarcinoma
120
what are lacerations (Mallory-Weiss Tears) caused by?
-forceful or prolonged vomiting or coughing
-epileptic convulsions
121
sx of atypical pneumonia
minimal or nonproductive cough, headache; chest X-ray shows no consolidation
122
sx:
-Association with ulcerative colitis*
-asymptomatic to progressive jaundice
*risk factor for cholangiocarcinoma
primary sclerosing Cholangitis
123
prognosis of heptoblastoma is determined by what?
-Prognosis: stage, AFP level, histologic subtype
*Chemotherapy and resection: cure rate ~70%
124
-Small airway obstruction due to inflammation and mucus secretion
-transient
-Type I hypersensitivity (allergic) reaction
asthma
125
Adrenocorticotropic hormone (ACTH) and Antidiuretic hormone (ADH) are related to what?
small cell carcinoma
126
Chronic remitting, relapsing autoimmune-mediated injury to hepatocytes with an indolent to severe clinical course, often seen in young women with other autoimmune diseases
autoimmune hepatitis
127
SCLC staging
-Small cell is staged differently from non-small cell
-Limited disease (LD): Disease confined to the thoracic space
-Extensive disease (ED): Disease has moved out of the thoracic space
128
related to what?
-Genetic: HLA-A2, HLAB46, HLAB17
nonkeratinizing nasopharyngeal carcinoma
129
Benign hepatic tumors
-Cavernous Hemangioma
-heptocelluar adenoma
130
sx: chronic cough, dyspnea, hemoptysis, infected sputum production
Bronchiectasis
131
Asbestos bodies are formed when ____ .
Iron is deposited on fibers, presumably derived from ____.
*Asbestos body stained with Prussian Blue iron stain
macrophages attempt to phagocytose asbestos fibers
phagocyte ferritin
(malignant mesothelioma histology)
132
splenic sequestration of platelets due to portal hypertension, auto-antibody destruction of platelets, and bone marrow suppression
cirrhotic liver disease resulting in decreased TPO level
133
Histology: Hyaline thick membranes
Chest X-ray: white out
infant RDS
134
Lobular disarray, marked inflammation, numerous single necrotic hepatocytes, marked necrosis, background architecture normal (no fibrosis)
acute hepatitis
135
define obstructive respiratory disease
-A family of diseases that share the common feature of reduced air flow somewhere between trachea and alveoli
136
Displacement of the squamocolumnar junction from the anatomic GE junction
Barrett Esophagus
137
Pathogenesis:
-Focal weakness in the wall
-Increased intraluminal pressure
acquired (pseudo)- diverticuli
138
describe the Mechanism, Source, and Clinical features of Clostridium difficile (bacterial enterocolitis)
-Mechanism: cytotoxin, local invasion
-Source: Nosocomial
-Clinical features: fever, bloody diarrhea
139
subtypes of asthma
1. atopic asthma
2. non-atopic asthma
140
-results from missing nerve cells in the muscles of part or all of the baby's colon
-A condition of the large intestine (colon) that causes difficulty passing stool
Hirschsprung Disease
141
4 complications of peptic ulcers
1. Perforation leading to peritonitis
2. Hemorrhage by erosion of vessel in base
3. Penetration of surrounding organ (liver/pancreas)
3. Obstruction (by scarring) – pyloric stenosis
142
for HepB, describe the
-Virus type:
-Transmission:
-Frequency of chronic hep:
-vaccine?
-virus type: partially dsDNA (only hepatotropic DNA virus)
-Transmission:blood and body fluids, vertical transmission
-Frequency of chronic hep: 5% chance of chronic (10% do not clear the virus)
-vaccine? YES
143
benign epithelial neoplasms that most often have the appearance of a polyp and are the direct precursors
colorectal adenomas
-precursor to colorectal adenocarcinoma
144
Acetaminophen toxicity is likely to occur with dose
-occur with single ingestions greater than 250 mg/kg or those greater than 12 g over a 24-hour period
*recommend daily dose is 4g
145
-autosomal recessive genetic disease most often caused by an inactivating mutation in the intestinal iron absorption regulating gene HFE and resulting in excessive iron accumulation in the body
Hereditary Hemochromatosis
146
-more specific and sensitive indicator of obstruction, also increased in alcohol
GGT (gamma-glutamyl transpeptidase)
*used to asses liver
147
These are associated with what?
-Decreased LES tone (e.g. CNS depressants, hypothyroidism, tobacco)
-Hiatal hernia
-Inadequate/slowed clearance of refluxate
-Delayed gastric emptying / increased gastric volume
-Reduction in reparative capacity of the esophageal mucosa
GERD
148
-A white patch or plaque that cannot be scraped off and cannot be characterized clinically or pathologically as any other disease
-5-25% are premalignant
-tobacco risk factor
leukoplakia
149
-Defect in certain DNA mismatch repair genes
-Increased risk of colon and endometrial cancer, among others
Hereditary Nonpolyposis Colorectal Cancer Syndrome (Lynch Syndrome)
*risk factor for colorectal CA
150
-Usually peripheral, but can be central
-Metastasize early
-Have multiple histologic patterns: Acinar, papillary, mucinous, solid
adenocarcinoma of the lung
151
-Leading cause of death in allogeneic bone marrow transplant recipients
-Herpes-type virus
-Diffuse interstitial pneumonia common feature
CVM caused pneumonia
152
Histology: Glandular mucosa with goblet cells, squamous mucosa
Barrett Esophagitis
153
What part of spirometry?
