1
Q
Primary Teeth?
A
- 20 (8 incisors, 4 canines, 8 molars)
- A-T
- no premolars or third molars
2
Q
Age of mixed dentition?
A
6-12
3
Q
Permanent Teeth?
A
- 32 (8 incisors, 4 canines, 8 premolars, 12 molars)
- 1-32
4
Q
When do 3rd molars erupt?
A
17-21
5
Q
Most commonly missing teeth?
A
3rd molars > lateral incisors > 2nd premolars
-last teeth in each series
6
Q
Most common supernumerary teeth?
A
- permanent
- males
- maxillary
- mesiodens
7
Q
Cleidocranial Dystosis?
A
congenital disorder of bone
-abnormal clavicles, skull, jaw, long bones
8
Q
Gardner’s syndrome?
A
- multiple impacted supernumerary teeth with multiple osteomas
- familial colorectal polyposis
9
Q
Parulus?
A
gum boil
-abscess that drains to root
10
Q
Dental origin of acute cellulitis?
A
- strep
- bacteroides
11
Q
Cause of dental caries?
A
- plaque
- sugar
- strep mutans
12
Q
S. mutans enzyme?
A
glucosyl transferase
13
Q
Xylitol function?
A
prevents decay by interfering with S. mutant
- decreases plaque
- promotes remineralization
14
Q
Cause of gingivitis?
A
plaque around neck of teeth cause swelling of gums
15
Q
Pathophys of periodontal disease and CVD?
A
inflames gums and sends bacterial infection through blood that triggers C-reactive protein to inflame arteries and clot blood
16
Q
Acute necrotizing ulcerative gingivitis?
A
- punched out papilla
- caused by smoking, steroids, stress, poor hygiene
- spirochetes and bacteroides
17
Q
Causes of enamel erosion?
A
- soda
- energy drinks
- lemons
- bulimia
- GERD
- mallory weis
- esophagitis
- barretts esophagus
18
Q
Triggers for apthous ulcers?
A
- CMV
- hormones (female, puberty)
- nutrition (zinc)
- allergies (autoimmune type 4 hypersensitivity)
- crohns
19
Q
HSV1 and HSV2 latency?
A
1- trigeminal ganglion
2-sacral ganglion
-treat with acyclovir, valtrex
20
Q
HPV types causing cervical cancer?
A
16 and 18
21
Q
What oral cancers does HPV cause?
A
tonsils and base of tongue (16)
22
Q
Mallory weis tears?
A
longitudinal tears at GE junction due to retching from alcohol intoxication
23
Q
HIV+ patient with infectious esophagitis. Diagnosis?
A
Candidiasis
24
Q
Herpes esophagitis?
A
- punched out ulcers
- nuclear viral inclusions
25
CMV esophagitis?
- linear ulcers
| - nuclear and cytoplasmic inclusions
26
Requirement to diagnose Barretts esophagus?
Goblet cells
27
Most common causes of esophageal varices?
1. cirrhosis (west)
| 2. hepatic schistosomiasis
28
Causes of sudden bleeding in esophageal varices?
1. vomiting
2. erosion of mucosa
3. pressure from dilated veins
29
Plummer vinson syndrome increases risk of what?
squamous cell carcinoma of esophagus
30
T/F
APC mutations are associated with squamous cell ca of esophagus.
False
31
Where does squamous cell ca occur in esophagus?
upper and middle
32
Most cases of esophageal adenocarcinoma develop from what?
barretts
33
Where does adenocarcinoma occur in esophagus?
distal 1/3
34
Most common benign tumor of esophagus?
Leiomyoma
35
Sudden onset of bright red hematemesis?
ruptured esophageal varices
36
When do symptoms of pyloric stenosis present in infants?
couple of weeks after birth
37
Curling ulcer?
mucosal ischemia from stress and shock causes severe gastric antral burns
38
Cushing ulcer?
CNS trauma causes increases vagal tone and acid secretion
39
Pathophys of autoimmune gastritis? complications?
- atrophy of body and fundus
- G cell hyperplasia of antrum causes increased gastrin and increased acid
- antrum and cardia not damaged
- risk of adenocarcinoma
40
What are most cases of peptic ulcer disease associated with?
H. pylori
41
Malignant transformation of peptic ulcers?
- very rare
| - cancer may actually be an ulcerated carcinoma, not a transformed ulcer
42
Most common form of peptic ulcer disease?
- occurs in antrum or duodenum due to chronic H. pylori
- increased acid secretion
- decreased bicarbonate secretion in duodenum
43
Cause of gastric ulcer on lesser curvature? Greater?
- Lesser: chronic gastritis
- Greater: NSAIDS
- single lesion less than 2cm
44
Complications of PUD?
1. hemorrhage
- lesser curve: left gastric a.
- greater: gastroduodenal a.
