GI Tract Flashcards
(209 cards)
1
Q
Incomplete relaxation of lower esophageal sphincter in response to swallowing.
A
Achalasia(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 585
2
Q
Destruction of the myenteric plexus of the esophagus, duodenum, colon and ureter caused by a flagellate protozoa.
A
Chagas disease(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 585
3
Q
Causative agent for Chagas disease.
A
Trypanosoma cruzi(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 585
4
Q
Adult with progressive dysphagia to solids and eventually to all foods, caused by a narrowing of the lower esophagus, usually as a result of chronic inflammatory disease.
A
Stenosis(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 585
5
Q
A congenital defect which causes the esophagus to end in a blind-ended pouch.
A
Esophageal atresia(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 585
6
Q
Most common type of esophageal atresia.
A
Esophageal atresia with distal tracheoesophageal fistula(Type C)(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 585
7
Q
Thin membranes of normal esophageal tissue consisting of mucosa and submucosa that can partially obstruct the esophagus.
A
Esophageal web(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 585
8
Q
Congenital esophageal webs commonly appear in which segment of the esophagus?
A
Middle and inferior third of the esophagus(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 585
9
Q
A diverticulum of the mucosa of the pharynx just above the cricopharyngeal muscle.
A
Zenker’s diverticulum(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 586
10
Q
A triangular area in the pharyngeal wall where a Zenker’s diverticulum may develop.
A
Killian’s triangle(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 586
11
Q
Protrusion of the stomach above the diaphragm, creating a bell-shaped dilation, bounded below by the diaphragmatic narrowing.
A
Sliding hernia(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 586
12
Q
Hernia wherein a portion of the stomach, usually along the greater curvature, enters the thorax through the widened space between the muscular crura.
A
Paraesophgeal (rolling) hernia(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 586
13
Q
Longitudinal tears along the gastroesophageal junction seen in chronic alcoholics after a bout of retching or vomiting.
A
Mallory-Weiss tears(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 586
14
Q
Tortuous dilated veins lying within the submucosa of the distal esophagus and proximal stomach due to increased portal pressure, usually due to cirrhosis. May cause massive hemorrhage if ruptured.
A
Esophageal varices(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 587
15
Q
Presence of eosinophils in the epithelial layer, basal zone hyperplasia and elongation of lamina propria papillae are histologic findings in this condition.
A
Reflux esophagitis(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 588
16
Q
Defined as the replacement of the normal distal stratified squamous mucosa by metaplastic columnar epithelium containing goblet cells. A complication of long-standing GERD.
A
Barrett esophagus(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 591
17
Q
Esophageal lesion at risk of developing adenocarcinoma:Reflux esophagitis or Barrett esophagus?
A
Barrett esophagus(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 589
18
Q
Squamous cell carcinoma of the esophagus commonly occur at which segment of the esophagus?
A
Proximal 2/3 of the esophagusAdenocarcinoma- distal 1/3(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 591
19
Q
Most common symptoms of esophageal cancer.
A
Dysphagia and odynophagia(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 591
20
Q
Mucin-producing glandular tumors of the distal esophagus showing intestinal-type features.
A
Adenocarcinoma of the esophagus(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 591
21
Q
Presence of chronic inflammatory changes in the mucosa of the stomach eventually leading to mucosal atrophy and epithelial metaplasia.
A
Chronic gastritis(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 592
22
Q
Most important etiologic association with chronic gastritis. A non-invasive, non-spore forming S-shaped gram negative rod.
A
Helicobacter pylori(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 592
23
Q
Gastritis resulting from production of autoantibodies to the gastric gland parietal cells, leading to gland destruction and mucosal atrophy with loss of acid and intrinsic factor.
A
Autoimmmune gastritis(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 592
24
Q
Refers to the replacement of gastric epithelium with columnar and goblet cells of intestinal variety.
A
Intestinal metaplasia(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 592
25
A acute mucosal inflammatory process of the stomach, marked by mucosal edema and inflammatory infiltrate of neutrophils and chronic inflammatory cells. Regenerative replication of cells in the gastric pit is prominent.
Acute gastritis(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 593
26
One of the major causes of hematemesis, especially in alcoholics.
Acute gastritis(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 593
27
A breach in the mucosa that extends through the muscularis mucosae into the submucosa or deeper.
Ulcers(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 593
28
Breach in the epithelium of the gastrointestinal mucosa only.
Erosions(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 593
29
Chronic, solitary lesions that occur in any portion of the GIT exposed to the aggressive action of acidic peptic juices.