How fast all the air can be expired from the lungs
FEF (force expiratory flow)
154
3 main forms of oral candidiasis
-pseudomembranous (thrush)
-erythematous
-hyperplastic
155
Strongly associated with H. pylori and low-grade [neoplasm] can be cured by eliminating infection
gastric lymphoma
156
gross appearance: Honey combing of the lungs- spongy appearance
histology: Fibroblastic areas in interstitium causing fibrosis
Idiopathic Pulmonary Fibrosis or usual interstitial pneumonia
157
laboratory findings associated w/ Wilson disease
-Low to normal ceruloplasmin (copper carrying protein) levels
-Increased urinary copper excretion
-Increased hepatic copper content
158
Excessive iron directly toxic to hepatocytes
-stimulates Lipid peroxidation
-Stimulation of collagen formation
-Formation of reactive oxygen species
Hemosiderosis
159
describe the different types of carcinoid lung cancers
-Typical carcinoid: Low, but not zero metastatic potential
-Atypical carcinoid: Higher metastatic potential
*Defined by mitotic rate of the tumor
160
viruses that commonly caused gastroenteritis
1. rotavirus (6-14 months)
2. Caliciviruses and Norwalk virus (child or adult)
3. Enteric Adenovirus (young child)
4. Astrovirus (child)
161
Etiology/Risk Factors for what:
-EBV
-Dimethylnitrosamine-containing smoked fish
-Wood fires, solvents, chemical fumes
-Genetic: HLA-A2, HLAB46, HLAB17
-Role of HPV uncertain
nonkeratinizing nasopharyngeal carcinoma
162
-Starts earlier (40-50)
-Mild dyspnea, late
-Early cough, sputum
-Common infections
-Cor pulmonale
-"blue bloater”
Chronic bronchitis
163
-Inflammation and necrosis (termed necroinflammatory activity) is used to determine the ___ of hepatitis disease
-fibrosis is used to determine the __ of disease
grade
stage
*Batts-Ludwig system used commonly
164
Ulcerative colitis puts one at increased risk of what
Markedly increased risk for colorectal cancer
165
-Serotonin
-Smooth muscle effects --> diarrhea, flushing, valvular disease, “asthma”, cyanosis
Carcinoid syndrome
(a paraneoplastic syndrome)
166
what types are ulcers would you expect following severe burns or a head injury
Curlings ulcers- following severe burns
Cushing's ulcers- following head injury
167
what types of lung cancers are responding better to targeted therapy (ex. EGFR)
adenocarcinoma
-squamous cell carcinoma is not responding as well
168
Crohn's disease can lead to what
sequela of intestinal fistulae
169
-Biliary colic, nausea, fatty food intolerance
-Obscure etiology but 90% associated with cholelithiasi
chronic cholecystitis
170
5 predisposing conditions of ischemic bowel disease
-Arterial thrombosis
-Arterial embolism
-Venous thrombosis
-Non-occlusive ischemia (e.g. hypotension)
-Other (e.g. radiation, volvulus, amyloidosis)
171
Permanent abnormal dilatation of the bronchi and bronchioles
Bronchiectasis
172
After ___% loss of total functional capacity, it is considered hepatic failure
80-90% loss of total functional capacity
*high mortality rate w/o transplant
173
The term bronchioloalveolar carcinoma (BAC) is the same as __
adenocarcinoma in situ
-3cm or less in size
174
Adverse drug reaction can cause what liver diseases
acute hepatitis
chronic hepatitis
cholestatic liver disease
**relatively common cause of acue and chronic liver injury
175
respiratory infections, which are more often seen in immunocompromised patients
-CMV pneumonia
-Pneumocystis jiroveci
-Mycobacterium avium-intracellulare
- invasive aspergillosis
- invasive candidiasis
-varicella-zoster--> greater sensitivity
-usual bacteria
-Histoplasma capsulatum
-acute respiratory infection (cold)
176
for HepC, describe the
virus type:
Transmission:
frequency of chronic hep:
vaccine?
virus type: ssRNA
Transmission: blood and body fluids, vertical transmission
frequency of chronic hep: 80% chance of chronic
vaccine? NO
177
Autosomal recessive disease marked by the accumulation of toxic levels of copper in the body and caused by mutations of ATP7B which encodes a copper transport gene
Wilson disease
178
5 causes/complications of acute gastritis
-Drugs (particularly NSAIDs)
-Alcohol
-stress (burns, trauma)
-Ischemia and shock
-Systemic infections
179
Most common benign neoplasm of salivary gland origin (45-76% of all salivary gland neoplasms)
pleomorphic adenoma
180
-Usually peripheral
-Locally aggressive with high metastatic potential
-Associated with cigarette smoking
-Accounts for 10-15% of lung CA
Large cell lung cancer
181
-Growth of a central lesion leads to obstruction of the main bronchus
-Can result in distal atelectasis, infection
Squamous cell lung cancer
182
-Children (and adults)
-Increasing prevalence
-Dysphagia (something feels stuck in throat)
-Unknown etiology
eosinophilic esophagitis
183
Chronic, progressive, autoimmune-mediated cholestatic liver disease, usually of middle-aged women, characterized by intrahepatic inflammatory bile duct loss that progresses to cirrhosis
Primary Biliary Cirrhosis
184
Histopathology: Granulomas with central caseous necrosis
secondary TB
185
-US incidence: 17,460 new cases in US (2012), 482,400 worldwide
-M more so than F (2:1 to 20:1 in low incidence regions)
-Peak age: 50-60 years old
-Can involve upper (20%), mid (50%) and lower (30%) esophagus
Squamous cell carcinoma of the esophagus
186
-Genetically unstable resulting in multiple genotypes and subtypes
-Neutralizing antibodies can be detected serologically, but virus escapes immune defense
HepC
187
what organisms cause croup (laryngotracheobronchitis)
-Parainfluenza virus most common
-RSV, measles, adenovirus, influenza viruses
188
causes of chronic gastritis
A, B, C's
1. Autoimmune (associated with vitamin B12 malabsorption (pernicious anemia)
2. bacteria- Helicobacter pylori infection
3. Chemical damage (bile reflux, drugs, alcohol)
4. Crohns
189
what causes primary bronchiolitis
Caused by viruses: RSV in infants
190
describe the Mechanism, Source, and Clinical features of EH. E. Coli (bacterial enterocolitis)
-Mechanism: shiga-like toxin
-Source: undercooked beef
-Clinical features: hemorrhagic colitis
191
Pyogenic granuloma AKA
lobular capillary hemangioma
192
a breach of mucosal lining of GI tract occurring from or in association with gastric acid and pepsin
peptic ulcer disease
193
Conditions that commonly lead to cirrhosis
-steatohepatitis
-Abnormal Hepatic blood flow
-Cholestatic Liver disease
-Chronic hepatitis
194
-Persistent productive cough for at least 3 consecutive months for at least 2 consecutive years.
chronic bronchitis
195
diffuse alveolar damage
Adult Respiratory distress syndrome
196
what type of emphysema?
