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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

-Diffuse consolidation (alveolar space collapse--> dense/pale appearance)
-Uniformly affects anatomically delineated segment(s) or entire lobe(s)
-CXR: Well-defined, homogenous opacity observed in the right middle lobe

lobar pneumonia