Test Bank for Robbins Basic Pathology 9th Edition by Kumar

Sample

Chapter 14: Oral Cavity and Gastrointestinal Tract

Test Bank

MULTIPLE CHOICE

1. Esophageal diverticulum located above the upper esophageal sphincter is called

a. congenital diverticulum

b. postinflammatory diverticulum

c. traction diverticulum

d. epiphrenic diverticulum

e. Zenker diverticulum

ANS: E

Zenker diverticulum is typically located above the upper esophageal sphincter.

2. Basal zone hyperplasia exceeding 20% of the thickness of the esophageal epithelium, accompanied by elongation of lamina propria papillae and by inflammatory infiltrates that contain eosinophils is a histologic finding most typical of which disease?

a. Reflux esophagitis

b. Viral esophagitis

c. Barrett esophagus

d. Mallory-Weiss syndrome

e. Boerhaave syndrome

ANS: A

These histologic findings are typically found in reflux esophagitis.

3. Carcinoma of the esophagus most often presents on gross examination as a

a. polypoid exophytic lesion

b. flat induration of the mucosa

c. volcano-like excavated lesion

d. diffuse narrowing of the esophageal lumen

e. linitis plastica

ANS: A

Esophageal cancer presents most often (in 60% of cases) as a protruding, exophytic polypoid tumor. Flat lesions are found in 15% of cases and excavated lesions in 25% of all cases.

4. Autoimmune atrophic gastritis and pernicious anemia are most often associated with

a. Helicobacter pylori infection

b. peptic ulceration of the duodenum

c. Ménétrier disease

d. Hashimoto thyroiditis

e. trichobezoars

ANS: D

Autoimmune atrophic gastritis is an autoimmune disease, and it may be associated with other autoimmune diseases, such as Hashimoto thyroiditis.

5. Protein-losing gastroenteropathy will most likely develop in patients who have

a. acute erosive gastritis

b. chronic Helicobacter pylori-related gastritis

c. autoimmune atrophic gastritis

d. hypertrophic gastropathy

e. gastric peptic ulcer

ANS: D

Hypertrophic gastropathy may be associated with extensive protein loss that may cause hypoalbuminemia and even generalized edema.

6. Most gastric polyps are microscopically classified as

a. tubular adenomas

b. villous adenomas

c. hyperplastic polyps

d. fundic gland polyps

e. carcinoids

ANS: C

In 90% of cases, gastric polyps are non-neoplastic and are microscopically classified as hyperplastic polyps.

7. Nonbacterial gastroenteritis in adults presenting with nausea, vomiting, watery diarrhea, and abdominal pain in most instances is caused by

a. astrovirus

b. Norwalk virus

c. rota virus

d. enteric adenovirus

e. poliovirus

ANS: B

Norwalk virus is responsible for most viral gastrointestinal infections in adults.

8. The finding of anti-endomysial antibodies in a person with intestinal malabsorption strongly favors the diagnosis of

a. Whipple disease

b. celiac sprue

c. tropical sprue

d. lactase deficiency

e. abetalipoproteinemia

ANS: B

Anti-endomysial and anti-gliadin antibodies strongly suggest a malabsorption syndrome that is caused by celiac sprue.

9. Which intestinal malabsorption syndrome is accompanied by a complete absence of chylomicrons, very-low-density lipoproteins, and low-density lipoproteins in plasma?

a. Crohn disease

b. Celiac sprue

c. Tropical sprue

d. Lactase deficiency

e. Abetalipoproteinemia

ANS: E

Abetalipoproteinemia is an inborn error of metabolism characterized by an inability to produce apolipoprotein B. Accordingly, all lipoproteins that contain apoprotein B are absent from the plasma.

10. Crohn disease is most often diagnosed in which age group?

a. 5-10 years

b. 15-25 years

c. 40-50 years

d. 60-70 years

e. Older than 80 years

ANS: B

Crohn disease can occur at any age, but most often it is diagnosed in the second and third decade (i.e., between 15 and 25 years of age).

11. Angiodysplasia causing lower intestinal bleeding is most often located in the

a. jejunum

b. ileum

c. cecum

d. transverse colon

e. rectum

ANS: C

Angiodysplasia is most often located in the cecum, probably because the cecum has the widest diameter. The mechanism of formation of angiodysplastic lesions is not known. It is thought that the cecum, as the most dilated part of the colon, generates the highest pressure on intramural blood vessels, thus causing their tortuosity and dilatation that predisposes to rupture.

12. In adults, which part of the intestine is most often involved in volvulus?

a. Jejunum

b. Ileum

c. Cecum

d. Transverse colon

e. Sigmoid colon

ANS: E

Volvulus (i.e., torsion of the intestinal loops around the mesentery) occurs most often in the sigmoid colon.

