Inflammatory Bowel Disease refers to what two closely related but distinct diseases?

Crohn's Disease and Chronic Ulcerative Colitis

Gastric Adenocarcinoma and Iflammatory Bowel Syndrome

Crohn's Disease and Cholecystitis

Peptic Ulcer Disease and Crohn's Disease

Crohn's Disease and Chronic Ulcerative Colitis

Inflammatory Bowel Syndrom and Peptic Ulcer Disease

Which of the following is true about CUC as compared to Crohn's Disease in Western Countries?

CUC is 2-3 times more prevalent than Crohn's Disease.

CUC has a prevalence of 20-40/100,000 while Crohn's has a prevalence of 70-150/100,000.

CUC is 2-3 times more prevalent than Crohn's Disease.

Crohn's disease is 2-4 times more prevalent than CUC.

CUC has a prevalence of 10/100,000 while Crohn's has a prevalence of 1/100,000.

A 32 year old white patient of Eastern European descent presents with chronic GI inflammation. The patient has a family history of Crohn's Disease. What is your initial diagnosis?

Chronic Ulcerative Colitis (CUC)

What is the correct order for the most common place of occurance for Crohn's Disease?

In 50% of cases, the disease affects both the terminal ileum and colon. In 30%, only the ileum, and in 20% of cases, limited to the colon.

In 50% of cases, the disease affects the colon only. In 30% of cases, both the colon and the terminal ileum, and in 20% of cases, limited to the terminal ileum.

In 75% of cases, the disease affects both the terminal ileum and the colon. In the remainding 25%, the disease afflicts only the colon.

In 95% of cases, the disease affects only the terminal ileum. The remainding 5% occurs in the Duodenum.

In 50% of cases, the disease affects both the duodenum and the terminal ileum. In 30%, it affects the colon and the rectum. And in 20% of cases, only the colon.

Which answer best describes Peyer's Patches?

Shallow mucosal defects overlying lymphoid aggregets which suggest immune cell involvement seen in Crohn's disease.

Inflammation extending through the entire wall of the intestine forming patch-like designs seen in Crohn's disease.

Non-caseating granulomas within the mucosa and submucosa associated with fibrosis of the muscularis and the serosa seen in Crohn's disease.

Creeping fat on the surface of the mucosa seen in CUC.

Creeping fat on the surface of the mucosa arranged in a patch-like formation seen in Crohn's disease.

Shallow mucosal defects overlying lymphoid aggregets which suggest immune cell involvement seen in Crohn's disease.

In Crohn's Disease, what leads to the formation of a fistula?

Inflammation of the serosa leading to adhesions with adjacent intestinal loops.

The narrowing of the fibrotic intestines causing stricture.

Inflammation of the serosa leading to adhesions with adjacent intestinal loops.

Shallow mucosal defects overlying lymphoid aggregates.

Cobblestone appearance interspersed between more normal appearing mucosa.

What are the most common symptoms associated with Crohn's Disease?

Diarrhea, abdominal pain, and weight loss characterized by exacerbations and remissions.

Bleeding, rectal involvement, and fever.

Fever and constipation, associated with chronic exacerbations.

Nasea, heartburn, indigestion, upset stomach, diarrhea.

Diarrhea, abdominal pain, and weight loss characterized by exacerbations and remissions.

Diagnostic tools used to identify Crohn's Disease include:

Colonoscopy, X-ray, and mucosal biopsy

Ultra Sound, Colonoscopy, X-ray

X-ray, mucosal biopsy, HIDA scan.

This picture depicts:

Crohn's disease-cobblestone mucosa and creeping fat

CUC with transmural inflammation

Crohn's disease-cobblestone mucosa and creeping fat

Crohn's disease with rubber hose fibrosis

CUC with raw, ulcerated hemorrhagic mucosa.

Which of the following is NOT true of Ulcerative Colitis?

A disease leading to the involvement of the colon which is typically segmental.

A diffuse disease that does not usually extend into the ileum aside from mild inflammation of the terminal ileum ("backwash ileitis")

Initially starts as rectal lesions and spreads proximally, eventually involving the entire colon.

A disease leading to the involvement of the colon which is typically segmental.

An Intestinal Inflammation of unknown etitology that most often involves the colon.

A disease typically limited to thecolonic mucosa and submucosa.

The earliest lesions in CUC (visualized by rectoscope and colonoscope) appear as flattened edematous patches involving the entire circumfrence of the colonic mucosa. What does the mucosa appear like?

Sandpaper, friable, and prone to bleeding.

Thick, purulent, and prone to bleeding

Shows cobblestone pattern with creeping fat.

Prone to deep fissures penetrating into the muscle wall.

Sandpaper, friable, and prone to bleeding.

What causes the Inflammatory Pseudopolyps (false tumors) usually seen in CUC?

Small remnants of inlfammed mucosa that appear to be elevated over the base of the surrounding ulcerations

They are due to neoplastic epithelium that show no evidence of normal differentiation.

Small remnants of inlfammed mucosa that appear to be elevated over the base of the surrounding ulcerations

Dilated glands due to the obstructed flow of mucus.

Invading aliens pushing through the lumen trying to make their way into the vasculature.

What does the following picture show?

Colonic ulcerations that spread through the entire colon and become confluent during ulcerative colitis known as serpiginous ulcerations.

Small remnants of inflammed mucosa that appear to be elevated over the base of the surrounding ulcerations known as inflammatory pseudopolyps.

Atrophy of the crypts with aggregates of lymphocytes in the base of the crypts known as crypt abscesses.

Mild inflammation of the terminal ileum that can occur in CUC known as backwash ileitis.

Colonic ulcerations that spread through the entire colon and become confluent during ulcerative colitis known as serpiginous ulcerations.

What diagnostic tools/tests would you use to confirm the diagnosis of a disease that causes a thin colonic wall which predisposes the patient to intestianal dilation and toxic megacolon with chance of perforation creating an increased risk for cancer?

Clinical, radiographic, and pathologic evaluation.

