Practice questions A Stomach pathology
Practice questions A
Stomach pathology
Updated: 03/01/2019
© Jun Wang,MD, PhD
1. Use this case for the next two questions. A 35-year-old woman
presents with sudden onset of epigastric pain and hematemesis for 2 hours. She
does not have fever or sweating. She has had severe headache two days ago and has
been taking Ibuprofen since then. Her past medical history is unremarkable. Physical
examination reveals a blood pressure of 95/55 mmHg, heart rate of 120 bpm, and
her skin appears to be pale. Laboratory tests reveal a hemoglobin of 10.5 g/dl
(normal 12-16 g/dl). No other abnormalities are noted. Gastroscopy exam reveals
diffuse erythematous changes of gastric mucosa, with a few shallow ulcers. Biopsy
reveal benign fundic type gastric mucosa with scattered neutrophilic
infiltrate. No significant lymphoplasmacytic infiltrate nor glandular atrophy
are noted. Silver stain reveals no evidence of bacteria. What is the diagnosis?
A. Acute gastritis
B. Chronic gastritis, type A
C. Chronic gastritis, type B
D. Curling ulcer
E. Peptic ulcer
2. A 35-year-old woman presents with sudden onset of epigastric pain and
hematemesis for 2 hours. She does not have fever or sweating. She has had severe
headache two days ago and has been taking Ibuprofen since then. Her past
medical history is unremarkable. Physical examination reveals a blood pressure
of 95/55 mmHg, heart rate of 120 bpm, and her skin appears to be pale.
Laboratory tests reveal a hemoglobin of 10.5 g/dl (normal 12-16 g/dl). No other
abnormalities are noted. Gastroscopy exam reveals diffuse erythematous changes
of gastric mucosa, with a few shallow ulcers. Biopsy reveal benign fundic type
gastric mucosa with scattered neutrophilic infiltrate. No significant
lymphoplasmacytic infiltrate nor glandular atrophy are noted. Silver stain
reveals no evidence of bacteria. What is most likely associated with her
presentations?
A. Auto-antibody against
intrinsic factor
B. Bacterial toxin
C. Hyperacidity
D. Inhibition of COX-1 and
COX-2
E. Mucinous gland atrophy
3. A 2-year-old boy presents
with melanotic stools for 2 days. He has a medulloblastoma that was removed 1
week ago. His past medical history is otherwise unremarkable. Laboratory tests
reveals a hemoglobin of 8.5 g/dl (normal 10.5-14.5 g/dl). No other abnormality
is noted. Gastroscopy exam reveals 2 ulcers, measuring up to 0.7 cm in diameter
in duodenal bulb, and a 0.5 cm ulcer at the lesser curvature of his stomach. The
background gastric mucosa has diffuse erythematous changes. What is the
diagnosis?
A. Autoimmune gastritis
B. Curling ulcer
C. Cushing ulcer
D. Metastatic
medulloblastoma
E. Peptic ulcer
4. Use this case for the next four questions. A 21-year-old man
presents with intermittent epigastric pain for 6 months. His past medical
history is unremarkable. His family history including multiple family members with
gastric cancers. He does not smoke cigarette nor drink alcohol. Physical
examination and laboratory test results are unremarkable. Gastroscopy exam reveals focal erythematous
changes at his antrum. No ulcer nor tumor is noted. Biopsy of his antrum mucosa
reveals diffuse lymphoplasmacytic infiltrate. Scattered neutrophils are seen
within glandular epithelium. No cytological atypia is noted. Immunohistochemistry
studies reveals a mixed T and B cell population with normal kappa/lambda ratio.
What test is likely to be positive for his antrum biopsy?
A. Acid fast bacilli stain
B. Immunofluorescence
studies for anti-K/hydrogen ATPase
C. Immunohistochemistry
studies for c-kit
D. Immunohistochemistry
studies for gastrin
E. Silver stain for
helicobacters
5. A 21-year-old man presents with intermittent epigastric pain for 6
months. His past medical history is unremarkable. His family history including multiple
family members with gastric cancers. He does not smoke cigarette nor drink
alcohol. Physical examination and laboratory test results are unremarkable. Gastroscopy exam reveals focal erythematous
changes at his antrum. No ulcer nor tumor is noted. Biopsy of his antrum mucosa
reveals diffuse lymphoplasmacytic infiltrate. Scattered neutrophils are seen
within glandular epithelium. No cytological atypia is noted. Immunohistochemistry
studies reveals a mixed T and B cell population with normal kappa/lambda ratio.