Peptic ulcers(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 594
30
Major cause of peptic ulcer disease in patients without H. pylori disease.
NSAID use(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 595
31
Histologic layers in a chronic, nonperforated, open ulcer.
From luminal surface:NecrosisInflammationGranulation tissueScar(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 596
32
Chief complication of peptic ulcer.
Bleeding(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 596
33
Increases risk of developing gastric adenocarcinoma:Acute gastritis vs. peptic ulcer disease?
Acute gastritisPUD is NOT a premalignant lesion(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 596
34
Acute gastric ulceration which occurs in the presence of extensive burns.
Curling ulcer(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 596
35
Acute gastric ulceration which occurs in the presence of injury to the CNS.
Cushing ulcer(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 596
36
Composed of hyperplastic gastric mucosal epithelium and an inflamed edematous stroma. A mass lesion arising from the mucosa.
Gastric polyp(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 597
37
Most common site of gastric carcinoma within the stomach.
Pylorus and antrum (50-60%), along the lesser curvatureCardia (25%)(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 598
38
What are the two most important factors in the genesis of colonic diverticula?
Focal weakness in the colonic wall and increased intraluminal pressure(TOPNOTCH)
39
Morphologic feature of gastric carcinomas with greatest impact on prognosis.
Depth of invasion(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 599
40
Gastric carcinoma confined to the mucosa and submucosa, regardless of the presence or absence of perigastric LN metastasis.
Early gastric carcinoma(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 599
41
Gastric carcinoma which has extended below the submucosa into the muscular wall.
Advanced gastric carcinoma(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 599
42
Three macroscopic growth patterns of gastric carcinoma.
Exophytic - protrusion of mass into lumenFlat or depressed - no obvious tumor mass within the mucosaExcavated - a shallow or deeply eroded crater(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 599
43
Rigid and thickened stomach, secondary to extensive malignant infiltration.
Linitis plastica(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 599
44
Histologic classification of gastric carcinoma composed of malignant cells forming neoplastic intestinal glands resembling colonic adenocarcinoma. Associated with H. pylori induced chronic gastritis.
Intestinal variant(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 599
45
Histologic classification of gastric carcinoma composed of gastric-type mucous cells that do not form glands but permeate the mucosa and wall as "signet-ring" cells in an infiltrative growth pattern.
Diffuse variant(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 599
46
A malignancy in the ovary that metastasized from a gastric adenocarcinoma.
Krukenberg tumor(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 599
47
Complete failure of development of the intestinal lumen.
Atresia(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 600
48
Narrowing of the intestinal lumen with incomplete obstruction.
Stenosis(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 600
49
Most common intestinal anomaly which results from the failure of involution of the omphalomesenteric duct, leaving a persistent blind-ended tubular protrusion as long as 5-6cm.
Meckel diverticulum(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 600
50
A congenital defect of the periumbillical abdominal musculature that creates a membranous sac, into which intestines herniate.
Omphalocoele(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 600
51
Extrusion of the intestines caused by lack of formation of a portion of the abdominal wall.
Gastroschisis(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 600
52
Condition that prevents the intestines from assuming their normal intra-abdominal positions.
Malrotation(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 600
53
Critical lesion in the development of Hirschprung disease.
Lack of ganglion cells in the muscle wall and submucosa of the affected segment.(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 601
54
Ischemic lesion of the intestines which extends only up to the muscularis mucosae.
Mucosal infarction(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 601
55
Ischemic lesion of the intestines involving the mucosa and submucosa, sparing the muscular wall.
Mural infarction(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 601
56
Ischemic lesion of the intestines involving all of the visceral layers.
Transmural infarct(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 601
57
Most common cause of transmural infarction of the intestines.
Acute occlusion of a major mesenteric artery(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 602
58
Development of sudden abdominal pain out of proportion to the physical signs. Sometimes accomplanied by bloody diarrhea. May progress to shock and vascular collapse within hours.
Ischemic bowel injury(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 602
59
A weakness or defect in the wall of the peritoneal cavity, which permits protrusion of a pouch-like serosa lined sac of peritoneum.
Hernia(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 603
60
A blind pouch that communicates with the lumen of the gut. Histologically describes as small, flask-like or spherical outpouchings, usually 0.5 to 1 cm diameter.
Diverticula(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 602
61
Telescoping of a proximal segment of a bowel into the immediately distal segment
Intussusception(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 604
62
Refers to twisting of a loop of bowel or other structure about its base of attachment, constricting venous outflow and sometimes the arterial supply.