Patho 1st Lecture, 2nd Half

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PA school pathophysiology quiz. Relating to GI system patho

Questions and Answers

1.

Inflammatory Bowel Disease refers to what two closely related but distinct diseases?
- A.
  
  Gastric Adenocarcinoma and Iflammatory Bowel Syndrome
- B.
  
  Crohn's Disease and Cholecystitis
- C.
  
  Peptic Ulcer Disease and Crohn's Disease
- D.
  
  Crohn's Disease and Chronic Ulcerative Colitis
- E.
  
  Inflammatory Bowel Syndrom and Peptic Ulcer Disease
Correct Answer
D. Crohn's Disease and Chronic Ulcerative Colitis

Explanation
Crohn's Disease and Chronic Ulcerative Colitis are two closely related but distinct diseases that fall under the category of Inflammatory Bowel Disease. Crohn's Disease is a chronic inflammatory condition that can affect any part of the digestive tract, while Chronic Ulcerative Colitis specifically involves inflammation and ulcers in the colon and rectum. Both conditions share similar symptoms such as abdominal pain, diarrhea, and weight loss, but they differ in terms of the areas of the digestive tract that are affected.

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2.

Which of the following is true about CUC as compared to Crohn's Disease in Western Countries?
- A.
  
  CUC has a prevalence of 20-40/100,000 while Crohn's has a prevalence of 70-150/100,000.
- B.
  
  CUC is 2-3 times more prevalent than Crohn's Disease.
- C.
  
  Crohn's disease is 2-4 times more prevalent than CUC.
- D.
  
  CUC has a prevalence of 10/100,000 while Crohn's has a prevalence of 1/100,000.
Correct Answer
B. CUC is 2-3 times more prevalent than Crohn's Disease.

Explanation
The correct answer is CUC is 2-3 times more prevalent than Crohn's Disease. This means that the prevalence of CUC (20-40/100,000) is higher compared to the prevalence of Crohn's Disease (70-150/100,000). The answer indicates that CUC is more commonly found in Western countries than Crohn's Disease.

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3.

A 32 year old white patient of Eastern European descent presents with chronic GI inflammation. The patient has a family history of Crohn's Disease. What is your initial diagnosis?
- A.
  
  Crohn's Disease
- B.
  
  Inflammatory Bowel Syndrome
- C.
  
  Inflammatory Bowel Disease
- D.
  
  Chronic Ulcerative Colitis (CUC)
- E.
  
  Diverticulosis
Correct Answer
C. Inflammatory Bowel Disease

Explanation
In the early stages, both diseases have morphologic changes often indistinguishable from each other. Furthermore, in some cases, familial disposition has been shown to include both diseases.

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4.

What is the correct order for the most common place of occurance for Crohn's Disease?
- A.
  
  In 50% of cases, the disease affects both the terminal ileum and colon. In 30%, only the ileum, and in 20% of cases, limited to the colon.
- B.
  
  In 50% of cases, the disease affects the colon only. In 30% of cases, both the colon and the terminal ileum, and in 20% of cases, limited to the terminal ileum.
- C.
  
  In 75% of cases, the disease affects both the terminal ileum and the colon. In the remainding 25%, the disease afflicts only the colon.
- D.
  
  In 95% of cases, the disease affects only the terminal ileum. The remainding 5% occurs in the Duodenum.
- E.
  
  In 50% of cases, the disease affects both the duodenum and the terminal ileum. In 30%, it affects the colon and the rectum. And in 20% of cases, only the colon.
Correct Answer
A. In 50% of cases, the disease affects both the terminal ileum and colon. In 30%, only the ileum, and in 20% of cases, limited to the colon.

Explanation
Crohn's Disease commonly occurs in different parts of the gastrointestinal tract. The correct order for the most common places of occurrence for Crohn's Disease is as follows: In 50% of cases, the disease affects both the terminal ileum and colon. In 30% of cases, it affects only the ileum, and in 20% of cases, it is limited to the colon. This means that the majority of cases involve both the terminal ileum and colon, followed by cases involving only the ileum, and a smaller percentage limited to the colon.

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5.

True or False: The appendix is involved in most cases of Crohn's Disease.
- A.
  
  True
- B.
  
  False
Correct Answer
A. True

Explanation
The appendix is a small pouch-like organ attached to the large intestine. While it was previously believed to have no significant function, recent studies suggest that the appendix may play a role in the immune system, specifically in the storage and maturation of beneficial gut bacteria. Crohn's Disease is a chronic inflammatory bowel disease that can affect any part of the digestive tract, including the appendix. Although not all cases of Crohn's Disease involve the appendix, it is involved in a significant number of cases. Therefore, the statement "The appendix is involved in most cases of Crohn's Disease" is true.

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6.

True or False: 10% of patients with Crohn's Disease have involvement of the esophagus, stomach, or fallopian tubes.
- A.
  
  True
- B.
  
  False
Correct Answer
B. False

Explanation
1-2% of patients with Crohn's disease have involvement of the esophagus, stomach, or fallopian tubes.

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7.

Which answer best describes Peyer's Patches?
- A.
  
  Inflammation extending through the entire wall of the intestine forming patch-like designs seen in Crohn's disease.
- B.
  
  Non-caseating granulomas within the mucosa and submucosa associated with fibrosis of the muscularis and the serosa seen in Crohn's disease.
- C.
  
  Creeping fat on the surface of the mucosa seen in CUC.
- D.
  
  Creeping fat on the surface of the mucosa arranged in a patch-like formation seen in Crohn's disease.
- E.
  
  Shallow mucosal defects overlying lymphoid aggregets which suggest immune cell involvement seen in Crohn's disease.
Correct Answer
E. Shallow mucosal defects overlying lymphoid aggregets which suggest immune cell involvement seen in Crohn's disease.