What is most likely the diagnosis?
A. Acute gastritis
B. Autoimmune gastritis
C. Dieulafoy lesion
D. Helicobacter gastritis
E. MALToma
6. A 21-year-old man
presents with intermittent epigastric pain for 6 months. His past medical
history is unremarkable. His family history including multiple family members with
gastric cancers. He does not smoke cigarette nor drink alcohol. Physical
examination and laboratory test results are unremarkable. Gastroscopy exam reveals focal erythematous
changes at his antrum. No ulcer nor tumor is noted. Biopsy of his antrum mucosa
reveals diffuse lymphoplasmacytic infiltrate. Scattered neutrophils are seen
within glandular epithelium. No cytological atypia is noted. Immunohistochemistry
studies reveals a mixed T and B cell population with normal kappa/lambda ratio.
What is most likely associated directly to his gastric epithelium injury?
A. Anemia associated with
intrinsic factor deficiency
B. Autoantibody mediated cell
injury
C. CagA associated mitogenic
effects
D. Urease induced mucosal
surface hyperacidity
E. VacA associated cell
membrane damage
7. A 21-year-old man
presents with intermittent epigastric pain for 6 months. His past medical
history is unremarkable. His family history including multiple family members with
gastric cancers. He does not smoke cigarette nor drink alcohol. Physical
examination and laboratory test results are unremarkable. Gastroscopy exam reveals focal erythematous
changes at his antrum. No ulcer nor tumor is noted. Biopsy of his antrum mucosa
reveals diffuse lymphoplasmacytic infiltrate. Scattered neutrophils are seen
within glandular epithelium. No cytological atypia is noted. Immunohistochemistry
studies reveals a mixed T and B cell population with normal kappa/lambda ratio.
What risk associated with these finding does this patient have?
A. Diffuse type
adenocarcinoma
B. Hodgkin lymphoma
C. Intestinal type
adenocarcinoma
D. Metastasis
E. Pernicious anemia
8. Use this case for the next four
questions. A
61-year-old woman presents with fatigue, clumsiness and vague upper abdominal discomfort
for 6 months. She has a history of Hashimoto thyroiditis and is currently
taking thyroxine. Her history is otherwise unremarkable. Physical examination
reveals mildly pale skin. The vital signs are normal. Neurological examination
reveals unsteady gait. Laboratory test results include a hemoglobin of 8 g/dl (normal
12-16 mg/dl), MCV of 112 fL (normal 80-95 fL), white count of 4 x 109/L
(normal 4.5-10.5 x 109/L), and platelet count of 132 x 109/L
(normal 150-450 x 109/L). Peripheral blood smear reveals slightly enlarged
red cells, and many neutrophils with 5 to 6 segments. No immature blood cells
are seen. Gastroscopic examination reveals pale smooth gastric mucosa. No ulcer
nor tumor is seen. Biopsy of the fundus and body reveal sheets of lymphoplasmacytic
infiltrate. No neutrophils are seen. The glandular components appear to be
shorter than normal. Many columnar cells with greyish cytoplasm are seen among normal
appearing gastric glandular cells. No significant cytological atypia is note. Immunohistochemistry
studies reveals a mixed T and B cell population with normal kappa/lambda ratio.
Biopsy from the antrum is unremarkable. What is the diagnosis?