Volvulus(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 604
63
Characterized by transmural inflammation of the bowel, associated with noncaseating granulomas and fistula formation. Intestinal walls are rubbery and thick. (+) skip lesions, creeping fat mesentery
Crohn's disease(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 613
64
An ulceroinflammatory disease of the colon which is limited to the mucosa and submucosa. No granulomas, no skip lesions. High risk of carcinoma development.
Ulcerative colitis(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 614
65
Small, nipple-like, hemispherical, smooth protrusions of the intestinal mucosa. May occur singly or multiple.contains abundant crypts luned by well-differentiated goblet or epithelial cells separated by scant lamina propria.
Hyperplastic polyps(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 617
66
Hamartomatous proliferations mainly of lamina propria, enclosing widely spaced, dilated cystic glands. Occur most frequently in children younger than 5 years old.
Juvenile polyps(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 618
67
Most common type of intestinal adenoma, which are tubular glands with slender stalks and raspberry-like heads composed pf neoplastic epithelium forming branching glands lined by tall, hyperchromatic cells.
Tubular adenomas(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 618
68
Larger, more ominous intestinal epithelial polyp. Tends to occur in older persons at the rectum or rectosigmoid. Sessile, velvety and cauliflower-like mass projecting 1-3cm above the surrounding mucosa. Frondlike villiform extensions covered by dysplastic columnar epithelium.
Villous adenomas(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 618
69
Composed of broad mix of tubular and villous areas, an intermediate between tubular and villous lesions.
Tubulovillous adenomas(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 618
70
Uncommon autosomal dominant disorder with propensity for malignant transformation. Patients with this disease typically develop 500 to 2500 colonic adenomas that carpet the mucosal surface.
Familial adenomatous polyposis(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 619
71
Uncommon hamartomatous polyps associated with melanotic mucosal and cutaneous pigmentation. Caused by germ-line mutations in LKB1 gene.
Peutz-Jeghers syndrome(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 619
72
Polypoid, exophytic masses that extend along the wall of capacious cecum and ascending colon. Symptoms of fatigue, weakness and iron deficiency anemia.
Right sided colorectal carcinoma(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 623
73
Annular, encircling lesions, "napkin-ring" constrictions of the bowel and narrowing of the lumen. Symptoms pf occult bleeding, changes in bowel habit or crampy left lower quadrant discomfort.
Left-sided colorectal carcinoma(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 623
74
Tumor of the small intestines, showing spindle cells with elongated nuclei with fine chromatin and eosinophilic fibrillar cytoplasm. (+) c-KIT gene mutation
Gastrointestinal stromal tumors (GIST)(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 628
75
Most common site of carcinoid tumors.
Small intestine(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 774
76
Tumors arising from endocrine cells along the GIT. Solid, yellow-tan appearance on transection. Neoplastic cells have a scant, pink granular cytoplasm and a round-to-oval stippled nucleus.
Carcinoid tumors(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 627
77
What is the most common ectopic tissue rests seen in the esophagus?
Ectopic Gastric Mucosa seen in the upper third of the esophagus (TOPNOTCH)
78
What is the most common location of Mallory Weiss Tears?
Esophagogastric junction or in the proximal gastric (TOPNOTCH)
79
Definitive diagnosis of Barret Esophagus is made when what type of cells is seen in the columnar mucosa?
Intestinal Goblet Cells(TOPNOTCH)
80
What type of esophagitis presents with punched out linear ulcers with nuclear inclusions seen in degenerating epithelial cells?
Herpesvirus esophagitis(TOPNOTCH)
81
What type of esophagitis presents with linear ulcerations of the esophageal mucosa with histologic findings of intranuclear and cytoplasmic inclusions?
CMV esophagitis(TOPNOTCH)
82
98% of Peptic Ulcers are located in what part of the GIT?
First portion of the anterior part of the duodenum(TOPNOTCH)
83
What is the most common location of gastric ulcer?
Lesser curvature (TOPNOTCH)
84
What is the most common location of gastric carcinoma is?
Pylorus and antrum > Cardia > body and fundus(TOPNOTCH)
85
What is the morphologic feature of gastric carcinoma that has the greatest impact on the clinical outcome?
Depth of invasion(TOPNOTCH)
86
What is the most common primary source of gastric metastasis?
Systemic lymphoma(TOPNOTCH)
87
What is the usual organism that cause spontaneous bacterial peritonitis in patients with nephrotic syndrome?
E. coli(TOPNOTCH)
88
In bacterial peritonitis, approximately how many hours from the time of initiation before there is loss of the gray, glistening quality of the peritoneal surface and it becomes dull and lusterless?