Explanation
The correct answer describes Peyer's Patches as shallow mucosal defects overlying lymphoid aggregates, which suggest immune cell involvement seen in Crohn's disease. This explanation indicates that Peyer's Patches are areas of the intestinal mucosa that have been damaged and show signs of immune cell activity. This is a characteristic feature of Crohn's disease, a chronic inflammatory condition that primarily affects the gastrointestinal tract.

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8.

Sharply demarcated non-caseating granulomas within the mucosa and submucosa, associated with fibrosis of the muscularis and the serosa causing the wall to be thickened and rigid describes which characteristic sign of Crohn's Disease?
- A.
  
  Peyer's Patches
- B.
  
  Skip Lesions
- C.
  
  Transmural inflammation
- D.
  
  Rubber-hose fibrosis
- E.
  
  Cobblestoning
Correct Answer
D. Rubber-hose fibrosis

Explanation
Rubber-hose fibrosis refers to the fibrosis of the muscularis and serosa layers of the intestinal wall in Crohn's disease. This fibrosis causes the wall to become thickened and rigid. The presence of sharply demarcated non-caseating granulomas within the mucosa and submucosa, along with the associated fibrosis, is a characteristic sign of Crohn's disease. This description aligns with the concept of rubber-hose fibrosis in Crohn's disease.

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9.

In Crohn's Disease, what leads to the formation of a fistula?
- A.
  
  The narrowing of the fibrotic intestines causing stricture.
- B.
  
  Anal involvement.
- C.
  
  Inflammation of the serosa leading to adhesions with adjacent intestinal loops.
- D.
  
  Shallow mucosal defects overlying lymphoid aggregates.
- E.
  
  Cobblestone appearance interspersed between more normal appearing mucosa.
Correct Answer
C. Inflammation of the serosa leading to adhesions with adjacent intestinal loops.

Explanation
In Crohn's Disease, the formation of a fistula is caused by inflammation of the serosa, which leads to adhesions with adjacent intestinal loops. This inflammation can result in the formation of abnormal connections between different parts of the intestine or between the intestine and other organs, creating fistulas. These fistulas can cause complications such as infection, abscesses, and the passage of stool or bacteria into other areas of the body.

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10.

True or False: Anal involvement in Crohn's disease is often associated with formation of fistulas as well as abscesses.
- A.
  
  True
- B.
  
  False
Correct Answer
B. False

Explanation
Anal involvement in Crohn's Disease is often associated with the formation of fissures as well as abscesses.

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11.

What are the most common symptoms associated with Crohn's Disease?
- A.
  
  Bleeding, rectal involvement, and fever.
- B.
  
  Fever and constipation, associated with chronic exacerbations.
- C.
  
  Nasea, heartburn, indigestion, upset stomach, diarrhea.
- D.
  
  Diarrhea, abdominal pain, and weight loss characterized by exacerbations and remissions.
- E.
  
  Nausea, vomitting, and fever.
Correct Answer
D. Diarrhea, abdominal pain, and weight loss characterized by exacerbations and remissions.

Explanation
Bleeding is more common in patients with rectal involvement and fever only occurs in 1/3 of patients.

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12.

Diagnostic tools used to identify Crohn's Disease include:
- A.
  
  Endoscopy and liver biopsy
- B.
  
  Colonoscopy, X-ray, and mucosal biopsy
- C.
  
  Ultra Sound, Colonoscopy, X-ray
- D.
  
  CT scan, Endoscopy, biopsy
- E.
  
  X-ray, mucosal biopsy, HIDA scan.
Correct Answer
B. Colonoscopy, X-ray, and mucosal biopsy

Explanation
Colonoscopy, X-ray, and mucosal biopsy are diagnostic tools commonly used to identify Crohn's Disease. Colonoscopy allows doctors to examine the entire colon and rectum, looking for signs of inflammation, ulcers, or other abnormalities. X-ray imaging can help identify areas of inflammation or narrowing in the digestive tract. Mucosal biopsy involves taking small tissue samples from the lining of the digestive tract to examine for inflammation and other characteristic features of Crohn's Disease. By combining these three diagnostic methods, doctors can gather comprehensive information to confirm the presence of Crohn's Disease and determine the extent and location of the inflammation.

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13.

This picture depicts:
- A.
  
  CUC with transmural inflammation
- B.
  
  Crohn's disease-cobblestone mucosa and creeping fat
- C.
  
  Crohn's disease with rubber hose fibrosis
- D.
  
  CUC with raw, ulcerated hemorrhagic mucosa.
Correct Answer
B. Crohn's disease-cobblestone mucosa and creeping fat

Explanation
The correct answer is Crohn's disease-cobblestone mucosa and creeping fat. Cobblestone mucosa refers to the appearance of the inflamed intestinal lining, which appears as a patchwork of raised areas and shallow ulcers. Creeping fat refers to the presence of fatty tissue that extends into the inflamed areas of the intestine. These findings are characteristic of Crohn's disease, an inflammatory bowel disease that can affect any part of the digestive tract.

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14.

Which of the following is NOT true of Ulcerative Colitis?
- A.
  
  A diffuse disease that does not usually extend into the ileum aside from mild inflammation of the terminal ileum ("backwash ileitis")
- B.
  
  Initially starts as rectal lesions and spreads proximally, eventually involving the entire colon.
- C.
  
  A disease leading to the involvement of the colon which is typically segmental.
- D.
  
  An Intestinal Inflammation of unknown etitology that most often involves the colon.
- E.
  
  A disease typically limited to thecolonic mucosa and submucosa.
Correct Answer
C. A disease leading to the involvement of the colon which is typically segmental.

Explanation
It is in Crohn's disease that involvement of the colon is typically segmental.

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15.

The earliest lesions in CUC (visualized by rectoscope and colonoscope) appear as flattened edematous patches involving the entire circumfrence of the colonic mucosa. What does the mucosa appear like?
- A.
  
  Thick, purulent, and prone to bleeding
- B.
  
  Shows cobblestone pattern with creeping fat.
- C.
  
  Prone to deep fissures penetrating into the muscle wall.
- D.
  