enlargement of proximal alveoli (a.k.a smallest brochioles) --> smoking
centriolobular (centriacinar)
197
NSCLC staging
TNM
-T is for tumor size and location (0-4)- The larger the tumor and the more extensive the local invasion, the higher the number
-N is for nodal involvement (0-3)- The further away from the primary tumor, the higher the number
-M is for distant (not nodal) metastasis (0-1)- Either absent or present
(If the parameter is unknown, assigned a value of “x”)
198
Treatment:
-patients have a higher likelihood of adverse response to a class of drugs
-Anti-VEGF inhibitors (e.g. Bevucizumab)
-Associated with hemorrhage** (potentially life threatening)
-Lower probability of a molecular event that is associated with targeted therapy (more on this later)
Squamous cell lung cancer
*therefore important to differentiate btwn squamous cell, adenocarcinoma and other subtypes
199
the 2nd leading cause of cancer deaths
Colorectal cancer
200
2 types of idiopathic inflammatory bowel disease
1. Crohn's disease
2. Ulcerative Colitis
201
-Antibiotics have decreased the mortality to 10%, but have no effect on the incidence of pneumococcal infections
-Often a post-viral infection (i.e., host mechanisms impaired)
-Route of infection: inhalation
-Gram-positive diplococcic
Streptococcus pneumoniae (pneumococcus)
(lobar pneumonia)
202
hepatic failure can result from:
-massive and sudden hepatic destruction
-end point of chronic liver disease (cirrhosis)
203
Mutation in APC on chromosome 5q21
Familial Adenomatous Polyposis (FAP)
*risk factor for colorectal CA
204
what lung cancers are associated w/ paraneoplastic syndrome?
-squamous cell carcinoma
-Small cell carcinoma
-carcinoid
205
LD (limited disease) SCLC can be effectively treated with ___
chemotherapy +/- surgery
206
____ implies that an acute HepB infection has peaked and is on the wane
Persistence of ___ is an important indicator of continued viral replication, infectivity, and probable progression to chronic hepatitis
Anti-HBe antibodies
Persistence of HBeAg is an important indicator of continued viral replication, infectivity, and probable progression to chronic hepatitis
207
what is the effect of NO?
a vaso- and bronchodilator synthesized during inflammation
208
Histology:
Extensive nuclear molding
HIGH Mitotic rate
Virtually no cytoplasm
Crush- streaming smushed look
small cell lung carcinoma
209
Enlargement (destruction) of alveoli
emphysema
210
when is direct (conjugated) bilirubin elevated?
in obstructive disease
211
for HepD, describe the
-Virus type:
-Transmission:
-vaccine?
-Virus type: circular RNA, replication incompetnt (delta agent)
-Transmission: IVDU (most common mode in US)
-vaccine? NO
*Infection completely dependent on the presence of HBV coinfection
212
Same process as non-pulmonary sites
-Thick fibrous wall with mixed inflammatory cells
-Core (center) has inflammatory debris
lung abscess
213
-Proliferation of fibrous connective tissue in response to local irritation
-Commonly along bite line or on the tongue
fibroma
214
most tumors in the liver are secondary tumors and they most often come from where?
breast
lung
colon
215
-Less impressive lobular disarray, less prominent inflammation, rare single necrotic hepatocytes, increasing fibrosis over time (most inflammation in portal tracts now and not lobules)
chronic hepatitis
216
treatment and implications:
-associated with ‘early’ metastasis, thus often presents in advanced stage
-Not associated with hemorrhage in response to anti-VEGF therapies
-Associated with a higher prevalence of molecular events which can be therapeutically targeted (more on this later)
adenocarcinoma of the lung
217
Most common oral fungal infection
oral candida albicans
218
Can be caused by complication of bacterial pneumonia
-Tissue destruction and necrosis
-Common with S. pneumoniae, Klebsiella, S. aureus
lung abscess
219
Histology: eosinophils, basal zone hyperplasia and basal layer spongiosis
GERD
220
What type of disease?
-FVC: Decreased
-FEV1: Decreased or normal
-FEV1/FVC Ratio: NORMAL
-TLC: DECRASED
Restrictive Disease
221
-Malignant neoplasm of mucosa associated lymphoid tissue (MALT)
-Low grade B-cell (marginal zone) lymphoma or Diffuse large B-cell lymphoma
gastric lymphoma
222
what are different paraneoplastic syndromes?
1. carcinoid syndrome
2. lambert-eaton myasthenic syndrome
223
acute febrile self-limited viral-like illness
pontiac disease caused by Legionella pneumonphila
224
-Community- or hospital- acquired
-Aerosol of contaminated water***
(humidifiers, respiratory therapy equipment, whirlpool spas, showers, etc.)
- high mortality in elderly and infants less than 1 y/o
Legionella pneumonphila
225
intrahepatic cholangiocarcinoma is associated with what?
-primary sclerosing cholangitis
- liver fluke infection
-congenital bile duct cysts (choledochal cysts)
226
Helicobacter pylori Gastritis is associated with what?
-Peptic ulcer disease
-risk factor for gastric adenocarcinoma*
-gastric MALT lymphoma
227
Histology:
Periductal “onion-skin” fibrosis and fibro-obliterative lesions à progressive loss of ducts (ductopenia)
primary sclerosing Cholangitis
228
describe the Progression of ischemic bowel disease:
mucosal infarction--> mural infarct--> transmural infarct----> can lead to perforation
229
what is typical pneumonia caused by
Streptococcus pneumoniae
230
Describe Batts-Ludwig Stage 0-4
-Stage 0- no fibrosis
-Stage 1- Portal expansion/fibrosis
-Stage 2- Periportal fibrosis or rare portal-portal septa
-Stage 3- Septal fibrosis (fibrous septa w/ architectural distortion; no obvious cirrhosis)
-Stage 4- Cirrhosis
231
15 factors that predispose someone to pulmonary infection.
- Loss or suppression of cough reflex
-Ciliary defects
-Mucus disorders
-Hypogammaglobulinemia
-Immunosuppression
-Macrophage function inhibition
-Pulmonary edema
-Cigarette smoke
-Viral infections
-Lipopolysaccharide (endotoxin)
-Cold
-Hypoxia
-Steroids
-Starvation
-Alcohol
232
clinical course of chronic bronchitis
-Cough and sputum, often without respiratory dysfunction
-Some patients develop COPD
-Complicated by recurrent infections, respiratory failure, cardiac failure
233
Parathyroid hormone-related peptide (PTHrP) and calcitonin is related to what?
squamous cell carcinoma
(paraneoplastic syndrome)
234
Malignant glandular epithelial neoplasm characterized by mucous, intermediate and epidermoid/squamoid cells
Mucoepidermoid carcinoma
*malignant salivary tumor
235
-Intrinsic hepatotoxin which causes a centrilobular pattern of necrosis (perivenular zone 3 **around central vein)
-may be idiosyncratic or unpredicatble
acetaminophen lnduced liver injury
236
what lung cancers are associated w/ smoking?