2. perforation
- pneumoperitoneum with referred pain to shoulder
3. obstruction
45
Increased risk what type of cancer from H. pylori?
gastric intestinal type adenocarcinoma
46
H. pylori toxins?
- CagA (cytotoxin) with pathogenicity islands
- VacA (vacuolating)
-damage to duodenum via toxins because organism only found in gastric mucosa
47
Cause of MALToma?
H. pylori causes lymphoid hyperplasia
| -extranodal marginal zone B-cell lymphoma
48
Associations with lymphocytic gastritis?
celiac
49
Hypertrophic gastropathy?
enlarged rugal folds without inflammation
50
Cause of menetrier disease?
excessive secretion of TGF-alpha
51
ZE syndrome?
Gastrinoma
- slow growing malignancy
- increased gastrin with hyperplasia of mucous neck cells, mucin, and endocrine cells forming carcinoid tumors
- hyperchlorhydria
52
Location of adenomatous polyps? what increases risk of malignancy?
- antrum
| - familial adenomatous polyposis
53
Fundic gland polyps are associated with what?
PPIs
54
Most common malignancy of stomach?
Gastric adenocarcinoma
55
Diffuse gastric adenoca associated with what?
E-cadherin mutation (CDH1)
56
Intestinal gastric adenoca associated with what?
FAP with germline mutations in adenomatous polyposis coli
57
Linitis plastica?
thick walls with partial loss of rugal folds
58
Microscopic feature of gastric ca?
signet ring cells
| -filled with mucin that pushes nuclei to periphery
59
Clinical features of gastric ca?
Virchow node
-left supraclavicular
Sister Mary Joseph nodule
-subcutaneous periumbilical
60
Carcinoid positive stains?
- synaptophysin
| - chromogranin A
61
What are carcinoids associated with?
- MEN1
- ZE
- hypergastrin
62
Carcinoid syndrome?
- ileal tumor produces cutaneous flushing, sweating, bronchospasm, ab pain, diarrhea, right side cardiac valve fibrosis
- tumor secrete hormones into non portal veins causing metastatic lesions
63
Location of most aggressive carcinoid tumors?
Midgut
| -jejunum and ileum
64
Carney's triad?
young female with Gastric stromal tumor, paraganglioma, and pulmonary chondroma
65
Associations with GIST?
- NF-1
- c-KIT
- PDGFRA
- pacemaker cajal cells with c-KIT and CD34
66
T/F
Gastric xanthomas are not associated with hypercholesterolemia.
True
67
Pathophys of chronic alcohol intake and pancreatitis?
causes release of protein rich pancreatic fluid with deposition of protein plugs and obstruction of small pancreatic ducts
68
Chronic pancreatitis destruction of pancreas?
- inflammation and irreversible destruction of exocrine
| - fibrosis and late destruction of endocrine
69
CFTR gene mutation and pancreatitis?
decreases bicarbonate secretion by duct cells causing protein plug and chronic pancreatitis
70
Long term chronic pancreatitis complications?
- Ductal obstruction by secretions
- Toxic effects from alcohol on acinar cells
- oxidative stress
- fibrosis and atrophy
- dilation and protein plugs
- pseduocysts
- DM late complication
- not ductal adenoca
71
Cause of fibrosis in chronic pancreatitis?
TGF-beta and PDGF induce activation of myofibroblasts causing increased collagen and fibrosis
72
What does pseudocyst contain?
blood, necrotic debris, pancreatic enzymes
73
Serous cystadenomas demographics and location?
- women
| - body or tail of pancreas
74
Mucinous cystic neoplasms demographics and location?
- women
- body or tail of pancreas
- identical to ovarian cysts
75
Intraductal papillary mucinous neoplasms demographics and location?
- men
| - head of pancreas
76
Pancreatic carcinoma risk factor?
smoking doubles risk
77
T/F
Pancreatic ca elicits intense desmoplastic reaction.
True
78
First symptoms of pancreatic ca?
Pain
| -then obstructive jaundice
79
Trousseau sign?
migratory thrombophlebitis from elaboration of platelet activating factors and procoagulants in pancreatic ca
80
Serum antigen in pancreatic ca?
CEA and CA 19-9
81
Lipase hypersecretion syndrome?
Acinar cell carcinoma producing trypsin and lipase that causes:
- subcutaneous fat necrosis
- polyarthralgia
- blood eosinophilia
- nonbacterial thrombotic endocarditis
82
Pancreatoblastoma?
squamous islands mixed with acinar cells
83
Estrogenic factors and cholelithiasis?
pregnancy and OCPs increases hepatic lipoprotein receptors that stimulate HMG-CoA reductase to increase cholesterol
84
What causes 10-20% of cholesterol stones to be radiopaque?
calcium carbonate
85
Causes of black stones?
- hemolytic anemia
- cirrhosis
- sclerosing cholangitis
86
Causes of brown stones?
infected bile ducts by E. coli or Ascaris lumbricoides
87
Charcot's triad of cholelithiasis?