2-4 hours(TOPNOTCH)
89
What is the histologic criterion for the diagnosis of acute appendicitis?
Presence of neutrophilic infiltration of the muscularis propria.(TOPNOTCH)
90
What is the most important prognostic indicator of colorectal carcinoma?
The extent of the tumor at the time of diagnosis or the stage(TOPNOTCH)
91
Morphology: a type of adenoma that has frondlike villiform extensions of the mucosa, covered by dysplastic, sometimes very disorderly columnar epithelium
Villous adenomas(TOPNOTCH)
92
These structures represent islands of inflamed regenerating mucosa surrounded by ulceration
Inflammatory or pseudopolyps(TOPNOTCH)
93
Most adenomas are seen in what part of the GIT?
Ampulla of Vater(TOPNOTCH)
94
Most tubular adenomas are found in what part of the GIT?
Colon(TOPNOTCH)
95
Gross morphology: small, flask like or spherical outpouchings, usually 0.5 to 1 cm and located in the sigmoid colon
Colonic diverticula(TOPNOTCH)
96
Morphology: thin wall composed of flattened or atrophic mucosa, compressed submucosa, and attenuated or totally absent muscularis propria.
Colonic diverticula(TOPNOTCH)
97
What are the two most important factors in the genesis of colonic diverticula?
Focal weakness in the colonic wall and increased intraluminal pressure(TOPNOTCH)
98
What is the most common site of angiodysplasia?
Cecum(TOPNOTCH)
99
Morphology: these are tortuous dilations of submucosal and mucosal blood vessels
Angiodysplasia(TOPNOTCH)
100
What area of the GIT is at greatest risk of ischemic injury?
Splenic flexure(TOPNOTCH)
101
Morphology: diffuse active inflammation with crypt abscess and glandular architectural distortion
Ulcerative Colitis(TOPNOTCH)
102
What is the earliest lesion seen in Crohn Disease?
Focal neutrophilic infiltration into the epithelial layer, particularly overlying mucosal lymphoid aggregates(TOPNOTCH)
103
What is the hallmark of inflammatory bowel disease, both CD and UC?
Chronic mucosal damage(TOPNOTCH)
104
Gross morphology: narrowing of lumen, bowel wall thickening, serosal extension of mesenteric fat, and linear ulceration of the mucosal surface
Crohn disease(TOPNOTCH)
105
What are the two key pathogenic abnormalities seen in Idiopathic Inflammatory Bowel disease?
Strong immune response against normal flora and defects in epithelial barrier function(TOPNOTCH)
106
Gross morphology: intestinal wall is rubbery and thick, as a consequence of edema, inflammation, fibrosis and hypertrophy of the muscularis propria
Crohn disease(TOPNOTCH)
107
Morphology: small intestinal mucosa laden with distended macrophages in the lamina propria which are PAS positive and contains numerous bacilli and diastase resistant granules
Whipple disease(TOPNOTCH)
108
Intestinal lipodystrophy is associated with what disease entity?
Whipple disase(TOPNOTCH)
109
Morphology: diffuse severe atrophy and blunting of villi, with a chronic inflammatory infiltrate in the lamina propria
Celiac disease(TOPNOTCH)
110
Morphology: focal crypt cell necrosis or apoptosis with minimal to absent inflammatory cell response in the lamina propria
Acute GVHD(TOPNOTCH)
111
Morphology: marked blunting of the small intestinal villi with a mixed inflammatory infiltrate resembling the atrophic stage of celiac disease
Giardiasis(TOPNOTCH)
112
Morphology: superficial erosion of the mucosa and an adherent pseudomembrane of fibrin, mucus, and inflammatory debris
Pseudomembranous colitis(TOPNOTCH)
113
Morphology: small intestinal mucosa usually exhibits modestly shortened villi and infiltration of the lamina propria by lymphocytes
Viral gastroenteritis(TOPNOTCH)
114
What virus affecting the GIT can produce a flat mucosa resembling celiac sprue?
Rotavirus(TOPNOTCH)
115
Morphology: characterized by the absence of ganglion cells and ganglia in the muscle wall and submucosa of the affected segment
Hirchsprung Disease/Congenital Aganglionic Megacolon(TOPNOTCH)
116
Stercoral ulcers are seen in what disease entity?
Hirchsprung Disease/Congenital Aganglionic Megacolon(TOPNOTCH)
117
The majority of these tumors are positive for c-KIT (CD 117)
Gastrointestinal Stromal Tumor(TOPNOTCH)
118
What is the most common site of gastric carcinoma?