-Squamous cell carcinoma--> strongly associated
-Adenocarcinoma--> associated but to a lesser degree
-Large cell Carcinoma--> associated
-small cell carcinoma --> almost exclusively
237
-Hypochlorhydria/achlorhydria
-Iron deficiency anemia
-Hypergastrinemia --> ECL (neurodendocrine) cell hyperplasia
-Loss of gastric intrinsic factor leads to malabsorption of vitamin B12 (Pernicious anemia)
-can lead to carcinoid tumor
autoimmune gastritis
238
Most common esophageal cancer worldwide (but not in US)
Squamous cell carcinoma of the esophagus
239
-Benign pedunculated lesion composed of lobular configuration of capillaries separated by bands of connective tissue
-Children, young adults, pregnant woman (~1%)
-Good outcome, but may recur
Pyogenic granuloma AKA lobular capillary hemangioma
240
Hepatic dysfunction without overt necrosis
-Reye syndrome
-Acute fatty liver of pregnancy
leads to
hepatic failure
241
-Can have extensive necrosis and cavitation
-Sometimes associated with paraneoplastic syndromes
-Follows a well-described sequence of histologically identifiable events
Squamous cell lung cancer
242
-Strongly associated with exposure to asbestos (90%), but not smoking
-At the same time only a minority (20%) have lung fibrosis
-Often (30%) distant metastasis
-No reliably effective therapy available
malignant mesothelioma
243
Copper catalyzes the formation of reactive oxygen species which cause cellular injury
-Chronic hepatitis leading to___
-Fulminant hepatitis leading to ____
Copper accumulation in Wilson Disease
-Chronic hepatitis leading to cirrhosis
-Fulminant hepatitis leading to acute liver failure
244
if GGT is increased and ALP is normal, suspect
alcoholic liver disease
245
Describe the common metastatic presentations of lung cancer
-Adrenals (>50%)
-Liver (30-50%)
-Brain (20%)
-Bone (20%)
246
-Rare, malignant adenocarcinoma of intrahepatic bile ducts
intrahepatic cholangiocarcinoma
247
describe the spirometry findings associated w/ restrictive disease
-FVC: Decreased
-FEV1: Decreased or normal
-FEV1/FVC Ratio: NORMAL
-TLC: DECRASED
248
-Usually causes pneumonia in right upper lobe
-Common in elderly men, alcoholics, patients with diabetes mellitus, malignancies, and heart disease
-Abscess formation common**;
25% develop empyemas
-Mortality approaches 30%
Klebsiella pneumonia
249
Range of clinical outcomes/presentations of HepC
-Chronic hepatitis +/- progressive fibrosis
-Asymptomatic
-Acute hepatitis
-Fulminant hepatitis
*Major cause of liver disease in the US
250
what type of emphysema?
enlargement of proximal and distal alveoli --> α1 antitrypsin deficiency
panlobular
251
gallbladder carcinoma is associated w/ what
gallstones and chronic infection
252
2 clinical syndromes caused by Legionella pneumonphila
1. Legionnaires disease
2. Pontiac
253
Basic pathogenic mechanisms of bacterial enterocolitis
1. Ingestion of pre-formed bacterial toxins
2. Infection by toxigenic bacterial organisms
3. Infection by enteroinvasive bacterial organisms
254
Pathology: many arise in background of chronic gastritis, intestinal metaplasia, and dysplasia
-Most are advance at presentation
-high mortality unless disease detected early
gastric adenocarcinoma
255
_____ is now standard of care for the treatment of adenocarcinoma
Molecular testing
-Evaluation for targetable mutations with TKIs with known effectiveness
*Squamous cell carcinoma is less likely to have one of these alterations
256
pathogenesis:
-inhaled
-difficult to differentiate from IPF
Asbestos pneumonoconiosis
*similar effects to silica
257
Manifestations of what?
-intermittant attacks of mild diarrhea and pain
-Occult or overt fecal blood
-Obstruction from fibrosing strictures of bowel
-Malabsorption with extensive small bowel involvement
Crohns disease
258
-Autoantibodies to gastric parietal cells
-Atrophy of mucosa
-Associated w/ other autoimmune disease (e.g. Hashimoto thyroiditis) and atrophic glossitis
autoimmune gastritis
259
what are 11 symptoms of hepatic failure
-Jaundice
-Hypoalbuminemia
-Hyperammonemia
-Fetor hepaticus
-Palmar erythema
-Spider angiomas
-Hypogonadism
-Gynecomastia
-Coagulopathy
-Hepatic encephalopathy
-Hepatorenal syndrome
260
-In the lungs it inhibits elastase released from ever-present neutrophils
-Smoking may also inactivate a1AT
-develop liver cirrhosis
α-1 Antitrypsin Deficiency
*by far the minority of patients with emphysema
*α-1 antitrypsin is a protease inhibitor
261
-Progressive RUQ pain, fever, nausea
-Due to chemical irritation and inflammation
acute cholecystitis
262
-inflammation of the trachea, major bronchi and/or bronchioles
-Destruction of alveoli
obstructive respiratory disease
263
if a patient survives a PE there is a chance of what complications
-infarct of pulmonary tissue can occur - especially bronchial blood supply is compromised
264
malignant mesothelioma arises from what?
lung pleura--> can cause lung incasement
265
what is the diagnostic hallmark of CMV infection
cellular enlargement with intranuclear and intracytoplasmic inclusion
266
What part of spirometry?