A. Acute gastritis
B. Autoimmune gastritis
C. Diffuse large B cell
lymphoma
D. Helicobacter gastritis
E. MALToma
9. A 61-year-old woman
presents with fatigue, clumsiness and vague upper abdominal discomfort for 6
months. She has a history of Hashimoto thyroiditis and is currently taking
thyroxine. Her history is otherwise unremarkable. Physical examination reveals
mildly pale skin. The vital signs are normal. Neurological examination reveals
unsteady gait. Laboratory test results include a hemoglobin of 8 g/dl (normal 12-16
mg/dl), MCV of 112 fL (normal 80-95 fL), white count of 4 x 109/L
(normal 4.5-10.5 x 109/L), and platelet count of 132 x 109/L
(normal 150-450 x 109/L). Peripheral blood smear reveals slightly enlarged
red cells, and many neutrophils with 5 to 6 segments. No immature blood cells
are seen. Gastroscopic examination reveals pale smooth gastric mucosa. No ulcer
nor tumor is seen. Biopsy of the fundus and body reveal sheets of lymphoplasmacytic
infiltrate. No neutrophils are seen. The glandular components appear to be
shorter than normal. Many columnar cells with greyish cytoplasm are seen among normal
appearing gastric glandular cells. No significant cytological atypia is note.
Immunohistochemistry
studies reveals a mixed T and B cell population with normal kappa/lambda ratio.
Biopsy from the antrum is unremarkable. What is the cause of these findings?
A. Auto-antibody against K/H
ATPase
B. CagA
C. Hyperacidity
D. Inhibition of COX-1 and
COX-2
E. Urease
10. A 61-year-old woman
presents with fatigue, clumsiness and vague upper abdominal discomfort for 6
months. She has a history of Hashimoto thyroiditis and is currently taking
thyroxine. Her history is otherwise unremarkable. Physical examination reveals
mildly pale skin. The vital signs are normal. Neurological examination reveals
unsteady gait. Laboratory test results include a hemoglobin of 8 g/dl (normal 12-16
mg/dl), MCV of 112 fL (normal 80-95 fL), white count of 4 x 109/L
(normal 4.5-10.5 x 109/L), and platelet count of 132 x 109/L
(normal 150-450 x 109/L). Peripheral blood smear reveals slightly enlarged
red cells, and many neutrophils with 5 to 6 segments. No immature blood cells
are seen. Gastroscopic examination reveals pale smooth gastric mucosa. No ulcer
nor tumor is seen. Biopsy of the fundus and body reveal sheets of lymphoplasmacytic
infiltrate. No neutrophils are seen. The glandular components appear to be
shorter than normal. Many columnar cells with greyish cytoplasm are seen among normal
appearing gastric glandular cells. No significant cytological atypia is note.
Immunohistochemistry
studies reveals a mixed T and B cell population with normal kappa/lambda ratio.
Biopsy from the antrum is unremarkable. What blood test might be abnormal for
this patient?
A. Antibody against helicobacter
B. Auto-antibody against intrinsic
factor
C. Folate
D. Iron
E. Total iron binding
capacity
11. A 61-year-old woman presents with fatigue, clumsiness and vague upper abdominal
discomfort for 6 months. She has a history of Hashimoto thyroiditis and is
currently taking thyroxine. Her history is otherwise unremarkable. Physical
examination reveals mildly pale skin. The vital signs are normal. Neurological
examination reveals unsteady gait. Laboratory test results include a hemoglobin
of 8 g/dl (normal 12-16 mg/dl), MCV of 112 fL (normal 80-95 fL), white count of
4 x 109/L (normal 4.5-10.5 x 109/L), and platelet count
of 132 x 109/L (normal 150-450 x 109/L). Peripheral blood
smear reveals slightly enlarged red cells, and many neutrophils with 5 to 6
segments. No immature blood cells are seen. Gastroscopic examination reveals
pale smooth gastric mucosa. No ulcer nor tumor is seen. Biopsy of the fundus
and body reveal sheets of lymphoplasmacytic infiltrate. No neutrophils are
seen. The glandular components appear to be shorter than normal. Many columnar cells
with greyish cytoplasm are seen among normal appearing gastric glandular cells.
No significant cytological atypia is note. Immunohistochemistry
studies reveals a mixed T and B cell population with normal kappa/lambda ratio.
Biopsy from the antrum is unremarkable.
What is the cause of her pancytopenia?