  Sandpaper, friable, and prone to bleeding.
Correct Answer
D. Sandpaper, friable, and prone to bleeding.

Explanation
The correct answer is "Sandpaper, friable, and prone to bleeding". This is because the question mentions that the earliest lesions in CUC appear as flattened edematous patches involving the entire circumference of the colonic mucosa. The term "sandpaper" suggests a rough texture, "friable" indicates that the mucosa is easily damaged or crumbles upon touch, and "prone to bleeding" suggests that there is a tendency for bleeding to occur.

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16.

Which disease histologically presents initially with fragile mucosa that is edematous and inflammed and then begins to show atrophy of the crypts with aggregates of lymphocytes in the base of the crypts ("crypt abscesses").
- A.
  
  CUC
- B.
  
  PUD
- C.
  
  IBS
- D.
  
  Crohn's disease
- E.
  
  Barretts esophagus.
Correct Answer
A. CUC

Explanation
CUC stands for ulcerative colitis, which is a type of inflammatory bowel disease. The given histological findings of fragile mucosa, edema, inflammation, and atrophy of the crypts with lymphocytic aggregates in the base of the crypts are characteristic of ulcerative colitis. This disease primarily affects the colon and rectum, causing symptoms such as bloody diarrhea, abdominal pain, and urgency to have bowel movements.

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17.

In this histological picture of CUC, what do the circular capsules represent?
- A.
  
  Rubber Hose Fibrosis
- B.
  
  Ulcerating Hemorrhagic mucosa
- C.
  
  Crypt Abscesses
- D.
  
  Creeping Fat
Correct Answer
C. Crypt Abscesses

Explanation
Crypt abscesses are represented by the circular capsules in the histological picture of CUC. Crypt abscesses are a characteristic feature of inflammatory bowel disease, particularly ulcerative colitis. They are formed by the accumulation of inflammatory cells, primarily neutrophils, within the crypts of the intestinal mucosa. These abscesses are often associated with ulceration and can contribute to the development of mucosal inflammation and damage in patients with CUC.

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18.

What causes the Inflammatory Pseudopolyps (false tumors) usually seen in CUC?
- A.
  
  They are due to neoplastic epithelium that show no evidence of normal differentiation.
- B.
  
  Small remnants of inlfammed mucosa that appear to be elevated over the base of the surrounding ulcerations
- C.
  
  Dilated glands due to the obstructed flow of mucus.
- D.
  
  Invading aliens pushing through the lumen trying to make their way into the vasculature.
Correct Answer
B. Small remnants of inlfammed mucosa that appear to be elevated over the base of the surrounding ulcerations

Explanation
The correct answer explains that Inflammatory Pseudopolyps in CUC are small remnants of inflamed mucosa that appear to be elevated over the base of the surrounding ulcerations. This suggests that the pseudopolyps are formed as a result of the body's inflammatory response to the ulcerations in the colon. The inflamed mucosa forms small protrusions or polyps as a way to heal and protect the damaged tissue.

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19.

What does the following picture show?
- A.
  
  Small remnants of inflammed mucosa that appear to be elevated over the base of the surrounding ulcerations known as inflammatory pseudopolyps.
- B.
  
  Atrophy of the crypts with aggregates of lymphocytes in the base of the crypts known as crypt abscesses.
- C.
  
  Mild inflammation of the terminal ileum that can occur in CUC known as backwash ileitis.
- D.
  
  Colonic ulcerations that spread through the entire colon and become confluent during ulcerative colitis known as serpiginous ulcerations.
Correct Answer
D. Colonic ulcerations that spread through the entire colon and become confluent during ulcerative colitis known as serpiginous ulcerations.

Explanation
The picture shows colonic ulcerations that spread through the entire colon and become confluent during ulcerative colitis, known as serpiginous ulcerations. This explanation accurately describes the features seen in the picture, where the ulcerations are spread throughout the colon and have a serpiginous, or winding, appearance. This is a characteristic finding in ulcerative colitis, a chronic inflammatory bowel disease.

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20.

True or false: This picture represents foci of mucosal regeneration that will never undergo malignant transformation.
- A.
  
  True
- B.
  
  False
Correct Answer
B. False

Explanation
Pseudopolyps represent foci of mucosal regeneration that may undergo malignant transformation which is the most significant late complication of CUC.

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21.

A chronic course of CUC is characterized by alternating periods of recrudenscence and asymptomatic intervals in what precentage of patients?
- A.
  
  7%
- B.
  
  25%
- C.
  
  55%
- D.
  
  95%
- E.
  
  70%
Correct Answer
E. 70%

Explanation
A chronic course of CUC, which stands for ulcerative colitis, is characterized by alternating periods of recrudescence (flare-ups) and asymptomatic intervals. The given answer of 70% suggests that the majority of patients with CUC experience this pattern of symptoms. This means that 70 out of 100 patients with CUC will have periods of flare-ups followed by periods of no symptoms.

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22.

True of False: In 10% of patients, ulcerative colitis has only a single episode and then heals spontaneously.
- A.
  
  True
- B.
  
  False
Correct Answer
A. True

Explanation
In some cases, ulcerative colitis, a chronic inflammatory bowel disease, can have only one episode and then heal on its own. This means that approximately 10% of patients may experience a single episode of ulcerative colitis and then have no further recurrence or symptoms. However, it is important to note that the majority of patients with ulcerative colitis will have a chronic or recurring condition that requires ongoing management and treatment.

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23.

Your patient presents with GI inflammation primarily affecting the left side of the colon. The lesions are diffuse and limited to the mucosa and submucosa. What is your initial diagnosis?
- A.
  
  IBS
- B.
  
  CUC
- C.
  
  GERD
- D.
  
  Crohn's Disease
- E.
  
  Apendicitis
Correct Answer
B. CUC

Explanation
The patient's symptoms of GI inflammation primarily affecting the left side of the colon, with diffuse and limited lesions to the mucosa and submucosa, suggest the initial diagnosis of CUC (Ulcerative Colitis). This is a chronic inflammatory bowel disease that specifically affects the colon and rectum, causing inflammation and ulcers in the lining of the colon. The symptoms described align with the characteristic features of CUC, making it the most likely initial diagnosis in this case.