-Maximum flow rate achieved during the forced vital capacity maneuver
Peak expiratory flow rate
(PEFR)
267
-Typical patients older than 60 y/o M with occupational exposure to metal or wood dust
-Present with increasing SOB and dry cough
-Usually respiratory failure within 5 years
-“Usual interstitial pneumonia”
describe the typical course of idiopathic pulmonary fibrosis
268
Autoimmune disease that is inflammatory, serology shows AMA and results in progressive loss of bile duct which can lead to cirrhosis
Histology shows: florid duct lesion
Primary biliary cirrhosis
269
-Mesenchymal neoplasms derived from interstitial cells of Cajal (pacemaker cells controlling peristalsis)
-variable behavior
GIST tumor
*looks like a protruding ball into the stomach or peritoneal cavity
270
General histologic features:
-Interstitial inflammation
-Lymphocytic infiltrates
-Nuclear and cytoplasmic inclusion bodies
-Cell necrosis
viral pneumonia
271
what is the most common site of nasopharyngeal carcinoma
Fossa rosenmuller- lateral wall of nasopharynx
272
describe the findings of sarcoidosis in regards to different systems
-Skin --> erythema nodusum
-Joints --> increased osteoclast activity
-Heart --> fibrosis
-CNS --> depends on location
273
Often a hospital-acquired pneumonia associated w/:
-Burn patients
-Patients on mechanical ventilation
-Patients on antibiotics
-Cystic fibrosis patients
Gram-negative rod
pseudomonas aeruginosa pneumonia
274
Treatment implications:
-the squamous component eliminates use of anti-VEGF therapies (e.g. Bevucizumab)
-Associated with similar rates of treatable molecular events as adenocarcinoma
adenosquamous carcinoma
*has features of both adenocarcinoma and squamous carcinoma
275
Benign epithelial tumor with exophytic growth, composed of multiple frond-like projections of squamous epithelium with fibrovascular core
squamous papilloma of the larynx
276
-Worldwide, most common in chronic HBV infection
-In U.S., most common in cirrhosis due to chronic HCV
-Also in fatty liver disease (AFLD, NAFLD)
-Rare cases in younger patients without cirrhosis
hepatocellular carcinoma
277
-Can lead to fibrosis/cirrhosis, chronic liver disease, hepatocellular carcinoma
-Subsinusoidal pattern of fibrosis
-Historically – micronodular cirrhosis
steatohepatitis
278
-____ accounts for over 95% laryngeal cancer
-Tobacco and alcohol
-M more so thanF 7:7
SCC of larynx
279
most common odontogenic tumors
-Periapial cyst/granuloma
-Ameloblastoma
-Odontoma
280
-Epithelial tumor composed of epithelial, modified myoepithelial, and mesenchymal elements (myxoid, mucoid, or chondroid spearing-material)
-Significant architecture diversity (rather than cytologic pleomorphism)
pleomorphic adenoma
*benign salivary gland tumor
281
what organisms cause acute bronchitis?
-Usually viral: RSV
-Bacterial Causes: Hemophilus influenzae and Streptococcus pneumoniae
282
Pathogenesis
-Hypersecretion of mucus from goblet cells
-Associated with cigarette smoking and air pollutants
chronic bronchitis
283
___ is the most common cause of liver injury
acetaminophen
284
-Usually occurs in the distal esophagus near GEJ
-US Incidence is rising (more common than SCC in US)
-males more so than females (8:1)
adenocarcinoma of the esophagus
285
Most common cause of acute liver failure and 2nd most common cause leading to liver transplant in US
acetaminophen lnduced liver injury
286
Multiple pulmonary tissues and visitors (white blood cells) can synthesize ___
NO
287
what do ACTH and ADH do/promote?
-ACTH stimulates secretion of adrenal cortisol --> Cushing’s disease
-ADH increases water retention --> hyponatremia
288
-Benign neoplasm of endothelial cells that results in communicating and dilated vascular spaces
Cavernous Hemangioma
289
Pathogenesis
-Arises in various lung conditions
-Chronic infx, CF, immotile cilia, radiotherapy, chronic aspiration, etc.
-Results from pulmonary inflammation and scarring 2o/2 infx, obstruction, lung fibrosis
-Airways dilate when fibrosis contracts
Bronchiectasis
*Recurrent infection/inflammation damages airways
-Can be idiopathic
290
risk factor for adenocarcinoma of the esophagus
-associated w/ barrett esophagus (still low 1-5%)
-may become dysplastic (precancerous) and develop into cancer
291
Range of clinical outcomes/presentations for HepB
-Asymptomatic
-Acute hepatitis
-Chronic hepatitis +/- progressive fibrosis
-Fulminant hepatitis
*can integrate into genome
292
-Strong link with cigarette smoking
-M more so than F; 5th-7th decade
-Almost exclusively parotid
-Bilateral – 10%
-Multifocal- 12%
-Recurrence is rare
-Lymphoid stroma, oncocytic epithelium and bilayered
Warthin tumor
293
Clinical manifestations
-Pulmonary emphysema
-Liver disease in 10% (hepatitis, cirrhosis)
alpha-1-antitrypsin deficiency
294
Infant respiratory distress syndrome occurs most commonly in who
due to prematurity or maternal diabetes, though some are due to a genetic deficiency
295
7 Associations with peptic ulcer disease
1. Chronic NSAID use
2. Cigarettes,
3. alcohol
4. Gastric hyperacidity
5. Duodenal-gastric reflux
6. Zollinger-Ellison Syndrome - gastrinoma
7. Stress
296
Aphthous Ulcers AKA
canker sore
297
-The second most common fatal malignancy in the world (after lung cancer), but not in the US
-Most common in Far East (Japan)
gastric adenocarcinoma
298
Unregulated secretion of active hormones by tumor cells
paraneoplastic syndromes
299
4 etiologies of steatohepatitis
-alcohol
-DM or metabolic syndrome
-Obesity
-Drug rxn
300
AST/ALT
-Very high (greater than 1000) indicates=
-slightly elevated less than 100 indicates=
if AST:ALT ratio is greater than 2 suggests=
-greater than 1000= acute live injury, hepatitis, fulminant liver failure
- less than 100= chronic liver disease
-AST:ALT greater than 2= alcoholic hepatitis
301
etiologies of acute hepatitis and chronic hepatitis
viral
autoimmune
adverse drug reactin
idiopathic
302
-Centered on bronchioles or bronchi with subsequent spread to surrounding alveoli
Resolves with treatment
-May heal by organization with scarring
bronchopneumonia
303
what type of emphysema?
varied enlargement --> often secondary to infection (TB)
irregular emphysema
304
-stomach protrudes through the stomach
-can lead to strangulation or ulcers
*strongly associated w/ GERD
hiatial hernia (or sliding hernia)
305
Leads to atrophy of the vili and scalloping of the folds in intestines
celiac disease
306
sx: CP and SOB
Pulmonary embolism
-venous thrombus usually from lower extremities; much less likely affects upper extremities or right heart (mural thrombus)
307
Histology: Intraepithelial eosinophils in reactive squamous mucosa
eosinophilic esophagitis
308
how to treat infant RDS after birth
-Give oxygen along with CPAP
-Give exogenous surfactant
-But…can induce bronchopulmonary dysplasia and retinopathy of prematurity
-Fibrosis of the alveolar membrane which, despite its name, is not precancerous
-However…much less common with modern ventilation techniques
309
for HepA, describe the
virus type:
Transmission:
frequency of chronic hep:
vaccine?
virus type: ssRNA, non-enveloped
Transmission: fecal-oral
frequency of chronic hep: acute ONLY!
vaccine? YES
310
Chronic mucosal injury causes the squamous mucosa to change (undergo metaplasia) to intestinal-type mucosa with goblet cells (“intestinal metaplasia”)
-Most prevalent in middle-aged to older white men
barrett esophagitis
*a complication of longstanding GERD
311
describe diffuse alveolar damage in Adult Respiratory distress syndrome
-Decreased surfactant
-Inflammatory exudate
-Hyaline membranes
312
pathogenesis:
-inhaled
-toxic to macrophages
Silica pneumoconiosis
*similar effects to asbestos
313
malignant salivary tumors
Mucoepidermoid carcinoma
Adenoid cystic carcinoma
acinic cell carcinoma
Salivary duct carcinoma
314
-Significant cause of pneumonia in children and infants
-Mortality
Respiratory Syncytial Virus caused pneumonia
315
-Common response to infectious or inflammatory injury to lungs
-Also associated with drugs, collagen vascular disease, graft-versus-host disease in bone marrow transplant patients
Bronchiolitis Obliterans- Organizing Pneumonia (BOOP)
316
pneumoconiosis can be caused by
inhalation of particulate matter: Coal dust, Asbestos, Silica, Allergens
317
fetal lung maturity testing looks for what?