Pylorus and antrum 50%-60%(TOPNOTCH)
119
What is the most favored site of gastric carcinoma?
lesser curvature of the anthropyloric region(TOPNOTCH)
120
What is the most common type of gastric polyp?
Hyperplastic polyp(TOPNOTCH)
121
In gastritis, histologically, what signifies an active inflammation?
Presence of neutrophils above the basement membrane.(TOPNOTCH)
122
H. pylori infection in duodenal ulcers is present in about how many percent of patients?
Virtually ALL (70% in patients with gastric ulcer(TOPNOTCH)
123
Most common site of diverticulitis
Sigmoid colon (TOPNOTCH) Robbins Pathologic Basis of Disease, 9th ed., p. 803
124
A 10 y/o male presented with recurrent painless rectal bleeding with no other associated symptoms. PE findings were unremarkable. The abdomen was soft, non tender, with no palpable mass. What is the clinical impression?
Meckel Diverticulum (TOPNOTCH)
125
Most common site of Meckel Diverticulum
Antimesenteric border of ileum (TOPNOTCH)
126
True or False. Meckel diverticulum is a true diverticulum
True (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 751
127
Most common site of acquired diverticula.
Sigmoid colon (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 751
128
The most common true diverticulum
Meckel Diverticulum (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 751
129
A 3 week old male infant presented to the ER due to vomiting. Mother denies bilious or bloody emesis. Mother states he is always hungry and vomits after nearly every bottle. PE reveals firm, ovoid, 2 cm abdominal mass. What is the most likely diagnosis?
Pyloric stenosis (TOPNTOCH)
130
Pathology of Pyloric stenosis
Hyperplasia of pyloric muscularis propria (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 751
131
Pyloric is more common in male or female?
3-5x more common in male (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 751
132
A 3-day-old infant presented with emesis and failure to pass meconium for the first 36 hours. PE revealed a moderately distended abdomen. Bowel sound are active. No organs or abdominal masses were palpated. Anus was patent. What is the clinical impression?
Hirchsprung's Disease (TOPNOTCH)
133
Most important diagnostic test in Hirchsprung Disease
Rectal biopsy (TOPNOTCH)
134
Histologic findings in Hirchsprung Disease
Absence of ganglion cells in the submucosal and myenteric plexuses.(and hypertrophic extrinsic nerve fibers) (TOPNOTCH)
135
Typically presentes with failure to pass mecondium in the immediate postnatal period, followed by obstruction or constipation, often with visible ineffective peristalsis, progressing to abdominal distention and bilious vomiting.
Hirchsprung's Disease(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 752
136
Most frequent site of ectopic gastric mucosa
Upper third of esophagus (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 750
137
Aganglionic segment of the colon presents with distention or contracted appearance?
Grossly normal or contracted appearance. Normal proximal colon-dilated. (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 752
138
Dysphagia, regurgitation of undigested food, aspiration, and halitosis strongly suggest diagnosis of ______.
Zenker diverticulum (TOPNOTCH)
139
It is characterized by the triad of incomplete LES relaxation, increased LES tone, and aperistalsis of the esophagus
Achalasia(TOPNOTCH) Robbins Basic Pathology, 9th ed., p.753
140
Patient presented with dysphagia for both solid and liquid, difficulty in belching, and chest pain. The esophageal obstruction is most likely caused by?
Impaired smooth muscle relaxation of LES (Case of Achalasia) (TOPNOTCH)
141
It is the result of distal esophageal inhibitory neuronal/ganglion cell degeneration.
Primary achalasia (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 753
142
Characterized by transmural tearing and rupture of the distal esophagus. Patients present with severe chest pain, tachypnea and shock.
Boerhaave syndrome. (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 754
143
Most frequent cause of esophagitis
Reflux of gastric contents in the lower esophagus. (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 755
144
Most common cause of gastroesophageal reflux
Transient lower esophageal sphincter relaxation. (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 755
145
Severe form of this condition may have histologic finding of eosinophils recruited into the squamous mucosa followed by neutrophils. Basal zone hyperplasia and elongation of lamina propria papillae of the esophagus may be present.
GERD (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 755
146
Barrett esophagus confers an increased risk of what cancer?
Esophageal adenocarcinoma (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 757
147
A 55 y/o patient with a chronic history of heartburn and acid regurgitation underwent EGD, and revealed patches of red, velvety mucosa with interface of light-brown columnar epithelium with goblet cells. He is at risk for developing___.