A. Bone marrow stem cell
failure
B. Folate deficiency
C. Iron deficiency
D. Neoplastic process involving marrow
E. Vitamin B12 deficiency
12. A 45-year-old
man presents with epigastric discomfort and mild diarrhea for 1 year. She
denies other constitutional symptoms. She has a history of asthma and reflux
esophagitis. Physical examination and laboratory tests are unremarkable. Parasitological
and bacteriologic studies are negative. Endoscopic examination reveals normal appearing
esophagus and focal erythematous changes of the antral mucosa. No ulcer nor
tumor is noted. Antral biopsy reveal predominantly mucinous glands with
numerous eosinophils in stroma. No neutrophils are seen. There is no intestinal
metaplasia. Silver stain is negative for helicobacters. What is the diagnosis?
A. Acute gastritis
B. Autoimmune
gastritis
C. Eosinophilic
gastritis
D. Gastric antral
vascular ectasia
E. Lymphocytic
gastritis
13. Use this case for the next two questions. A 31-year-old man presents
with intermittent epigastric pain for 2 months. The pain is dull, and tends to
be worse at night, or 2-3 hours after meal. He does not have nausea or
vomiting. His past medical history is unremarkable. He has a 10 pack-year
history of cigarette smoking. He denies alcohol or other recreational drug use.
Physical examination reveals epigastric tenderness. No other abnormalities are
noted. Laboratory tests are unremarkable. Gastroscopic examination reveals a
1.5 cm deep ulcer at distal lesser curvature. The ulcer has sharp edge without induration.
A few foci of his antral mucosa have erythematous changes. Biopsy of the ulcer
reveals proteinaceous debris and granulation tissue. No cytological atypia is
noted. Biopsies from the antrum reveal antral mucosa with diffuse lymphoplasmacytic
infiltrate. Silver stain reveals groups of short curved rod. What is the
diagnosis for the ulcer?
A. Curling ulcer
B. Cushing ulcer
C. Diffuse type
adenocarcinoma
D. Intestinal type adenocarcinoma
E. Peptic ulcer
14. A 31-year-old man presents
with intermittent epigastric pain for 2 months. The pain is dull, and tends to
be worse at night, or 2-3 hours after meal. He does not have nausea or
vomiting. His past medical history is unremarkable. He has a 10 pack-year
history of cigarette smoking. He denies alcohol or other recreational drug use.
Physical examination reveals epigastric tenderness. No other abnormalities are
noted. Laboratory tests are unremarkable. Gastroscopic examination reveals a
1.5 cm deep ulcer at distal lesser curvature. The ulcer has sharp edge without induration.
A few foci of his antral mucosa have erythematous changes. Biopsy of the ulcer
reveals proteinaceous debris and granulation tissue. No cytological atypia is
noted. Biopsies from the antrum reveal antral mucosa with diffuse lymphoplasmacytic
infiltrate. Silver stain reveals groups of short curved rod. What is the most likely
cause of the ulcer?
A. Cigarette smoking
B. Helicobacter pylori
C. Hyperacidity
D. Hypergastrinemia
E. Monoclonal lymphocytic proliferation
15. A 22-year-old man
presents with severe sharp epigastric pain and vomiting for 2 hours. He has had
intermittent epigastric discomfort for a year. His past medical history including
helicobacter gastritis. The patient appears to be in pain. He has a heart rate
of 120 bpm with regular rhythm. Other vital signs are within normal range. Physical
examination reveals guarding, rigidity, tenderness and rebound tenderness at
upper left abdomen and periumbilical area. Laboratory tests reveal a white cell
count of 14 x 109/L (normal 4.5-10.5 x 109/L) with left
shift. Peripheral blood smear reveals no significant morphological
abnormalities, except toxic granulation of neutrophils. Other blood tests,
including amylase, liver and kidney function tests, are within normal range.
Fecal occult blood test is positive. Abdominal X-ray reveals intraperitoneal
air. What is likely the diagnosis?
A. Acute appendicitis
B. Acute cholecystitis
C. Acute leukemia
D. Acute pancreatitis
E. Perforated peptic ulcer
Back to stomach
pathology
Back to contents
Comments
Post a Comment