-Lecithin-sphingomyelin ratio (L/S ratio)
-Phosphatidol choline
-Phosphatidol glycerol
-Surfactant/albumin ratio
-Fluorescent polarization (F. Pol.)
-Shake Test
*High values good at predicting maturity, but low values not so good at predicting immaturity (if suggest immaturity can give mother steroids)
318
most salivary gland tumors involve what gland and what % are benign
parotid- 80% benign
submandibular- 50% benign
sublingual- less than 40% benign
319
Sx:
RLQ pain, N/V, mild fever, leukocytosis
acute appendicitis
320
treatment for heptocellular carcinoma
Chemotherapy, chemoembolization, radio frequency ablation, surgical removal, and liver transplantation
321
-Classic symptoms are a chronic cough with blood-tinged sputum, fever, night sweats, and weight loss
primary TB
*Diagnosed by chest X-ray, tuberculin skin test, sputum culture, histopathology
322
Massive hepatic necrosis
-Drugs and toxin
-Some acute hepatitis A (esp in pregnancy) and hepatitis B (usually with delta)
-Other viruses: HSV
Hepatic failure
323
-Organic particles such as cotton, sugar cane, bird feces, mold
-A type III hypersensitivity reaction can occur
Hypersensitivity alveolitis
324
The lung is sterile from where to where?
the first bronchial division to the terminal lung units (no microorganisms)
325
Most common cause of esophagitis overall
GERD
*risk factor for Barretts esophagus
326
-When larynx, trachea, and lungs are involved
-severe in children and COPD patients
Croup (laryngotracheobronchitis)
327
the leading cause of death in children under 5 years, worldwide
pneumonia
328
Usually presents at a late stage with dismal survival
-30% 5-year survival for Stage 2
-Less than 10% for Stage 3 or 4
gallbladder carcinoma
329
describe 3rd stage of acute inflammation in lobar pneumonia
Gray hepatization: 3-4 days
-Further accumulation of fibrin in alveoli
-disintegrated inflammatory cells
-Lung is grey-brown and solid
330
-Hyaline membrane disease
-Caused by insufficient amount of surfactant
Infant respiratory distress syndrome
331
4 principal clinical consequences for portal HTN
-Ascites
-Portosystemic shunts
-Congestive splenomegaly
-Hepatic encephalopathy
332
Malignant neoplasm of hepatocytes that occurs most commonly in chronically injured livers (e.g. hepatitis)
hepatocellular carcinoma
333
what do anti-HCV antibody and HCV RNA indicate?
anti-HCV- indicates exposure
(Positive in 97% of people exposed to HCV after 6 months)
HCV-RNA- ongoing infection
(Can follow for response to interferon therapy)
334
Adenosquamous carcinoma is thought to have mutation profiles similar to ___
adenocarcinoma
335
what organisms cause acute pharyngitis
Rhinovirus
coronavirus
RSV
parainfluenza
336
7 complications of bronchiectasis
-Pneumonia
-lung abscess
-emphysema
-remote abscesses
-amyloid
-pulmonary fibrosis
-cor pulmonale
337
-Hundreds to thousands of polyps in colon
-Adenomas elsewhere in GI tract as well
familial adenomatous polyposis (FAP)
338
-Very common tumor: ~2% of the population
-Young to middle aged adults
-More common in women
-Usually asymptomatic; may present with pain
-Surgery only if expanding or if symptomatic
Cavernous Hemangioma
339
6 serum proteins responsible for coagulation
2, 7, 9, 10, Protein C, Protein S
340
Histology:
-Shows pattern of injury with interface and lobular necroinflammatory activity
-Infiltrate is lymphocyte predominant with occasional increase in plasma cells (ddx with AIH, adverse drug reaction)
HepA virus
341
CVM caused pneumonia is often associated w/ what else
Pneumocystis jirovecii pneumonia
342
T-cell mediated chronic inflammatory process in the genetically predisposed, due to sensitivity to dietary gluten leading to a reduced small intestinal surface area and thus malabsorption.
celiac disease
343
-5-20% of adenomas would progress to cancer
-Progression to carcinoma takes about 10 years
colorectal adenomas
344
-mucosal injury eventually leading to mucosal atrophy and intestinal metaplasia…increased risk for dysplasia and carcinoma
chronic gastritis
345
most SCC of the larynx occurs where?
Glottic
supraglottic
subglottic
346
Most important risk factor for esophageal adenocarcinoma
barrett esophagitis
*Patients with greater than 3cm of Barrett mucosa have a 30-40 times increased risk of developing CA
347
what are the laboratory findings associated w/ steatohepatitis secondary to alcohol
-AST:ALT ratio greater than 2
-ALP normal with increased GGT
348
describe 1st stage of acute inflammation in lobar pneumonia
Edema and congestion: 12-14 hours
-Vascular engorgement (congestion)
-Intra-alveolar fluid (proteinaceous exudate)
-Lung is heavy, edematous, red
349
describe ED (extensive disease) SCLC prognosis and treatment
a very poor prognosis with poor treatment response
350
-Chronic inflammatory disorder of unknown cause that leads to obliterative fibrosis and ectasia of the extrahepatic and intrahepatic biliary tree and eventually to cirrhosis
primary sclerosing Cholangitis
351
-produces a small mid-zone lung lesion with hilar lymph node involvement
primary TB
352
-“Scarred”, functionally impaired liver
-risk of HCC
-Vascular architecture is reorganized: much of blood flow bypasses parenchyma
-commonly causes portal HTN
Cirrhosis
353
describe the major sources of HepC
injecting drugs (60%),
Sexual (15%),
Transfusion (10%),
Unknown (10%),
Occupational (4%),
Other (1%)
354
-Rare tumor with a marked female predominance
-Associated with oral contraceptive use, obesity, anabolic steroids, and some metabolic liver diseases
hepatocellular adenoma
355
-Autosomal recessive disorder characterized by abnormally low levels of the protease inhibitor A-1-A most commonly due to misfolding of the protein in the endoplasmic reticulum of hepatocytes (PiZZ)
alpha-1-antitrypsin deficiency
356
-Most cases of asthma, classic Type I reaction to dust, pollen, food, animal dander, etc
atopic asthma
357
-Sx: Acute onset with cough, shortness of breath, fever and malaise
-Concentric fibrosis of submucosa of small bronchioles, resulting in obliteration of lumen
Bronchiolitis Obliterans- Organizing Pneumonia (BOOP)
358
what lung cancers have neuroendocrine features?