Esophageal adenocarcinoma. This is a case of Barret esophagus. (TOPNOTCH)
148
Patient presented with odynophagia, dysphagia, progressive weight loss, chest pain and vomiting. A 5 cm mass was noted at the distal 3rd of the esophagus, which ulcerate and invade deeply. The most likely diagnosis is
Esophageal adenocarcinoma. It usually occurs in the distal 3rd of esophagus. (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 758
149
Most common site of volvulus
Sigmoid colon(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 778
150
Most common cause of intestinal obstruction in children younger than 2 years of age
Intussusception(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 778
151
Presents with sudden onset of cramping, left lower abdominal pain, a desire to defecate, and passage of blood or bloody diarrhea.
Acute colonic ischemia(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 780
152
Most common acquired GI emergency of neonates, particularly those who are premature or of low birth weight.
Necrotizing enterocolitis(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 780
153
Immune-mediated enteropathy triggered by ingestion of gluten-containing food in genetically predisposed individual
Celiac disease/Celiac sprue/Gluten-sensitive enteropathy(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 782
154
Most sensitive test for Celiac sprue
IgA antibodies against tissue transglutaminase(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 783
155
Most common bacterial enteric pathogen; an important cause of traveler's diarrhea
Campylobacter jejuni(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 786
156
Watery diarrhea associated with ingestion of improperly cooked chicken, unpasteurized milk or contaminated water. It is an important bacterial cause of food poisoning.
Campylobacter enterocolitis(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 786
157
Diagnosis of Campylobacter enterocolitis, stool culture or biopsy?
Stool culture(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 787
158
Presents with 1 week of diarrhea, fever, and abdominal pain, constitutional symptoms for about 1 month. May also present with waxing and waning diarrhea. Caused by gram-negative, facultative anaerobe.
Shigellosis(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 787
159
Complications of Shigella infection(Triad)
Sterile reactive arthritis, urethritis, and conjunctivitis.(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 788
160
Infection by a gram-negative bacilli causing diarrhea, common in young children and older adults by ingestion of contaminated food, particularly raw or undercooked meat, poultry, eggs, and milk.
Salmonella(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 789
161
Patients with sickle cell disease are particularly susceptible to osteomyelitis caused by:
Salmonella(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 789
162
The principal cause of traveler's diarrhea
Enterotoxigenic E. Coli(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 790
163
Mechanism of diarrhea in this infection : adenylate cyclase activation, increase intracellular cAMP, opens CFTR to drive chloride secretion and diarrhea.
Cholera(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 785
164
Most common etiologic agent causing pseudomembranous colitis/antibiotic-associated colitis.
Clostridium difficile(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 791
165
Most frequent complication of Peptic ulcer disease
Bleeding(TOPNOTCH)Robbins Basic Pathology, 9th Ed p. 768
166
Most frequent etiology of noninfectious chronic gastritis
Autoimmmune gastritis(TOPNOTCH)Robbins Basic Pathology, 9th Ed p. 768
167
Characterized by irregular enlargement of gastric rugae associated with excessive secretion of TFG-alpha.
Menetrier disease(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 768
168
Syndrome most commonly found in the small intestine or pancreas, caused by gastrin-secreting tumors; most remarkable feature is doubling of oxyntic mucosal thickness
Zollinger-Ellison Syndrome(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 769
169
Most common site of gastric adenoma in the stomach
Antrum(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 770
170
Most common malignancy of the stomach
Adenocarcinoma(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 771
171
Most common type of cancer the predominates in high-risk areas and develops from flat dysplasia and adenomas
Intestinal-type gastric cancer(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 772
172
Most common site of extranodal lymphoma
Stomach(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 773
173
Most common inducer of MALToma in the stomach
H. pylori(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 773
174
GI Tumor characterized by cutaneous flushing, sweating, bronchospasm, colicky abdominal pain, diarrhea, and right-sided cardiac valvular fibrosis.
Carcinoid tumor(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 774
175
The most common mesenchymal tumor of the abdomen
GI stromal tumor(GIST) tumor(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 775
176
The most important prognostic factor for GI Carcinoid tumor
Location(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 775
177
Most common site of GIST
Stomach(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 777
178
Most frequent cause of intestinal obstruction
Hernias(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 777
179
Most common sites of ischemic bowel disease
Splenic flexure, sigmoid colon, rectum(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 784
180
Autosomal recessive disorder presenting with explosive diarrhea with watery, frothy stools, and abdominal distention.