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24.

Your patient presents with GI inflammation of the ileum accompanied by granulomas. The ulcers involved are linear and resemble cobblestones. What is your initial diagnosis.
- A.
  
  CUC
- B.
  
  Gastric Adenocarcinoma
- C.
  
  PUD
- D.
  
  Crohn's Disease
Correct Answer
D. Crohn's Disease

Explanation
The patient's presentation of GI inflammation of the ileum accompanied by granulomas, as well as the presence of linear ulcers resembling cobblestones, is consistent with Crohn's Disease. Crohn's Disease is a chronic inflammatory bowel disease that can affect any part of the gastrointestinal tract, including the ileum. The characteristic cobblestone appearance of the ulcers is a common finding in Crohn's Disease. Therefore, Crohn's Disease is the most likely initial diagnosis for this patient.

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25.

What diagnostic tools/tests would you use to confirm the diagnosis of a disease that causes a thin colonic wall which predisposes the patient to intestianal dilation and toxic megacolon with chance of perforation creating an increased risk for cancer?
- A.
  
  Colonoscopy and biopsy
- B.
  
  Clinical, radiographic, and pathologic evaluation.
- C.
  
  Endoscopy and HIDA scan
- D.
  
  Biopsy only
Correct Answer
B. Clinical, radiographic, and pathologic evaluation.

Explanation
The disease described above is CUC and is diagnosed by clinical, radiographic, and pathologic evaluation.

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26.

What extrainstestinal complications are identical for both Crohn's Disease and CUC?
- A.
  
  Osteoporosis, hypertension, and hyperlipidemia.
- B.
  
  Eye lesions, rash, and chronic dermititis.
- C.
  
  Arthritis, eye lesions, and skin lesions.
- D.
  
  Achalasia, arthritis, and rash.
- E.
  
  Hypertension, blepharitis, and joint pain.
Correct Answer
C. Arthritis, eye lesions, and skin lesions.

Explanation
The correct answer is arthritis, eye lesions, and skin lesions. Both Crohn's Disease and CUC can cause these extraintestinal complications. Arthritis refers to inflammation in the joints, which can occur in both conditions. Eye lesions can manifest as uveitis or episcleritis, and skin lesions can include erythema nodosum or pyoderma gangrenosum. These complications are not specific to either Crohn's Disease or CUC, but can occur in both conditions.

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27.

What is the 3rd most common type of malginant disease behind breast and lung cancer?
- A.
  
  Brain Cancer
- B.
  
  Cancer of the mouth
- C.
  
  Cancer of the intestines
- D.
  
  Prostate cancer
- E.
  
  Ovarian Cancer
Correct Answer
C. Cancer of the intestines

Explanation
The 3rd most common type of malignant disease behind breast and lung cancer is cancer of the intestines. This type of cancer refers to the abnormal growth of cells in the intestines, which can lead to various symptoms and complications. It is important to detect and treat this cancer early to improve the chances of successful treatment and survival.

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28.

In more than 95% of intestinal neplasmsof epethial origin, the tumors protrude into the lumen of the intestine and can be seen by what methods?
- A.
  
  Anal digital palpation
- B.
  
  Endoscopy, colonoscopy, HIDA scan
- C.
  
  Endoscory or x-ray examination with barium enima
- D.
  
  CT scan with contrast.
Correct Answer
C. Endoscory or x-ray examination with barium enima

Explanation
The correct answer is endoscopy or x-ray examination with barium enema. This method allows for visualization of the tumors protruding into the lumen of the intestine. Endoscopy involves the use of a flexible tube with a camera to directly visualize the inside of the intestine. X-ray examination with barium enema involves the administration of a contrast material (barium) into the rectum, which coats the lining of the intestine and allows for better visualization of any abnormalities on x-ray images. These methods are commonly used to diagnose and evaluate intestinal neoplasms of epithelial origin.

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29.

True or false: Surveillance for blood in the stool is an effective approach for early diagnosis of intestinal tumors.
- A.
  
  True
- B.
  
  False
Correct Answer
A. True

Explanation
The intramural location of intestinal tumors makes them vulnerable to mechanical trauma by the intestinal contents, and accounts for the frequent intestinal bleeding that is a common presenting sign with intestinal tumors.

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30.

Which of the following is NOT true of intestinal tumors?
- A.
  
  Most GI tumors are located in the large intestine.
- B.
  
  More than 1/3 of all GI tumors involve the rectum and can be detected by digital exam.
- C.
  
  The small intestines are only involved in a small percentage of GI tumors.
- D.
  
  GI tumors are never present in the rectum, only the small and large intestine.
Correct Answer
D. GI tumors are never present in the rectum, only the small and large intestine.

Explanation
Intestinal tumors can be found in the rectum, as mentioned in the second statement. Therefore, the statement "GI tumors are never present in the rectum, only the small and large intestine" is not true.

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31.

Your husband tends to eat very high fat meals that include red meat and foods rich in refined carbohydrates. As a PA student you feel obligated to let him know that his dietary tendencies predispose him for what?
- A.
  
  Prostate caner
- B.
  
  Brain tumors
- C.
  
  Intestinal neoplasms
- D.
  
  Acute pancreatitis
Correct Answer
B. Brain tumors

Explanation
The husband's high fat meals that include red meat and refined carbohydrates can predispose him to brain tumors. Certain dietary factors, such as a high intake of red meat and processed foods, have been associated with an increased risk of developing brain tumors. These foods may contribute to inflammation and oxidative stress, which are known to play a role in the development of tumors. Therefore, as a PA student, it is important to inform the husband about the potential risks of his dietary habits on his health, specifically the increased risk of brain tumors.

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32.

Which of the following is NOT true about hyperplastic polyps?
- A.
  
  Most common type of non-neoplastic polyp.
- B.
  