1. RUQ pain
2. Fever
3. Jaundice
88
Complications of cholelithiasis?
- perforation
- fistula
- cholangitis
- pancreatitis
89
What increases risk of GB carcinoma?
cholelithiasis
90
Strawberry GB?
yellow deposits on mucosal surface from cholesterolosis
91
Rokitansky aschoff sinuses?
out pouchings of mucosal epithelium from chronic cholecystitis
92
Porcelain GB?
Hyalinizing cholecystitis from long standing injury causing diffuse fibrosis and calcification
-high risk of carcinoma, needs to be removed
93
Xanthogranulomatous cholecystitis?
shrunken GB, nodular, chronically inflamed with necrosis and hemorrhage with macrophages filled with lipids and fibrosis
94
Hydrops of GB?
atrophic obstructed GB with clear secretions
95
Reynalds pentad of ascending cholangitis?
1. RUQ pain
2. fever
3. jaundice
4. septic shock
5. CNS depression
96
Fetal biliary atresia?
ineffective establishment of laterality of thoracic and abdominal organ development
97
Perinatal biliary atresia?
normal biliary tree is destroyed after birth by viral infection
98
Coagulative necrosis?
ischemia
99
Apoptotic cell death?
shrunken, pyknotic
100
Lytic necrosis?
cell swell, rupture leaving debris
101
Interface necrosis?
between periportal parenchyma and portal tracts
102
Bridging necrosis?
portal-portal
portal-central
central-central
103
Cirrhosis?
advanced fibrosis forming nodules
104
Does Hep A produce chronic disease?
No
105
Importance of HBsAg?
immunogenic but not infectious and is basis for vaccine
106
T cells in HBV pathogenesis?
CD8 T cells recognize and destroy infected cells
107
Presence of HBeAg in serum?
intense viral replication and maximal infectivity
108
Common cause of fulminant hepatitis?
HBV
109
Polyarteritis nodosa and HBV?
1/3-2/3 of patients with PAN are carriers for HBV
110
Are anti-Hb Ab found in the blood of those with chronic hepatitis?
No
111
Chronic hepatitis B increases risk for what?
HCC
112
Can HCV cause chronic disease?
yes
113
Sicca syndrome?
Chronic HCV with immunologically related destruction of lacrimal and salivary glands
114
Morphology of acute hepatitis?
- lymphoplasmacytic infiltration
| - HBV: ground glass hepatocytes
115
Morphology of chronic hepatitis?
- lymphoplasmacytic infiltration
| - scarring
116
Hepatitis associated with fatty change?
Chronic HCV
117
Macronodular cirrhosis?
Chronic hepatitis
118
Cells causing cirrhosis?
Stellate cells with collagen
119
Hepatic steatosis?
micro vesicular progresses to macro vesicular with chronic alcohol and is reversible
120
Morphology of alcoholic hepatitis?
- cell swelling and necrosis from fat accumulation
- mallory denk bodies: cytokeratin and intermediate filaments
- fatty change
- necrosis
- fibrosis
- nodule regeneration
121
Acetaldehyde?
metabolite of alcohol induces lipid per oxidation injuring the hepatocytes cytoskeleton and membrane
122
Why does alcohol cause regional hypoxia?
endothelins are potent vasoconstrictors
123
Defects causing hemochromatosis?
- HFE
- Transferrin receptor 2
- Hepcidin
124
Bronze diabetes with cirrhosis?
Hemochromatosis
125
Wilsons disease?
copper deposits in liver, brain, eye
| -Kayser fleisher rings in cornea
126
Mutation in wilsons disease?
ATP7B leads to decreased copper in ceruloplasmin
127
Genetic mutation associated with A1-AT deficiency?
PiZ
| -PAS+
128
Secondary biliary cirrhosis?
extra hepatic bile duct obstruction
129
Primary biliary cirrhosis?
- intra hepatic bile duct destruction
- women
- Anti-mitochondrial Ab
130
Primary sclerosing cholangitis?
- males with ulcerative colitis
- beading of bile ducts
- increased risk of cholangiocarcinoma
131
Findings in liver failure?
1. Hypoalbumin causing edema
2. Hyperammonia causing Encephalopathy
3. Fetor hepaticus
4. Palmar erythema
5. Spider angiomas
6. Hypogonadism and gynecomastia
7. Impaired coagulation
132
Most common cause of acute liver failure?
acetaminophen suicide attempt
133
Pathophys of cerebral edema in liver failure?
glutamate is converted to glutamine by ammonia which accumulates in the astrocytes and then causes osmotic stress
134
Causes of hepatic encephalopathy?
1. increased ammonia production from infection and constipation, GI bleed
2. decreased ammonia removal from liver failure, TIPS, diuretics
135
Key mediator of hepatopulmonary syndrome?
Nitric oxide
Upper GI
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