-Carcinoid
-large cell neuroendocrine carcinoma
-Small cell lung CA
(from least to most malignant)
359
-No invasion (growth along alveolar septae) in adenocarcinoma
‘lepidic’ growth
360
sx:
-Skin pigmentation, diabetes, liver disease, cardiac dysfunction, joint disease
-affects 0.5% of people from north Europe
Hereditary Hemochromatosis
361
-acute respiratory distress, dyspnea, tachypnea
-Resolves in a few days, may develop secondary pneumonia
primary bronchiolitis
362
-Hypertrophy of pyloric sphincter smooth muscle
-M more so than F (3-4:1)
-1 in 300-900 live births
pyloric stenosis
363
-Measure of hepatocyte death
-in cardiac muscle, liver, skeletal muscle, kidney and other organs
-more specific to liver
AST/ALT
-AST
-ALT more specific to liver
364
Morphological changes:
-Fibroblastic plug/ fibrous tissue in lumen
-Concentric fibrosis of submucosa of small bronchioles, resulting in obliteration of lumen
BOOP
365
-may show increased plasma cells
-Potentiates effects of HBV: increased risk of fulminant hepatitis**, increased activity, and faster progression to end stage liver disease
HepD
366
5 – 10% of all pneumonias
-High mortality rate
-Classically follows influenza infection
-20 – 40 % of normal adults carry the organism in the nares
staphylococus aureus
367
-Chronic irritation causes hypertrophy of the respiratory mucous glands
-In large bronchi this just causes lots of sputum
-In smaller bronchi the hypertrophy and hypersecretion causes obstruction
-Chronic inflammation of bronchi and bronchioles
-due to inflammation caused by cigarette smoke
Chronic Bronchitis
368
4 risk factors for colorectal cancer
-“Western” Diet
-Inactivity
-Genetics (e.g. FAP and Lynch syndrome)
-Inflammatory bowel disease
369
-Antigen detection tests available
-Virus culture shows syncitia
-Necrotizing bronchiolitis and interstitial pneumonia, infrequent cytoplasmic inclusion bodies
Respiratory Syncytial Virus caused pneumonia
370
-Very common (most common site for tumors)
-Most are epithelial derived neoplasms
Large intestine tumors
*Small intestine tumors are similar to those found in the colon but are much less common
371
sites were peptic ulcers (disease) develop
-Duodenum (DU) **
-Stomach (GU) **
-Esophagus
-All 3 in Zollinger Ellison syndrome
-Ileum (related to ectopic gastric mucosa in Meckel’s diverticulum)
372
3 phases/types ot tuberculosis infection
1. primary TB
2. Secondary TB
3. Miliary TB
373
-Pneumonia occurs in approximately 5% of patients with chickenpox (mostly adults)
-herpes-type virus
varicella zoster caused pneumonia
374
-Centrally located, near main hilar bronchi
-Metastasize very early with small primary**
-Can cause paraneoplastic syndromes
small cell lung CA
375
Histology:
-Ground glass hepatocytes: represent crystalline array of virus particles
-Sanded nuclei
Chronic HepB
376
Benign neoplasm of hepatocytes that occurs in an otherwise structurally normal liver (i.e. non-cirrhotic)
-heptocelluar adenoma
377
what lab values would you expect to find in hepatitis and cholestatic?
Hepatitis – Elevated AST, ALT, bili
Cholestatic – Elevated ALP, GGT, and bili
378
Severe pneumonia and multisystemic disease
legionnaires disease caused by Legionella pneumonphila
379
4 common causes of intestinal obstruction
-Herniation
-Adhension
-Intussusecption
-Volvulus
380
complete obstruction of the lumen of the extrahepatic biliary tree within first 3 months of life
biliary atresia
381
pathogenesis:
-atypical hyperplasia- precursor lesion
-BAC
-minimally invasive
-invasive
adenocarcinoma
-atypical adenomatous hyperplasia= precursor lesion
-BAC (bronchioloalveolar carcinom)= adenocarcinoma in situ
382
causes of bronchopneumonia
-Staphylococcus, Streptococcus, H. influenza
383
Muscle weakness due to autoantibodies directed against neuronal calcium channel
lambert-eaton myasthenic syndrome
(a paraneoplastic syndrome)
384
most common site of Pyogenic granuloma AKA lobular capillary hemangioma
gingiva
385
-Diffuse inflammation affecting the entire lobe or segment. Pleural exudate is common
-Uncommon in infancy and old age
-Affects otherwise healthy adults 20-50
lobar pneumonia
386
-Acute inflammation of the gallbladder, often precipitated by obstruction of gallbladder neck or cystic duct, usually by choleliths
acute cholecystitis
*other causes: severe trauma, organ failure, post-partum
387
what labs are most specific for liver function?
total protein, albumin, INR, coaguation proteins (C, S, 2, 7, 9, 10)
388
describe 2nd stage of acute inflammation in lobar pneumonia
Red hepatization: 1-3 days
-Neutrophils accumulate in alveoli, also lymphs and macrophages
-Extravasation of red blood cells
-Fibrinous exudate on pleura
-Lung is red, solid and airless. Resembles fresh liver
389
Histology shows interstitial inflammation and fibrinous exudate
atypical pneumonia
390
what is Helicobacter pylori Gastritis associated with?
-Most all have duodenal ulcers
-70% have gastric ulcers
-Human variability also plays a part
(e.g. individuals who produce high levels of IL-1b in inflammation get pan gastritis and GU
lower levels associated with antral gastritis and DU)
391
-Tumors that lack morphologic or IHC differentiation
-Tumor cells are large nuclei, prominent nucleoli
large cell lung cancer
392
What part of spirometry?
