Block 14 GI Tumor Polyp Gerd EsophaGItis

16 Questions | Total Attempts: 437

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Block 14 GI Tumor Polyp Gerd EsophaGItis

CTL Week 7 - Diseases of the Esophagus: Dysphagia, GERD, Infectious Esophagitis CTL Week 7 - Additional GI tumors and polyps


Questions and Answers
  • 1. 
    A 45 year old woman presents with dysphasia to solids and a long history of iron deficiency anemia.  Her most likely diagnosis would be:
    • A. 

      Plummer-Vinson syndrome

    • B. 

      Pagophagia

    • C. 

      Schatzski’s ring

    • D. 

      Barrett’s esophagitis

  • 2. 
    A 24 yo HIV positive patient who has had AIDS for 3 years presents with painful swallowing and dysphasia to solids and liquids.  He has no previous history of heart burn or reflux disease.  He recently required a 3 wk course of antibiotics for Pneumocystis carinii pneumonia.  Examination of the pharynx reveals oral thrush.  Barium swallow demonstrates multiple nodular filling defects of various sizes that resemble a “cluster of grapes”.  (see images below)
    • A. 

      Reflux disease

    • B. 

      Schatzski’s ring

    • C. 

      Pneumocystis esophagitis

    • D. 

      Candida esophagitis

  • 3. 
    A 45-year-old man presents with dysphagia.   He says the onset was insidious and his condition is getting worse.  His vital signs are within normal range and there are no significant signs on physical examination. Endoscopy reveals a mass lesion in the middle third of the esophagus.  A biopsy is taken.  Which of the following is the most likely microscopic appearance of this lesion?
    • A. 

      Pleomorphic, anaplastic squamous cells that are hyperchromatic

    • B. 

      Fibroblasts arranged in whorls

    • C. 

      Nests of well-differentiated cells that stain positively for vasoactive amines

    • D. 

      Sheets of “signet ring” cells containing mucus

    • E. 

      Well-differentiated goblet cells arranged in glandular patterns

  • 4. 
    A 45-year-old man has had periodic bouts of extreme vomiting. This photograph is taken from the esophagus of a man with a similar condition.  Which of the following is the best description of this condition? (see image)
    • A. 

      Achalasia

    • B. 

      Barrett esophagus

    • C. 

      Mallory-Weis syndrome

    • D. 

      Esophageal varices

    • E. 

      Squamous cell carcinoma

  • 5. 
    An autopsy was performed on an emaciated 65 year old homeless man who presented to the ER with severe hematemesis.  Image “A” is the "inverted" esophagus from the patient.  Which of the following autopsy findings is the most likely cause of his death? (See Attached colored images)
    • A. 

      Hemorrhagic shock caused by bleeding esophageal varicies

    • B. 

      Adenocarcinoma of the esophagus

    • C. 

      Squamous cell carcinoma of the esophagus

    • D. 

      Mallory Weiss Syndrome

  • 6. 
    M.S. has the following barium swallow: One would expect this patient to have the following symptom:
    • A. 

      Bilious projectile vomiting

    • B. 

      Globus Pharyngeus

    • C. 

      Absolute constipation

    • D. 

      Odynophagia

  • 7. 
    A 53-year-old Caucasian woman presented with a one week history of progressive dysphagia with associated sore throat and voice changes. She initially was having difficulty swallowing solid foods which then progressed to swallowing difficulty with liquids. The patient also noted episodes of bright red blood per rectum in the past. She denied any melena and weight loss. Her only medication use was occasional use of naproxen. Her physical was exam was unremarkable including a negative guaiac exam. Her laboratory findings revealed hemoglobin of 5.7 g/dl and RBC count of 3.2X106/mm3. She subsequently underwent a barium swallow test and esophagogastroscopy.  Peripheral blood smear, esophageal x-ray and endoscopic appearance of the esophagus are shown for you evaluation. Which of the following is the most likely diagnosis?
    • A. 

      Plummer-Vinson syndrome

    • B. 

      Mallory-Weiss syndrome

    • C. 

      Zenker diverticulum

    • D. 

      Achalasia

  • 8. 
    A 39-year-old woman has experienced substernal burning pain following meals for the past 15 years. On physical examination there are no abnormal findings. Upper GI endoscopy is performed and the lower part of the esophagus is shown. Biopsies are performed of this region and microscopic examination shows areas of gastric cardiac-type mucosa and intestinalized mucosa. Which of the following interpretations is most appropriate for this woman's findings?
    • A. 

      Her risk for squamous cell carcinoma is increased

    • B. 

      She has chronic gastroesophageal reflux

    • C. 

      Her anti-centromere antibody test is positive

    • D. 

