Sweep 1.4

Question 1

1. Secondary biliary cirrhosis-results from ————-

Answer 1

obstruction extrahepatic duct

Question 2

a. Biliary tree obstruction-the primary cause is

Answer 2

cholelithiasis (gall stones), then malignancies of biliary tree or head of pancreas.

Question 3

Secondary biliary cirrhosis

b. Develop secondary inflammation-then

Answer 3

fibrosis, hepatic scarring.

Question 4

2. Primary biliary cirrhosis (PBS)

a. Inflammatory ——– disease-affects ———–

Answer 4

autoimmune

intrahepatic bile ducts.

Question 5

2. Primary biliary cirrhosis (PBS)
   b. Primary feature-nonsuppurative inflammatory destruction of ————-also get portal inflammation, scarring and eventually cirrhosis.

Answer 5

medium sized intrahepatic ducts

Question 6

2. Primary biliary cirrhosis (PBS)

c. Thought to be an ——— etiology.

Answer 6

autoimmune

Question 7

2. Primary sclerosing cholangitis (PSC)

a. Fibrosing cholangitis of bile ducts-develop ———–

Answer 7

luminal obliteration

Question 8

2. Primary sclerosing cholangitis (PSC)

b. Liver eventually develops ———-

Answer 8

biliary cirrhosis

Question 9

2. Primary sclerosing cholangitis (PSC)

d. Note an increase in ———- and ———— in PCS patients

Answer 9

chronic pancreatitis

hepatocellular carcinoma (HCC)

Question 10

G. Metabolic liver disease
3. Nonalcoholic steatohepatitis (NASH). Patients develop ——–, and 10-20% progress to ———- (seen primarily in ——– patients).

Answer 10

hepatocyte injury

cirrhosis

obese

Question 11

6. Alpha1-antitrypsin deficiency. Develop ——— from protein degrading enzymes. Also develop liver disease, formation ———————- within hepatocytes.

Answer 11

pulmonary emphysema

of Mallory bodies and PAS positive granules

Question 12

4. Alcoholic liver disease

o 3 overlapping forms:

Answer 12

1) hepatic steatosis,
2) EtOH hepatitis,
3) cirrhosis (only develops in a minority of patients).

Question 13

A. Small Intestine-reactive, non-neoplastic conditions

2. Infectious enterocolitis e.g. Vibrio cholerae, Campylobacter jejuni-

Answer 13

acute, self-limited colitis “traveler’s diarrhea”.

Question 14

Clinical aspects of malabsorption:

1. Osteopenia, tetany:

Answer 14

Defective Ca, Mg, Vitamin D and protein absorption

Question 15

Clinical aspects of malabsorption:

2. Amenorrhea, impotence and infertility:

Answer 15

Generalized malnutrition

Question 16

Clinical aspects of malabsorption:

3. Deficiencies in Vitamin A and B12:

Answer 16

Peripheral neuropathy, nyctalopia (↓ Vitamin A)

Question 17

A. Colon polyps

a. Hyperplastic:

Answer 17

↑ number of cells

Question 18

A. Colon polyps

b. Hamartomatous:

Answer 18

↑ in tissue normally at this site

Question 19

B. Adenoma

Answer 19

• Neoplastic
• Dysplastic
• Shape: Tubular, tubulo-villous, Villous
• Size: Most important predictor of malignant change

Question 20

B. Adenoma

• Shape:

Answer 20

Tubular, tubulo-villous, Villous

Question 21

Adenoma

• Size:

Answer 21

Most important predictor of malignant change

Question 22

D. TNM Classification

T: Depth of tumor invasion

Answer 22

1. Submucosa
2. Muscularis propria
3. Subserosa or pericolic fat
4. Contiguous structures

Question 23

D. TNM Classification

N:

Answer 23

Lymph nodes

Question 24

D. TNM Classification

M:

Answer 24

Metastasis

Question 25

A. Familial Adenomatous Polyposis Entails mutations of

Answer 25

APC gene.

Question 26

A. Familial Adenomatous Polyposis 1. Gardner’s syndrome: --------------------

Answer 26

FAP + Extraintestinal lesions

Question 27

A. Familial Adenomatous Polyposis Gardner's syndrome • Oral manifestions of Gardner syndrome:

Answer 27

Unerupted teeth, supernumerary teeth, dentigerous and mandibular cysts, increased risk for odontomas, delayed tooth eruption.

Question 28

Gardner's syndrome | Also develop ------------.

Answer 28

benign skin lesions

Question 29

Gardner's Syndrome Congenital hypertrophy of ------------ (CHRPE).

Answer 29

retinal pigment epithelium

Question 30

B. Peutz Jegher Syndrome • Second most common --------- syndrome • ---------------- (Intussusception) and pigmented ---------- of mucous membranes and skin.

Answer 30

polyposis Gastrointestinal hamartomatous polyps macules

Question 31

B. Peutz Jegher Syndrome • ----------- deposits around nose, lips, buccal mucosa, hands and feet, genitalia and perianal region. Develop in early --------

Answer 31

Melanin childhood

Question 32

B. Peutz Jegher Syndrome • Non-sun dependant freckling of the skin around the

Answer 32

lips and the vermilion zone of the lips – Common feature.