The volume of air exhaled during the first second of a forced expiratory maneuver
FEV1
393
Chronic, relapsing inflammatory disorders of obscure origin with a genetic susceptibility resulting from inappropriate and persistent activation of the mucosal immune system, driven by the presence of normal intraluminal flora and coming in two “flavors”
Idiopathic Inflammatory Bowel Disease
394
-Not associated with cigarette smoking
-Central location (can lead to obstruction)
-Often endobronchial
-Can cause localized symptoms, but rarely metastasizes
-Can cause paraneoplastic syndrome
carcinoid lung canger
395
-5-10% of GI bleeds (usually self limiting)
-Often near gastroesophageal junction (GEJ)
-Often in alcoholics
Lacerations (Mallory- Weiss Tears)
396
describe the spread of mycobacterium tuberculosis
-After 3-10 weeks, may spread through lymphatic and hematogenous channels to hilar nodes and to multiple organs and tissues prior to the development of adequate cell-mediated immunity
-lymphohematogenous dissemination probably occurs in most cases, setting the stage for reactivation
397
what things are associated with Squamous cell carcinoma of the esophagus (4)
-Alcohol and tobacco**
-Carcinogens in food- nitrosamine compounds in pickled foods, toxin-producing fungi, betel nut
-Dietary deficiencies (China and South Africa)
398
how to diagnose PE
-D-dimer (sensitive, not specific)
-Spiral CT or VQ scan (may miss small emboli)
-Angiography (best diagnostically, but highest risk)
-Lower extremity ultrasound
-Autopsy
399
-Arises from the cells lining large airways*
-Thus is nearly always seen as a central lesion
squamous cell carcinoma
400
-Histologically can be very well differentiated or have minimal histologic squamous features
-Histology: TTF-1 (-), and CK5/6 (+)
Squamous cell lung cancer
401
Pathologically,
-Sharply delimited and typically transmural** involvement of the bowel by an inflammatory process with mucosal damage (SEGMENTS effected)
-The presence of non-caseating granulomas
-Fissuring with the formation of fistulae
Crohn's disease
402
sx:
-Insidious onset
-Eventual pruritus followed by jaundice
Primary Biliary Cirrhosis
403
95% of oral cavity cancer is what
SCC
404
sx:
-5-35 y/o
-presents with LIVER or NEUROLOGIC disease
-Keyser-Fleischer rings in eyes
Wilsons disease
405
what hepatitis's are associated w/ chronic liver disease?
HepC
HepB
HepD
406
Common in:
-Infancy or elderly or Patients with debilitating disease or chronic pulmonary disease
-Patients often become septicemic
-Multifocal, patchy consolidation
-Tends to involve several lobes, basal, bilateral
bronchopneumonia
407
End stage liver disease w/ bridging fibrous septae, Regenerative hepatocyte nodules, and distortion of architecture
cirrhosis
408
-Low DLCO means ___
-Low alveolar volume / lung capacity means ____
-Low DLCO means poor gas exchange
-Low alveolar volume / lung capacity means emphysema
409
-Macroscopic: variably cystic, circumscribed to poorly defined periphery
-Microscopic: cystic spaces with: epidermoid cells, intermediate cells, mucous cells
(Clear cells (10% predominate, glycogen, occasionally mucin) columnar cells )
Mucoepidermoid carcinoma
*malignant salivary tumor
410
most common benign odontogenic lesions
-Dentigerous cyst
-Odontogenic keratocyst
411
Histology: “Generic” acute esophagitis, numerous neutrophils in the epithelium, reactive squamous cells
infectious esophagitis
412
why is distinction between squamous cell carcinoma, adenocarcinoma and other subtypes critical for therapy?
-Squamous cell carcinoma patients have a higher likelihood of adverse response to a class of drugs
-ex. Anti-VEGF inhibitors (e.g. Bevucizumab)
-->Associated with hemorrhage (potentially life threatening)
413
what does PTHrP and calcitonin do/promote?
-PTHrP promotes absorption of Ca++ and removal of Ca++ from bones --> hypercalcemia
-Calcitonin does the opposite --> hypocalcemia
414
what syndrome can carcinoid lung cancer call?
paraneoplastic syndrome
415
how to diagnose Legionella pneumonphila
Negative lab studies do not rule out infection
-Culture on buffered charcoal yeast extract (BCYE) agar
-Direct fluorescent antibody on secretions/BAL or lung tissue
416
-Most common malignant salivary gland tumor (adults and children)
-F more so M, wide age range
-Parotid=most common location
-Most common salivary gland tumor to arise in gnathic bones
-Major salivary glands slightly > minor glands
Mucoepidermoid carcinoma
*malignant salivary tumor
417
Evidence of hepatic injury/inflammation for greater than 6 months
chronic hepatitis
418
describe 4th stage of acute inflammation in lobar pneumonia
Resolution: 8-10 days (untreated)
-Resorption of exudate
-Enzymatic digestion of inflammatory debris with preservation of alveolar architecture
419
-Can be recognized morphologically
-Usually confirmed by IHC
large cell neuroendocrine (LCNC)
420
what is the most common carcinogen for lung cancel?
tobacco
*risk factor for CA NOT cause
421
Clinical Features
-Obesity, diabetes type II, hypertriglyceridemia
-Increasing in frequency as DM and obesity increases
Non-alcoholic Steatohepatitis (NASH)
422
-Most lesions converted to fibrocalcific scars
-many complications can ensue, i.e., progressive pulmonary disease and/or dissemination to pleura and organs
secondary TB
423
Focal inflammation centered on the airways; often bilateral
bronchopneumonia
424
Second most common benign salivary gland tumor
Warthin tumor
425
-Rare malignant neoplasm of the gallbladder epithelium
-Usually affects the elderly; more common in women
gallbladder carcinoma
426
what labs are most specific for biliary injury?
GGT and ALP
427
Histology: Chronic inflammatory cell infiltration, +/- mucosal atrophy, +/- intestinal metaplasia
chronic gastritis
428
-Causes suppurative and ulcerative bronchiolitis with necrosis of bronchiolar wall
-Septic infarction and abscess formation are complications
staphylococus aureus
429
Total protein and albumin are decreased in _____ due to ____
__ is also decreased
end-stage chronic liver disease (cirrhosis)
decreased production (Synthetic Defect)
coag. factors are also decreased--> prlonged PT and INR
430
-Increase suggests obstructive process, biliary disease
-Not specific: also in bone, intestine, placenta
ALP (alkaline phosphatase)
*used to assess liver
431
-Inflammation associated with luminal obstruction in many cases (e.g. fecalith)
Acute appendicitis
432
squamous papilloma of the larynx is associated w/ what
HPV 6 and 11
433