      Her consumption of alcohol is high

  • 9. 
    A 52-year-old Caucasian male has a history of drinking 1 to 2 liters of whisky per day for the past 20 years. He has had numerous episodes of nausea and vomiting in the past 5 years. He experiences a bout of prolonged vomiting, followed by massive hematemesis. On physical examination in the emergency room, he has vital signs with temperature of 36.8 C, pulse of 110 beats per minute, respiratory rate of 22 breaths per minute, and a blood pressure of 80/40 mm Hg. His heart has a regular rate and rhythm with no murmurs and his lungs are clear to auscultation. There is no abdominal tenderness or distension and bowel sounds are present. His stool is negative for occult blood. Which of the following is the most likely diagnosis?
    • A. 

      Hiatal hernia

    • B. 

      Barrett esophagus

    • C. 

      Esophageal squamous cell carcinoma

    • D. 

      Esophageal laceration (Mallory-Weiss syndrome)

  • 10. 
    A 15-year-old boy is diagnosed with familial adenomatous polyposis.  He asks his physician about his prognosis and what complications he might expect.  Which of the following statements will be the physician’s reply?
    • A. 

      A high incidence of intussusceptions

    • B. 

      Multiple diverticuli

    • C. 

      Obstruction that leads to infarction of the bowel

    • D. 

      Progression to adenocarcinoma

    • E. 

      Perforation leading to localized and sometimes generalized peritonitis

  • 11. 
    An 84-year-old woman presents with upper right quadrant abdominal pain, nausea and vomiting.  Her vital signs are within normal limits and there is slight tenderness on palpation of her abdomen in the right upper quadrant.  Ultrasound reveals a mass in the region of the fundus of the gall bladder.  A biopsy of the mass reveals anaplastic glandular tissue.  The glands are characterized by pleomorphism, hyperchromaticity and a lack of polarity. What is associated with the vast majority of patients with this condition of the gall bladder?
    • A. 

      Biliary cirrhosis as a predisposing condition

    • B. 

      Cholelithiasis as a risk factor

    • C. 

      Cholangiocarcinoma as a predisposing condition

    • D. 

      Hydrops of the gall bladder as a predisposing condition

    • E. 

      Ascending cholangitis as a risk factor

  • 12. 
    A 75-year-old alcoholic and heavy smoker presents to his physician because of progressive dysphagia, first for solids, then for liquids. He also has lost some weight and is regurgitating food. Endoscopy reveals a large, fungating mass 2 cm above the gastroesophageal junction. Biopsy of the mass demonstrates glands, extending into the muscular layer, containing cells with large hyperchromatic nuclei. Which statement is correct about the disease?
    • A. 

      Commonest site is the upper third of esophagus

    • B. 

      Commonest spread of tumor is by venous route

    • C. 

      Esophageal cancers are always primary

    • D. 

      Anaplastic cancers are the commonest histological type

    • E. 

      The patient may have sudden death due to severe hemorrhage

    • F. 

      Chemoradiotherapy is the cornerstone of treatment

    • G. 

      Prognosis of the disease is excellent

  • 13. 
    An autopsy was performed on a 55 year old man who died of a myocardial infarction.  A review of his medical records reveals multiple visits to the ER for vague substernal and epigastric pain.  His autopsy showed a soft hemorrhagic area in the left ventricular septum as well as the gross and microscopic images shown. What is the most likely diagnosis?
    • A. 

      Squamous cell carcinoma of the esophagus

    • B. 

      Adenocarcinoma of the esophagus

    • C. 

      Intestinal or glandular metaplasia of the esophagus

    • D. 

      Adenocarcinoma of the colon

    • E. 

      Squamous cell carcinoma of the anus

  • 14. 
    This section of colon was removed from a patient with a family history of colon cancer and osteomas.  What is the most likely diagnosis?
    • A. 

      Familial polyposis (FAP)

    • B. 

      Gardner syndrome

    • C. 

      Turcot syndrome

    • D. 

      Carcinoid syndrome

    • E. 

      Gastrointestinal lymphoma

  • 15. 
    An 80-year old woman complains of “always feeling tired and dark colored bowel movements”.  Percussion and palpation of the abdomen revealed non-shifting dullness and a mass in the lower right abdominal quadrant. A surgical resection reveals the following images.  The surgeon also noted nodules in the liver which was confirmed microscopically as metastasis to the liver.  What is the most likely diagnosis? (See Attached colored images)
    • A. 

      Adenocarcimoma of the cecum, T4, N2, M1

    • B. 

      Adenocarcinoma of the rectum, T3, N2, M1

    • C. 

      Neuroendocrine tumor of transcending colon, T4, N2, M0

    • D. 

      Neuroendocrine tumor of small intestines, T4, N0, M1

  • 16. 
    The shown images represent three different tubulovillous colon adenomas. Which of them has the highest malignant potential? (A Peutz-Jeghers polyp is shown below for comparison).
    • A. 

      A

    • B. 

      B

    • C. 

      C

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