13. Polyps of Peutz-Jeghers syndrome are best classified as

a. serrated adenomas

b. hyperplastic polyps

c. tubular adenoma

d. villous adenomas

e. hamartomas

ANS: E

Polyps of Peutz-Jeghers syndrome are hamartomas, composed of branching fibromuscular network enclosing glands lined by normal intestinal epithelium with numerous goblet cells.

14. Which cells in the intestines are the precursors of carcinoids?

a. Goblet cells

b. Enterocytes

c. Paneth cells

d. Neuroendocrine cells

e. Stromal cells

ANS: D

Carcinoids originate from resident neuroendocrine intestinal cells.

15. T-cell lymphoma was diagnosed in a 55-year-old man who had a lengthy history of intestinal disease. Which of the following diseases most likely preceded this malignancy?

a. Celiac disease

b. Whipple disease

c. Crohn disease

d. Abetalipoproteinemia

e. AIDS

ANS: A

Most likely this man had celiac sprue, a disease associated with a disproportionately high incidence of T-cell lymphomas.

16. A 60-year-old man who complained of persistent right lower quadrant pain underwent an appendectomy. The appendix appeared globular and dilated due to an obstruction by a fecalith. It was filled with mucus. Histologically, the cavity was lined with normal appendiceal mucosa; there was no evidence of neoplasia. This lesion most likely represents a

a. mucocele

b. mucinous cystadenoma

c. mucinous cystadenocarcinoma

d. pseudomyxoma peritonei

e. pseudocyst

ANS: A

A mucocele is a dilatation of the appendix in which the lumen of the appendix is filled with mucus. It results from an obstruction of the appendix by a fecalith or chronic inflammation, and less often by tumors.

17. Primary tumors of the peritoneum are called

a. adenocarcinomatosis peritonei

b. pseudomyxoma peritonei

c. peritoneal sarcoma

d. mesothelioma

e. myxomatosis

ANS: D

Malignant tumors of the peritoneum are called mesotheliomas. Histologically, they are indistinguishable from mesotheliomas of the pleural cavity.

18. This esophageal carcinoma developed in a 65-year-old man who had reflux esophagitis for 15 years. Most likely this tumor was histologically classified as

a. adenocarcinoma

b. squamous cell carcinoma

c. transitional cell carcinoma

d. basal cell carcinoma

e. oat cell carcinoma

ANS: A

The squamo-columnar line in this esophagus is a few centimeters above the normal gastroesophageal junction, suggesting that the terminal esophagus has undergone metaplasia into a Barrett esophagus. Tumors originating in Barrett esophagus are typically adenocarcinomas.

19. This slide shows the muscle layer of a stomach that was removed from a 60year-old man who complained of dyspepsia and bleeding. The tissue section was taken from the muscle underneath a large prepyloric ulcer. Which of the following is the most likely diagnosis?

a. Peptic ulcer disease

b. Helicobacter pylori-related gastritis

c. Autoimmune gastritis

d. Hyperplastic gastropathy

e. Adenocarcinoma

ANS: E

The muscle layer of this stomach is infiltrated with adenocarcinoma cells forming irregular tubular and gland-like structures.

20. This figure shows a portion of the mesentery and omentum removed during a work-up of a 60-year-old woman with ascites and large multicystic ovarian masses. The lesions seen here are most consistent with the diagnosis of

a. primary peritoneal benign tumor

b. primary peritoneal malignant tumor

c. metastatic carcinoma

d. metastatic sarcoma

e. lymphoma

ANS: C

The white nodules in the omentum most likely represent metastases of an ovarian carcinoma. The ovarian masses, described above, most likely represent ovarian carcinoma, which is often bilateral and typically metastasizes by seeding through the peritoneal cavity.

21. This small intestinal lesion was removed from a 56-year-old woman and is most likely a

a. tubular adenoma

b. hamartoma

c. carcinoma

d. sarcoma

e. pseudopolyp

ANS: C

This large partially exophytic and partially ulcerated necrotic lesion most likely represents an adenocarcinoma. Although adenocarcinomas are uncommon in the small intestine, they are nevertheless more common than sarcomas. The tumor is too large and too irregular and necrotic to be benign.

22. This slide illustrates the lesions seen in the partial colectomy specimen obtained from a 78-year-old man who has chronic constipation, left lower quadrant pain, and fever. On cross section, this sigmoid colon shows changes most consistent with the diagnosis of

a. Crohn disease

b. toxic megacolon

c. carcinoma of the colon

d. carcinoid

e. diverticulitis

ANS: E