Practice questions B Stomach pathology

Practice questions B
Stomach pathology
Updated: 03/01/2019
© Jun Wang, MD, PhD


1. Use this case and this image for the next 4 questions. A 69-year-old man presents with intermittent epigastric discomfort for 4 weeks. He has a history of coronary heart disease and received bypass grafting 5 years ago. His past medical history also include diabetes, hypertension, and helicobacter gastritis. Physical examination, laboratory tests and complete cardiac tests are unremarkable. Gastroscopy examination reveals a 1.5 cm ulcer at the antrum. The ulcer has a raised irregular edge. Image of the ulcer biopsy is shown. What is the diagnosis?
(Image credit: Kwz~commonswiki)

A. Curling ulcer
B. Cushing ulcer
C. Diffuse type adenocarcinoma
D. Intestinal type adenocarcinoma
E. Peptic ulcer

2. A 69-year-old man presents with intermittent epigastric discomfort for 4 weeks. He has a history of coronary heart disease and received bypass grafting 5 years ago. His past medical history also include diabetes, hypertension, and helicobacter gastritis. Physical examination, laboratory tests and complete cardiac tests are unremarkable. Gastroscopy examination reveals a 1.5 cm ulcer at the antrum. The ulcer has a raised irregular edge. Image of the ulcer biopsy is shown. What in his history is most likely associated with his antral lesion?

(Image credit: Kwz~commonswiki)

A. Coronary bypass grafting
B. Diabetes
C. Helicobacter gastritis
D. Hypertension

3. A 69-year-old man presents with intermittent epigastric discomfort for 4 weeks. He has a history of coronary heart disease and received bypass grafting 5 years ago. His past medical history also include diabetes, hypertension, and helicobacter gastritis. Physical examination, laboratory tests and complete cardiac tests are unremarkable. Gastroscopy examination reveals a 1.5 cm ulcer at the antrum. The ulcer has a raised irregular edge. Image of the ulcer biopsy is shown. Abnormality of what intracellular component is most likely associated with this antral lesion?

(Image credit: Kwz~commonswiki)

A. Beta-catenin
B. CDH1
C. C-kit
D. Gastrin
E. MEN1

4. A 69-year-old man presents with intermittent epigastric discomfort for 4 weeks. He has a history of coronary heart disease and received bypass grafting 5 years ago. His past medical history also include diabetes, hypertension, and helicobacter gastritis. Physical examination, laboratory tests and complete cardiac tests are unremarkable. Gastroscopy examination reveals a 1.5 cm ulcer at the antrum. The ulcer has a raised irregular edge. Image of the ulcer biopsy is shown. Additional immunohistochemistry studies reveal nuclear located beta-catenin in these glandular cells in this image, but not those on the surface. What causes this finding?

(Image credit: Kwz~commonswiki)
A. Adhesins
B. CagA
C. Urease
D. VacA


5. Use this case and this image for the next 2 questions. A 39-year-old man presents with indigestion and left upper abdomen discomfort for 3 months. His past medical history is unremarkable. He has a family history of stomach cancer and helicobacter gastritis. Physical examination reveal vague tenderness at left upper abdomen. Gastroscopy exam reveals slightly thickened rugae. No erythema, ulcer nor tumor is noted. An image of the biopsy is shown. What is the diagnosis?
(Image credit: Nephron/wiki commons)
A. Acute gastritis
B. Chronic gastritis
C. Diffuse type adenocarcinoma
D. Intestinal type adenocarcinoma
E. Menetrier’s disease

6. A 39-year-old man presents with indigestion and left upper abdomen discomfort for 3 months. His past medical history is unremarkable. He has a family history of stomach cancer and helicobacter gastritis. Physical examination reveal vague tenderness at left upper abdomen. Gastroscopy exam reveals slightly thickened rugae. No erythema, ulcer nor tumor is noted. An image of the biopsy is shown. Mutation of what gene is likely identified?

(Image credit: Nephron/wiki commons)
A. APC
B. Beta-catenin
C. CDH-1
D. EGFR
E. Her2


7. A 45-year-old woman presents with vague epigastric discomfort for 3 months. She has a history helicobacter gastritis. Physical examination and laboratory tests are unremarkable. Gastroscopy examination reveals a 0.7 cm nodule at her fundus. The nodule has smooth unremarkable surface. No other abnormalities are noted. Biopsy of the nodule reveals fundic type gastric mucosa with irregular trabeculae of cells with small to intermediate sized round nuclei and stippled chromatin and moderate amount of cytoplasm. No significant pleomorphism is seen. Per immunohistochemistry studies, these cells are positive for chromogranin. What is the diagnosis?
A. Carcinoid
B. Diffuse type adenocarcinoma
C. Helicobacter gastritis
D. Intestinal type adenocarcinoma
E. Small cell carcinoma