  Usally discovered accidentally during an endoscopy.
- C.
  
  Over 95% located in the rectosigmoid area.
- D.
  
  Appear as small, dew-drop like protrusions on the mucosa measuring less than 5mm in diameter.
- E.
  
  Histologically, composed of hyperplastic glands rich in goblet cells and mucin.
Correct Answer
C. Over 95% located in the rectosigmoid area.

Explanation
Over 80% are located in the rectosigmoid area.

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33.

True or False: This type of polyp commonly leads to cancer.
- A.
  
  True
- B.
  
  False
Correct Answer
B. False

Explanation
Hyperplastic polyps never lead to malignancy.

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34.

A 4 year old child comes to your offices presenting with a harmatoma causing him rectal irritation and bleeding. After further inspection you see that it is a solitary, 1-3 cm. sessile lesion located in the rectum. Your initial diagnosis is:
- A.
  
  A hyperplastic polyp
- B.
  
  Tubulovillous adenoma
- C.
  
  Juvenile polyp
- D.
  
  Villous adenoma
- E.
  
  Tubular adenoma
Correct Answer
C. Juvenile polyp

Explanation
The correct answer is Juvenile polyp. A juvenile polyp is a benign growth that commonly occurs in children and is typically found in the rectum or colon. It is characterized by a solitary, sessile lesion and can cause rectal irritation and bleeding, which aligns with the symptoms presented by the 4-year-old child in this case. Hyperplastic polyps, tubulovillous adenomas, villous adenomas, and tubular adenomas are all different types of polyps, but they are less likely to occur in children compared to juvenile polyps.

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35.

True or false: Juvenile polyps may also be known as "detention polyps" because histologically, they are composed of glands lined by normal epethelium with a well-differentiated stroma. They tend to dilate cystically because of the obstructed flow of mucus.
- A.
  
  True
- B.
  
  False
Correct Answer
B. False

Explanation
Juvenile polyps are also known as "retention polyps" for the same reason listed above.

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36.

What is the difference between Non-neoplastic and benign neoplastic polyps?
- A.
  
  Non-neoplastic polyps are composed of normal glandular and stromal cells. Neoplastic polyps are composed of neoplastic epithelium with no normal differentiation.
- B.
  
  Neoplastic polyps are defined as hyperplastic or juvenile. Non-neoplastic polyps are defined as tubular, tubulovillous, and villous.
- C.
  
  Non-neoplastic polyps are composed of neoplastic epithelium with no normal differentiation. Neoplastic polyps are composed of normal glandular and stromal cells.
- D.
  
  Neoplastic polyps are defined as hyperplastic and jeuvenile. Furthermore they are composed of normal glandular and stromal cells.
- E.
  
  Non-neoplastic polyps are defined as tubular, tubulovillous, and villous and are composed of normal glandular and stromal cells.
Correct Answer
A. Non-neoplastic polyps are composed of normal glandular and stromal cells. Neoplastic polyps are composed of neoplastic epithelium with no normal differentiation.

Explanation
Non-neoplastic polyps are characterized by the presence of normal glandular and stromal cells, while neoplastic polyps contain neoplastic epithelium that lacks normal differentiation. This means that non-neoplastic polyps are made up of cells that appear and function normally, whereas neoplastic polyps consist of abnormal cells that do not exhibit normal characteristics.

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37.

Choose the correct percentage risk for progression to adenocarcinoma that corresponds to the order: Tubular, Tubulovillous, villous.
- A.
  
  50%, 30-35%, 20%
- B.
  
  15%, 50%, 35%
- C.
  
  95%, 2.5%, 2.5%
- D.
  
  20%, 30-35%, 50%
Correct Answer
D. 20%, 30-35%, 50%

Explanation
The correct answer is 20%, 30-35%, 50%. The risk for progression to adenocarcinoma increases as the polyp morphology changes from tubular to tubulovillous to villous. Tubular adenomas have the lowest risk of progression at 20%, followed by tubulovillous adenomas at 30-35%, and villous adenomas have the highest risk at 50%.

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38.

Which of the following is NOT true about all benign neoplastic polyps?
- A.
  
  Their incidence increases with age
- B.
  
  Most commin in Asian populations
- C.
  
  More common in males at a 2:1 ratio
- D.
  
  They are often multiple
- E.
  
  70% of large polyps are located in the rectosigmoid area
Correct Answer
B. Most commin in Asian populations

Explanation
Benign neoplastic polyps are growths that are not cancerous. The given statement, "Most common in Asian populations," is not true about all benign neoplastic polyps. The incidence of these polyps may vary across different populations and ethnicities, and it is not specific to Asian populations.

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39.

True or False: All tubular polyps are pedunculated
- A.
  
  True
- B.
  
  False
Correct Answer
B. False

Explanation
Some can also be sessile

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40.

Which of the following is not a characteristic of malignant transformation of a tubular polyp?
- A.
  
  Nuclear atypia
- B.
  
  Abnormaly mitotic features
- C.
  
  Tend to be sessile in nature
- D.
  
  Malignant glands are crowded and show back to back arrangement
- E.
  
  Tendency to invade the stalk.
Correct Answer(s)
A. Nuclear atypia
C. Tend to be sessile in nature

Explanation
Malignant transformation of a tubular polyp is characterized by various features. Nuclear atypia refers to abnormal changes in the size, shape, and appearance of the cell nucleus, which is a common characteristic of malignant cells. The tendency to be sessile means that the polyp is attached to the surface and does not have a stalk, which is not a characteristic of malignant transformation. Therefore, the statement "Tend to be sessile in nature" is not a characteristic of malignant transformation of a tubular polyp.

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41.

This particular polyp is lined by what type of epithelium with no obvious nuclear cytoplasmic atypia?
- A.
  
  Squamous
- B.
  
  Stratified columnar
- C.
  
  Columnar
- D.
  
  Stratified squamous
Correct Answer
C. Columnar

Explanation
Tubular adenomas arel lined by columnar epithelium with no obvious nuclear or cytoplasmic atypia.