Congenital lactase (disaccharidase) deficiency(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 784
181
IBD presenting with thick wall appearance, transmural inflammation, skip lesions, knife-like ulcer, marked fibrosis and serositis
Crohn disease(TOPNOTCH)Robbins Basic Pathology, 9th ed., . 797
182
IBD which may presents with thin wall appearance, inflammation limited only to mucosa, marked pseudopolyps, broad-based ulcer, moderate lymphoid reaction, and toxic megacolon (complication)
Ulcerative colitis(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 797
183
Most important characteristic of colorectal adenomas that correlates with risk of malignancy.
Size of the tumor(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 808
184
An autosomal dominant disorder in which patients develop numerous colorectal adenomas as teenager caused by mutation of APC
Familial adenomatous polyposis(TOPNOTCH)Robbins Basic Pathology, 9th Ed p. 809
185
Most common syndromic form of colon cancer; colon cancers tend to occur at younger ages
HNPCC or Lynch syndrome(TOPNOTCH)Robbins Basic Pathoogy, 9th ed., p. 809
186
Most common location of HNPCC
Right colon(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 809
187
Autosomal dominant disorder characterized by familial clustering of cancers at several sites caused by DNA mismatch repair
HNPCC or Lynch syndrome(TOPNOTCH)Robbins Basic Pathoogy, 9th ed., p. 809
188
Location of colorectal cancer presenting with fatigue and weakness due to iron deficiency anemia
Right-sided colorectal carcinoma(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 623
189
Most common site of metastasis of colorectal adenocarcinoma
Liver(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 813
190
Which of the following statements regarding oral plaques is TRUE? (A) leukoplakia has a strong association with tobacco use (B) among the oral leukoplakias, those on the floor of the mouth have the highest rate of transformation to squamous cell carcinoma (C) hairy leukoplakia in AIDS patients have a high risk of malignant transformation (D) erythroplakia is less likely to undergo malignant transformation than leukoplakia
leukoplakia has a strong association with tobacco use (TOPNOTCH)Robbins Basic Pathology, 8th Ed pp 581-82
191
Which of the following is the most common site of oral cavity carcinoma? (A) lateral orders of the mobile tongue (B) floor of mouth (C) vermilion border of the lateral margins of the lower lip (D) hard palate
Vermillion border of the lateral margins of the lower lip(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 582
192
A 28 year old man presents with a 5 year history of a slow growing, painless, preauricular mass. FNAB showed clusters of bland cells admixed with myxoid material. He undergoes parotidectomy, and histopathologic examination of the mass shows bland epithelial cells forming clusters, ducts, and sheets, with surrounding myxoid stroma. There are also islands of cartilage. His tumor (A) can metastasize (B) is a chondrosarcoma (C) is the commonest tumor of the parotid gland (D) does not undergo malignant transformation
is the commonest tumor of the parotid gland (pleomorphic adenoma) (TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 584
193
A 55 year old male smoker undergoes parotidectomy for a cystic mass. Histopathology shows cystic spaces lined by abranching, two-tiered layer of epithelial cells, with well developed lymphoid tissue right beneath the lining. This tumor is thought to arise from (A) respiratory epithelium (B) heterotopic salivary tissue trapped within a lymph node (C) myoepithelial cells (D) macrophages
heterotopic salivary tissue in a lymph node (Warthin tumor) (TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 585.
194
A 60 year old chronic alcoholic man suddenly has massive hematemesis and dies. At autopsy, his lower esophagus shows bluish, dilated veins in the submucosa with surrounding erythema. One of the veins is ruptured. Which of the following is expected of his liver? (A) smaller than normal, firm, with nodular external surface (B) markedly enlarged, with multiple hemorrhages on cut section (C) smaller than normal, with a nutmeg appearance on cut section (D) markedly enlarged, with a greasy yellowish cut surface
smaller than normal, firm, with a nodular external surface (cirrhosis) (TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 587
195
A 24 year old female complains of heartburn, usually following spicy or sour meals. She takes antacids, with partial relief. She undergoes endoscopy where her lower esophagus appears diffusely erythematous with some epithelial erosions. A biopsy showed eosinophils in the epithelial layer, with basal zone hyperplasia. This is (A) reflux esophagitis (B) Barrett esophagus (C) esophageal candidiasis (D) squamous cell carcinoma
Reflux esophagitis(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 588
196
A 33 year old man with a 10 year history of intermittent heartburn undergoes endoscopy, where his lower esophagus appears salmon-pink and velvety. Biopsy of the velvety area shows an epithelium composed of columnar cells with dark basal nuclei, and interspersed goblet cells. Compared to the normal population, this man has a 30- to 100-fold greater risk of developing (A) lymphoma (B) squamous cell carcinoma (C) adenocarcinoma (D) carcinoid
