Gastrointestinal and liver — Past Paper OmpathStudy

Gastrointestinal and liver — Questions and Answers Complete review bank: 45 questions recovered from all 32 source pages. 1. A 41-year-old man 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 now experiences a bout of prolonged vomiting, followed by massive hematemesis. On physical examination his vital signs are: T 36.9°C, P 110/min, RR 26/min, and BP 80/40 mm Hg lying down. 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. Esophageal laceration C. Esophageal pulsion diverticulum D. Barrett esophagus E. Esophageal squamous cell carcinoma F. Esophageal stricture Answer: B. This is Mallory-Weiss syndrome. The lacerations are induced by the forceful, prolonged vomiting and can extend to submucosal veins that bleed profusely. Esophageal variceal bleeding should also be suspected with such a history, because hepatic cirrhosis is likely to be present. The acute nature of the process means blood has not yet passed through the bowel to the rectum. 2. A 50-year-old man has had persistent nausea for 5 years with occasional vomiting. On physical examination there are no abnormal findings. He undergoes upper GI endoscopy, and a small area of gastric fundal mucosa has loss of rugal folds. Biopsies are taken and microscopically reveal well- differentiated adenocarcinoma confined to the mucosa. An upper GI endoscopy performed 5 years previously showed a pattern of gastritis and microscopically there was chronic inflammation with the presence of. Which of the following is the most likely risk factor for his neoplasm? A. Inherited APC gene mutation B. Helicobacter pylori infection C. Chronic alcohol abuse D. Use of non-steroidal anti-inflammatory drugs E. Vitamin B12 deficiency Answer: B. H. pylori infection can lead to chronic gastritis that promotes development of adenocarcinoma. The prognosis with early gastric carcinoma (EGC) is good, compared with other gastric cancers. 3. A 58-year-old man has had increasing difficulty swallowing for the past 6 months and has lost 5 kg. No abnormal physical examination findings are noted. Upper GI endoscopy reveals a nearly circumferential mass with overlying ulceration in the mid esophageal region. Biopsy of the mass reveals pink polygonal cells with marked hyperchromatism and pleomorphism. Which of the following is the most likely risk factor for development of his disease? A. Iron deficiency B. Helicobacter pylori infection C. Chronic alcohol abuse D. High fruit diet E. Zenker diverticulum Answer: C. Chronic alcoholism and tobacco use are two of the most important risk factors for squamous cell carcinoma of the esophagus in the U.S., specifically related to squamous cell carcinomas of the mid-esophagus, as in this man. Zinc and molybdenum are trace elements in the diet whose absence increases the risk for carcinoma of the esophagus. Food contaminated with Aspergillus also carries a risk, as does food containing nitrosamines. 4. A 31-year-old man with a stab wound to the abdomen is taken to surgery. While repairing the small intestine, the surgeon notices the presence of a 1 cm circumscribed submucosal mass in the ileum. The lesion is resected and on gross examination has a firm, yellow-tan cut surface. Microscopically, the mass is composed of nests of cells with uniform small round nuclei and cytoplasm with small purple granules. The cytoplasm is positive with antibody to chromogranin on immunohistochemical staining. Which of the following pathologic findings is most likely to accompany this man's lesion? A. Liver metastases B. Another similar lesion C. Multiple gastric ulcerations D. Pancreatic adenocarcinoma E. Inflammatory bowel disease F. Tropheryma whippelii infection Answer: B. This lesion is a carcinoid tumor, and these neoplasms can be multiple, even when biologically benign. Small carcinoids typically act in a benign fashion. Most of them do not secrete hormones causing clinical symptoms, but some do. They are often incidental findings. 5. A 38-year-old man has had upper abdominal pain for 3 months. For the past week he has had nausea. On physical examination a stool sample is positive for occult blood. An upper GI endoscopy reveals no esophageal lesions, but there is a solitary 2 cm diameter shallow, sharply demarcated ulceration of the stomach. Which of the following is most characteristic for this lesion? A. Antral location B. Potential for metastases C. Increased gastric acid production. D. No need for biopsy E. Accompanying pancreatic gastrinoma Answer: A. The gastric antrum is the typical location for a benign peptic ulcer. The small size and sharp margins are characteristics for a benign ulcer, but all gastric ulcerations requ