Question 33

A. Crohn Disease 2. Pathology • ----------- inflammation of bowel, particularly ileum (distal small bowel) and colon. Any portion of the GI tract → --------------

Answer 33

Segmental transmural oral involvement frequently seen

Question 34

Crohn disease: 3. Oral manifestations: a. ------------- mucosal thickening with predilection for ----------------- –Can be confused with -----------. b. Mucosal ulcer “cobblestone” ---------- lower than normal tissue

Answer 34

Multifocal, linear, nodular, polypoid or diffuse labial and buccal mucosa and mucosal folds aphthous ulcers Diseased tissue

Question 35

A. Crohn Disease c. ----------------- identical to those seen in the bowel. Infections (fungal, TB) should be ruled out.

Answer 35

Subepithelial, noncaseating granulomatous inflammation

Question 36

B. Ulcerative Colitis | 2. Pathology:

Answer 36

* Begins in rectosigmoid area and extends proximally. Not transmural * Continuous (diffuse) involvement (pseudo-polyps), not patchy

Question 37

PENILE DISORDERS Two markers have proven to be helpful in diagnosis, staging and follow-up for these cancers: --------------. These markers are rarely positive in ---------- but frequently beneficial in ------------- tumors.

Answer 37

α-fetoprotein and human chorionic gonadotropin (HCG) seminomas nonseminomatous

Question 38

Prostate specific antigen (PSA) represents a useful marker in the management of prostate cancer, but is elevated in both normal prostate and those affected by cancer, prostatitis, or nodular hyperplasia. PSA is of limited value when used as an ----------, but its value is enhanced considerably when combined with ----------------------

Answer 38

isolated screening test digital rectal examination, transrectal sonography, and needle biopsy.

Question 39

In addition to being beneficial in the initial diagnosis, PSA also is important in

Answer 39

staging of the neoplasm and judging response to treatment.

Question 40

SYPHILIS | A historically famous pattern of congenital syphilis is called Hutchinson triad and consists of:

Answer 40

1. Interstitial keratitis 2. Hutchinson’s teeth 3. Eighth nerve deafness

Question 41

``` NONGONOCOCCAL URETHRITIS AND CERVICITIS Reactive arthritis (Reiter Syndrome) is a significant manifestation of --------------. ```

Answer 41

chlamydial infection

Question 42

NONGONOCOCCAL URETHRITIS AND CERVICITIS This is an immune-mediated process that develops in response to genitourinary or gastrointestinal infections and predominates in patients who are ------------ positive.

Answer 42

HLA-B27

Question 43

NONGONOCOCCAL URETHRITIS AND CERVICITIS It typically presents as a combination of

Answer 43

urethritis/cervicitis, arthritis, conjunctivitis, and mucocutaneous lesions.

Question 44

GENITAL HERPES SIMPLEX The lesions are small vesicles that quickly ulcerate; the diagnosis is made via a smear or biopsy which will reveal the ----------- of the virus in epithelial cells (ballooning degeneration of epithelial cells with

Answer 44

cytopathologic effects large, multinucleate “Tzanck cells”).

Question 45

``` HUMAN PAPILLOMAVIRUS INFECTION Human papillomavirus (HPV) is the cause of a number of epithelial proliferations in the genital tract, including --------------, some precancerous lesions and some carcinomas. ```

Answer 45

condyloma acuminatum

Question 46

HPV infection Condyloma acuminatum is usually associated with

Answer 46

HPV types 6 or 11 and typically arises on moist mucocutaneous surfaces.

Question 47

HPV infection They present as -------------, and frequently appear in clusters. Other types of HPV (16, 18, 31, 33, 45, 52, and 58) are found more frequently in epithelial neoplasia, including cervical and oropharyngeal cancer. Condylomata sometime occur ---------- but more often in -------------.

Answer 47

benign papillary nodules singly multiple sites

Question 48

DISOSRDERS OF THE CERVIX Cervical Intraepithelial Neoplasia and Carcinoma of the Cervix Abnormalities revealed during a ------------ examination following application of ----------- appear as ---------- patches.

Answer 48

colposcopy acetic acid white

Question 49

menorrhagia

Answer 49

(profuse or prolonged bleeding),

Question 50

metrorrhagia

Answer 50

(irregular bleeding between periods), and

Question 51

dysmenorrhea

Answer 51

(unusually painful menstrual bleeding).

Question 52

Endometriosis is the presence of --------------- in locations other than the -----------.

Answer 52

endometrial glands and/or stroma uterine lining

Question 53

Endometriosis the causation is ---------, the most accepted “regurgitation” theory proposes that

Answer 53

unknown menstrual endometrium backflows through the fallopian tubes and also somehow enters the local venous and lymphatic systems.

Question 54

Endometrial Carcinoma | The most common early symptoms are

Answer 54

leukorrhea and irregular bleeding, a red flag in postmenopausal women.

Question 55

Polycystic ovarian disease is a common hormonal disorder affecting --------------

Answer 55

5-10% of females of reproductive age.

Question 56

Polycystic ovarian disease The condition was named due to the presence of ------------- in ovaries, resulting in increased size of ovaries and excess production of ------------.

Answer 56

multiple cystic follicles androgens and estrogens

Question 57

Teratomas of the ovary are tumors which develop from differentiation of ----------- into mature tissues which represent all three germ layers: ectoderm, mesoderm, and endoderm.

Answer 57

totipotential germ cells

Question 58

Teratomas | These tumors have a tendency to arise in the ----------, and the earlier onset the greater the likelihood of malignancy.

Answer 58

first two decades of life

Question 59

Teratomas Fortunately, at least 90% of these germ cell neoplasms are -------------. Usually, these cysts contain an ---------- lining with adnexal skin appendages (hair follicles, sebaceous glands, sweat glands), hence the common designation of --------------.

Answer 59

benign mature cystic teratomas epidermal appearing cyst dermoid cysts

Question 60

Teratomas Most are discovered incidentally in young women on abdominal scans or radiography. These tumors often contain

Answer 60

hair, bone, cartilage, bronchial or gastrointestinal epithelium, and even teeth!