adenocarcinoma of the esophagus(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 581
197
Which is the most common site of esophageal squamous cell carcinoma? (A) cervical (B) upper thoracic (C) middle third (D) distal third
middle third (TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 590
198
What is the most important etiologic association of chronic gastritis? (A) Helicobacter pylori (B) Smoking (C) Alcohol abuse (D) NSAIDS
Helicobacter pylori(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 592
199
The histologic changes in chronic gastritis may predispose to the development of (A) squamous cell carcinoma and adenocarcinoma (B) adenocarcinoma and lymphoma (C) lymphoma and gastrointestinal stromal tumour (D) gastroinstestinal stromal tumor and squamous cell carcinoma
adenocarcinoma and lymphoma (TOPNOTCH)Robbins Basic Pathology, 8th Ed p.592
200
A 34 year old triathlete on chronic NSAIDs consults for chronic epigastric pain. An endoscopy showed a punched out, 2cm diameter ulcer in the duodenum, with perpendicular margins, extending into the submucosa. If a biopsy is performed, arrange the following layers from internal to external: (A) inflammation (B) necrosis (C) scar (D) granulation tissue
necrosis, inflammation, granulation tissue, scar (TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 596
201
A 25 year old man who suffered from a scalding burn, 80% of his body surface area, is admitted. In the burn unit, coffee ground material is observed in his NGT. Which of the following describes the type of gastric ulcer expected? (A) multiple,
multiple,
202
Which of the following gastric polyps is a true neoplasm? (A) hyperplastic polyp (B) hypoplastic polyp (C) fundic gland polyp (D) adenoma
adenoma (TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 597-598
203
Which of the following is a known risk factor for the diffuse type of gastric adenocarcinoma? (A) intestinal metaplasia (B) dietary nitrites (C) E-cadherin mutation (D) Her2-neu amplification
E cadherin mutation (all other choices are risk factors for intestinal type) (TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 598
204
Why do infants and children with Meckel diverticulum often present with melena? (A) the mucosa of the diverticulum is highly vascular (B) the diverticulum may have functioning gastric mucosa (C) patients with Meckel diverticulum have an increased likelihood of developing adenomas that can bleed (D) Meckel diverticulum is susceptible to Entamoeba histolytica infection
the diverticulum may have functioning gastric mucosa (TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 600
205
A 3 month old female with a perinatal history of delayed passage of meconium presents with alternating diarrhea and constipation. Imaging studies show a dilated cecum, ascending and transverse colon. The remaining distal colon is not dilated. Which of the following biopsy findings confirms Hirschprung disease? (A) absence of ganglion cells in the sigmoid (B) presence of ganglion cells in the transverse colon (C) presence of ganglion cells in the cecum (D) presence of ganglion cells in the descending colon
absence of ganglion cells in the sigmoid (TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 601
206
A 65 year old diabetic suffers an acute MI and is admitted at the ICU. The next day, he develops severe abdominal pain and melena, and dies a few hours later. Autopsy showed a dark red jejunum and ileum. Examination of one of the mesenteric artery branches shows 95% narrowing by atherosclerosis. Which of the following is the expected histologic finding of the affected bowel? (A) increased mitotic rate in mucosal crypts, decreased maturation of surface epithelial cells, variable neutrophilic infiltration (B) hemorrhagic and necrotic mucosa and submucosa with sloughing off of epithelium (C) tortuous mucosal and submucosal vessels (D) flask like submucosal ulcers filled with necrotic debris
hemorrhagic and necrotic mucosa and submucosa with sloughing off of epithelium (TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 602
207
Which of the following features of intestinal adenomas is the main determinant of risk of harboring an adenocarcinoma? (A) size (B) histologic architecture (C) severity of dysplasia (D) degreee of inflammation
size (TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 618
208
Which of the following is most likely affected by Familial Adenomatous Polyposis? (A) 44 year old female with 150-160 tubular adenomas in the colon (B) 65 year old male with 20-30 tubulovillous adenomas in the colon (C) 54 year old female with 120-130 hyperplastic polyps in the colon (D) 13 year old male with 30-40 hamartomatous polyps in the colon
44 year old female with 150-160 tubular adenomas in the colon (minimum of 100 colonic adenomas) (TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 619
209
Carcinoids in which of the following location is least likely to have metastasized at the time of diagnosis? (A) appendix (B) ileum (C) stomach (D) colon
appendix (also, rectum) (TOPNOTCH)Robbins Basic Pathology, 8th Ed p.626