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42.

What polyp (shown below) is predominantly tubular but that appears villous on at least 25% of it's surface?
- A.
  
  Tubular
- B.
  
  Hyperplastic
- C.
  
  Villous
- D.
  
  Juvenile
- E.
  
  Tubulovillous
Correct Answer
E. Tubulovillous

Explanation
A tubulovillous polyp is predominantly tubular in shape but has villous features on at least 25% of its surface. This means that the polyp has both tubular and villous characteristics, with the villous portion being less than 25% of the total surface area. It is important to identify this type of polyp correctly as it can have a higher risk of developing into colorectal cancer compared to purely tubular or purely villous polyps.

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43.

Which type of polyp is a sessile, large, broad-based tumor that projects into the lumen of the intenstines forming finger-like protrusions?
- A.
  
  Tubulovillous
- B.
  
  Villous
- C.
  
  Hyperplastic
- D.
  
  Tubular
- E.
  
  Juvenile
Correct Answer
B. Villous

Explanation
A villous polyp is a sessile, large, broad-based tumor that projects into the lumen of the intestines forming finger-like protrusions. This type of polyp is characterized by its appearance and structure, which includes elongated, finger-like projections. It is typically larger in size compared to other types of polyps and can be found in various parts of the intestines.

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44.

Which of the following is not true about this type of polyp that is lined by a single cell type that does not show signs of differentiation?W
- A.
  
  Invasive carcinoma is found in over 50% of these tumors.
- B.
  
  Because of their size and broad base, these tumors cannot be resected through and endoscope.
- C.
  
  On gross examination, they have a velvety appearance.
- D.
  
  Malignant disease is found in 20-35% of these tumors.
- E.
  
  Most measure more than 2 cm. in diameter.
Correct Answer
D. Malignant disease is found in 20-35% of these tumors.

Explanation
The picture is a villous adenoma and invasive carcinoma is found in over 50% of these tumors, not just 20-35%.

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45.

True or False: Colon cancer accounts for 95% of malignant tumors of he intestine and are 10 times more common in Asia and Africa than in the U.S. and other Western countries.
- A.
  
  True
- B.
  
  False
Correct Answer
B. False

Explanation
Colon cancer accounts for 95% of malignant tumors of the intestine and is 10 times more more common in the U.S. and other Western countries than in Asia and Africa.

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46.

A 60 year old males patient presents with a neoplastic polyp in the rectosigmoid area and has a family history of hereditary polyposis syndrome. Upon surgical removal and histological evaluation of the polyp, you expect to find?
- A.
  
  A benign tubular polyp
- B.
  
  Adenocarcinoma of the colon
- C.
  
  A hyperplastic polyp
- D.
  
  Chronic Ulcerative Colitis
Correct Answer
B. Adenocarcinoma of the colon

Explanation
Given the patient's age, family history of hereditary polyposis syndrome, and the presence of a neoplastic polyp in the rectosigmoid area, the most likely finding upon histological evaluation would be adenocarcinoma of the colon. Neoplastic polyps have the potential to develop into cancer, and the combination of risk factors in this patient increases the likelihood of finding adenocarcinoma.

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47.

Which of the following is not a possible presentation of established invasive carcinoma of the colon?
- A.
  
  Villous polyps
- B.
  
  Mucosal plaques
- C.
  
  Hyperplastic polyps
- D.
  
  Ulcerations
- E.
  
  Exophytic Protruding masses
Correct Answer
C. Hyperplastic polyps

Explanation
Hyperplastic polyps are not a possible presentation of established invasive carcinoma of the colon. Hyperplastic polyps are benign growths that do not have the potential to become cancerous. In contrast, invasive carcinoma of the colon is a malignant tumor that can cause symptoms such as ulcerations, exophytic protruding masses, and mucosal plaques. Villous polyps can also be a presentation of invasive carcinoma, as they have the potential to become cancerous. Therefore, the presence of hyperplastic polyps would not be indicative of invasive carcinoma.

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48.

What causes the so-called "napkin-ring" lesions?
- A.
  
  Adenocarcinomas of the sigmoid and rectum that tend to infiltrate the intestine circumfrerentially.
- B.
  
  Tumors of the right side of the colon that tend to grow as fungating masses or ulcerated shallow-like craters.
- C.
  
  Tumors of the small intestine that tend to infiltrate the intestine circumfrentially.
- D.
  
  Adenocarcinomas of the right side of the colon that grow in circles that eventually intertwince to encircle the entire circumference of the lumen.
Correct Answer
A. Adenocarcinomas of the sigmoid and rectum that tend to infiltrate the intestine circumfrerentially.

Explanation
The term "napkin-ring" lesions refers to a specific appearance of adenocarcinomas in the sigmoid and rectum. These tumors have a characteristic pattern of infiltration, where they grow in a circumferential manner, encircling the intestine. This results in a narrowing of the lumen, resembling a napkin ring. This pattern of growth is distinct from tumors of the right side of the colon, which typically grow as fungating masses or ulcerated shallow-like craters. Similarly, tumors of the small intestine may infiltrate the intestine circumferentially, but they are not specifically referred to as "napkin-ring" lesions. Therefore, the correct answer is adenocarcinomas of the sigmoid and rectum that tend to infiltrate the intestine circumferentially.

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49.

Which of the following is NOT true of cancers of the right side of the colon?
- A.
  
  Tend to be clinically silent.
- B.
  
  Produce non-specific signs such as weakness and fatigue.
- C.
  
  Chronic blood loss with melena may cause anemia.
- D.
  
  Slool will be narrow and pencil-like
Correct Answer
D. Slool will be narrow and pencil-like

Explanation
Cancers of the right side of the colon do not typically cause narrow and pencil-like stools. This symptom is more commonly associated with cancers of the left side of the colon. Cancers of the right side of the colon tend to be clinically silent, meaning they do not cause noticeable symptoms in the early stages. They may produce non-specific signs such as weakness and fatigue, and chronic blood loss with melena (dark, tarry stools) can lead to anemia.