8. Use this case and this image for the next 2 questions. A 44-year-old woman presents with vague epigastric pain for 6 months. She has a history of Hashimoto thyroiditis and autoimmune gastritis. She does not smoke cigarette nor drink alcohol. Physical examination and laboratory test results are unremarkable. Gastroscopy examination reveals a bulging mass at the gastric body. The mass has a normal appearing mucosal surface. No ulcer nor erythematous changes are noted. Biopsy of the mass reveals a spindle cell proliferation with unremarkable mucosal epithelium and glands. These spindle cells are positive for CD34. No significant cytological atypia is noted. What is the diagnosis?
A. Chronic gastritis with smooth muscle proliferation
B. Gastrointestinal stromal tumor
C. Intestinal type adenocarcinoma
D. Leiomyoma
E. Leiomyosarcoma

9. A 44-year-old woman presents with vague epigastric pain for 6 months. She has a history of Hashimoto thyroiditis and autoimmune gastritis. She does not smoke cigarette nor drink alcohol. Physical examination and laboratory test results are unremarkable. Gastroscopy examination reveals a bulging mass at the gastric body. The mass has a normal appearing mucosal surface. No ulcer nor erythematous changes are noted. Biopsy of the mass reveals a spindle cell proliferation with unremarkable mucosal epithelium and glands. These spindle cells are positive for CD34. No significant cytological atypia is noted. Mutation of what gene is likely associated with these findings?
A. APC
B. Beta-catenin
C. CDH-1
D. C-kit
E. Her2


10. Use this case and this image for the next 2 questions. A 58-year-old man presents with fatigue, nausea and vague epigastric pain for 2 months. He has a history of peptic ulcer and prostate adenocarcinoma. He does not smoke cigarette nor drink alcohol. Physical examination and laboratory tests are unremarkable. Gastroscopy exam reveals a 2.3 cm ulcer at the greater curvature and thickened surrounding mucosa. Biopsy of the ulcer reveals dense small to intermediate sized lymphocytic infiltrate. No cytological atypia is seen in the epithelial cells. Silver stain is negative for microorganism. His carbon 13/14 urea breath test is positive. Per immunohistochemistry studies, these lymphocytes are positive for CD20, CD45, negative for CD3, CD5 and CD10, and have predominant kappa light chain expression. What is the diagnosis?
A. Autoimmune gastritis
B. Diffuse large B cell lymphoma
C. Marginal zone lymphoma
D. Peptic ulcer
E. Poorly differentiated adenocarcinoma

11. A 58-year-old man presents with fatigue, nausea and vague epigastric pain for 2 months. He has a history of peptic ulcer and prostate adenocarcinoma. He does not smoke cigarette nor drink alcohol. Physical examination and laboratory tests are unremarkable. Gastroscopy exam reveals a 2.3 cm ulcer at the greater curvature and thickened surrounding mucosa. Biopsy of the ulcer reveals dense small to intermediate sized lymphocytic infiltrate. No cytological atypia is seen in the epithelial cells. Silver stain is negative for microorganism. His carbon 13/14 urea breath test is positive. Per immunohistochemistry studies, these lymphocytes are positive for CD20, CD45, negative for CD3, CD5 and CD10, and have predominant kappa light chain expression. What is most likely causing his gastric changes?
A. Androgen
B. Autoantibody against parietal cells
C. Helicobacter pylori
D. Hypergastrinemia
E. NSAID


12. Use this case and this image for the next 2 questions. A 76-year-old man presents with progressive weakness, night sweating, a 15 pound weight loss and vague epigastric discomfort for 4 months. He has a history of COPD, diabetes, hypertension and helicobacter gastritis. Physical examination reveals no significant abnormalities, except for pale skin. Laboratory tests reveal a hemoglobin of 7.5 g/dl (normal 13.5-18 g/dl). Other tests, including liver and renal function tests, are within normal range. Peripheral blood smear reveals no morphological abnormalities. Gastroscopy examination reveal 3 ulcers at the fundus and antrum. Biopsy of the ulcers reveal acute and chronic inflammation. Sheets of markedly atypical cells are seen. These cells are positive for CD20 and negative for cytokeratin. What is the diagnosis?
A. Autoimmune gastritis
B. Diffuse large B cell lymphoma
C. Marginal zone lymphoma
D. Peptic ulcer
E. Zollinger-Ellison syndrome

13. A 76-year-old man presents with progressive weakness, night sweating, a 15 pound weight loss and vague epigastric discomfort for 4 months. He has a history of COPD, diabetes, hypertension and helicobacter gastritis. Physical examination reveals no significant abnormalities, except for pale skin. Laboratory tests reveal a hemoglobin of 7.5 g/dl (normal 13.5-18 g/dl). Other tests, including liver and renal function tests, are within normal range. Peripheral blood smear reveals no morphological abnormalities. Gastroscopy examination reveal 3 ulcers at the fundus and antrum. Biopsy of the ulcers reveal acute and chronic inflammation. Sheets of markedly atypical cells are seen. These cells are positive for CD20 and negative for cytokeratin. What is most likely associated with these changes?
A. COPD
B. Diabetes
C. Helicobacter pylori
D. Hypergastrinemia
E. Hypertension


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