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50.

Which of the following is NOT true of adenocarcinomas of the left side of the colon?
- A.
  
  Tend to narrow the intestine and obstruct the passage of feces.
- B.
  
  Lead to chronic blood loss with dark red feces leading to anemia.
- C.
  
  Constipation produces narrow, pencil-like feces.
- D.
  
  A positive test for occult blood in the feces predicts the presence of cancer or an adenoma in 40-50% of cases
Correct Answer
B. Lead to chronic blood loss with dark red feces leading to anemia.

Explanation
Adenocarcinomas of the left side of the colon tend to narrow the intestine and obstruct the passage of feces. This can result in constipation and the production of narrow, pencil-like feces. Additionally, a positive test for occult blood in the feces predicts the presence of cancer or an adenoma in 40-50% of cases. However, chronic blood loss with dark red feces leading to anemia is not true of adenocarcinomas of the left side of the colon.

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Patho 1st Lecture, 2nd Half

Inflammatory Bowel Disease refers to what two closely related but distinct diseases?

Which of the following is true about CUC as compared to Crohn's Disease in Western Countries?

A 32 year old white patient of Eastern European descent presents with chronic GI inflammation. The patient has a family history of Crohn's Disease. What is your initial diagnosis?

What is the correct order for the most common place of occurance for Crohn's Disease?

True or False: The appendix is involved in most cases of Crohn's Disease.

True or False: 10% of patients with Crohn's Disease have involvement of the esophagus, stomach, or fallopian tubes.

Which answer best describes Peyer's Patches?

Sharply demarcated non-caseating granulomas within the mucosa and submucosa, associated with fibrosis of the muscularis and the serosa causing the wall to be thickened and rigid describes which characteristic sign of Crohn's Disease?

In Crohn's Disease, what leads to the formation of a fistula?

True or False: Anal involvement in Crohn's disease is often associated with formation of fistulas as well as abscesses.

What are the most common symptoms associated with Crohn's Disease?

Diagnostic tools used to identify Crohn's Disease include:

This picture depicts:

Which of the following is NOT true of Ulcerative Colitis?

The earliest lesions in CUC (visualized by rectoscope and colonoscope) appear as flattened edematous patches involving the entire circumfrence of the colonic mucosa. What does the mucosa appear like?

Which disease histologically presents initially with fragile mucosa that is edematous and inflammed and then begins to show atrophy of the crypts with aggregates of lymphocytes in the base of the crypts ("crypt abscesses").

In this histological picture of CUC, what do the circular capsules represent?

What causes the Inflammatory Pseudopolyps (false tumors) usually seen in CUC?

What does the following picture show?

True or false: This picture represents foci of mucosal regeneration that will never undergo malignant transformation.

A chronic course of CUC is characterized by alternating periods of recrudenscence and asymptomatic intervals in what precentage of patients?

True of False: In 10% of patients, ulcerative colitis has only a single episode and then heals spontaneously.

Your patient presents with GI inflammation primarily affecting the left side of the colon. The lesions are diffuse and limited to the mucosa and submucosa. What is your initial diagnosis?

Your patient presents with GI inflammation of the ileum accompanied by granulomas. The ulcers involved are linear and resemble cobblestones. What is your initial diagnosis.

What diagnostic tools/tests would you use to confirm the diagnosis of a disease that causes a thin colonic wall which predisposes the patient to intestianal dilation and toxic megacolon with chance of perforation creating an increased risk for cancer?

What extrainstestinal complications are identical for both Crohn's Disease and CUC?

What is the 3rd most common type of malginant disease behind breast and lung cancer?

In more than 95% of intestinal neplasmsof epethial origin, the tumors protrude into the lumen of the intestine and can be seen by what methods?

True or false: Surveillance for blood in the stool is an effective approach for early diagnosis of intestinal tumors.

Which of the following is NOT true of intestinal tumors?

Your husband tends to eat very high fat meals that include red meat and foods rich in refined carbohydrates. As a PA student you feel obligated to let him know that his dietary tendencies predispose him for what?

Which of the following is NOT true about hyperplastic polyps?

True or False: This type of polyp commonly leads to cancer.

A 4 year old child comes to your offices presenting with a harmatoma causing him rectal irritation and bleeding. After further inspection you see that it is a solitary, 1-3 cm. sessile lesion located in the rectum. Your initial diagnosis is:

True or false: Juvenile polyps may also be known as "detention polyps" because histologically, they are composed of glands lined by normal epethelium with a well-differentiated stroma. They tend to dilate cystically because of the obstructed flow of mucus.

What is the difference between Non-neoplastic and benign neoplastic polyps?

Choose the correct percentage risk for progression to adenocarcinoma that corresponds to the order: Tubular, Tubulovillous, villous.

Which of the following is NOT true about all benign neoplastic polyps?

True or False: All tubular polyps are pedunculated

Which of the following is not a characteristic of malignant transformation of a tubular polyp?

This particular polyp is lined by what type of epithelium with no obvious nuclear cytoplasmic atypia?

What polyp (shown below) is predominantly tubular but that appears villous on at least 25% of it's surface?

Which type of polyp is a sessile, large, broad-based tumor that projects into the lumen of the intenstines forming finger-like protrusions?

Which of the following is not true about this type of polyp that is lined by a single cell type that does not show signs of differentiation?W

True or False: Colon cancer accounts for 95% of malignant tumors of he intestine and are 10 times more common in Asia and Africa than in the U.S. and other Western countries.

A 60 year old males patient presents with a neoplastic polyp in the rectosigmoid area and has a family history of hereditary polyposis syndrome. Upon surgical removal and histological evaluation of the polyp, you expect to find?

Which of the following is not a possible presentation of established invasive carcinoma of the colon?

What causes the so-called "napkin-ring" lesions?

Which of the following is NOT true of cancers of the right side of the colon?

Which of the following is NOT true of adenocarcinomas of the left side of the colon?