Gastro-intestinal tract diseas 1 page

A 62-year-old man presents after fainting at home approximalety 1h ago. He says that for the past day he has had increasing left-sided abdominal pain, and also he as noted bright red blood in his stool. He denies any history of vomiting or diarrhea. Physical examination finds a low-grade level and gross blood on rectal examination. Further work-up finds abnormalities in his colon that are similar in appearance to the abnormalities seen in the gross picture of his colon below. Which of the following is the most likely cause of his GI bleeding?

Angiodisplasia

Appendicitis

@Diverticulosis

Hemorrhoids

Instussusception

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A 29-year-old woman presents with colicky lower abdominal pain and frequent bloody diarrhea with mucus. Physical examination finds fever and peripheral leukocytosis, while multiple stool examinations fail to reveal any ova or parasites. A colonoscopy reveals the rectum and sigmoid portions of her colon to have superficial mucosal ulcers with hemorrhage, but regions more proximal are within normal limits. Which of the following histologic changes is most likely to be seen in a biopsy specimen taken from her rectum?

@Crypt abscesses with crypt distortion

Dilated submucosal blood vessels with focal thrombosis

Increased thickness of the subepithelial collagen layer

Noncaseating granulomas with scattered giant cells

Numerous eosinophils within the lamina propria

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A 58-year-old man presents with increasing fatigue. His past medical history is unremarcable. Physical examination is also unremarcable exceptfor heme-positive stool. Laboratory examination finds his hematocrit to be slightly decreased and hypochromic microcytic red cells are present in his peripheral smear. An upper GI is unremarcable, but a barium enema study finds a 4-cm mass in the left side of his colon having an "apple core" appearance. Which of the following is the most likely histologic diagnosis for this colon mass?

@Adenocarcinoma

Leiomyosarcoma

Medullary carcinoma

Small-cell carcinoma

Squamous cell carcinoma

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A 45-year-old man presents with feve, chronic diarrhea, and weight loss. He is found to have multiple pain and swelling of his joints (migratory polyartritis)and generalized lymphadenopathy. Physical examination reveals skin hyperpigmentation. A biopsy from his small interstines reveals the presence of macrophagesin the lamina propria that contain PAS-positive cytoplasm. Which of the following is the most likely diagnosis?

Abetalipoproteinemia

Crohn’s disease

Hartnup disease

Nontropical sprue

@Whipple’s disease

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A microscopic investigation of a colon biopsy revealed a superficial defect of a mucosa, decrease of goblet cells number with lack of mucus in them. In addition, considerable lympho- plasmocyte infiltration with presence of segmented leucocytes and eosinocytes was defined. Choose the most probable and exact diagnosis.

@Nonspecific ulcerative colitis in exacerbation

Crohn's disease

Chronic ischemic colitis

Dysentery in the third stage

Amebiaz of intestine with forming of ulcers

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A 39-year-old man present with bloody diarrhea. Multiple stool examinations fail to reveal any ova or parasites. A barium examination of the patient's colon reveals a characteristic "string sign". A colonoscopy reveals the rectum and sigmoid portion of the colon to be unremarceble inflamatory cells within the lamina propria. Worsening of the patient's symptoms results in emergency resection of the distal small intestines. Gross examination of this resected bowel reveals deep, long mucosal fissures extending deep into the muscle wall. Several transmural fistulas are also found. Which of the following is the most likely diagnosis?

Ulcerative colitis

Lymphocytic colitis

Infectious colitis

Eosinophilic colitis

@Crohn's disease

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Two subtotal colectomy spesiments are sent to the laboratory with both showing a hemorrhagic cobblestone appearance of the mucosa. One, however, shows longitudinal grooving of the surface, which suggests

ischemic bowel disease

multiple polyposis syndrome

ulcerative colitis

@Crohn's disease

intestinal tuberculosis

#

A distinguishing feature when comparing ulcerative colitis with Crohn's disease is

colonic involvement

possible malignant transformation

artritis

@fistula formation

absence of granulomas

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The colonic wall 30 cm from the anal margin in a man with severe bloody diarrhea. All the statements regarding this condition are true EXCEPT

inflammation is usualy limited to the lamina propria

multiple crypt abscesses are comonly seen

atypical cytologic changes occur in the mucosa

@granulomas occur in the mucosa

"skip" lesions are not present

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A macroscopic investigation of the appendix, 9 cm in length and 0.9 cm in thickness, revealed dull and hyperemic serous membrane. Microscopic study determined edema, stases in capillaries and venules, fine hemorrhages throughout the mucosa. Besides these, the necrotic foci with leukocyte infiltration around them were also verified. What is the most likely diagnose?

@Superficial appendicitis.

Simple appendicitis.

Suppurative appendicitis

Flegmonous-ulcerative appendicitis

Gangrenous appendicitis.

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A vermiform appendix is 9cm long and 0,9cm thick. Serous membrana is dark and sanguineous. Microscopically: the wall is oedematous, capillary and venular stases, small hemorrhages. The focuses of necrosis that are surrounded by leukocytic infiltration are located in the mucous and submucous membranae. What is the most possible diagnosis?

Acute phlegmonous-ulcerative appendicitis

Acute simple appendicitis

Acute phlegmonous appendicitis

@Acute superficial appendicitis

Acute gangrenous appendicitis

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A 16-year-old boy was performed an appendectomy. He has been hospitalized for right lower quadrant abdominal pain within 18 hours. The surgical specimen is edematous and erythematous. Infiltration by what of the following cells is the most typical for the process occuring here?

Basophils

Eosinophils

Monocytes

@Neutrophils

Limphocytes

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An 18-year-old woman presents with abdominal pain localized to the right lower quadrant, nausea and vomiting, mild fever, and an elevation of the peripheral leukocyte count to 17,000/mL. An appendectomy is performed. Which of the following statement best describes the expected microscopic appearance of her appendix?

An appendix with a normal appearance

@Neutrophils within the muscular wall

Lymphoid hyperplasia and multinucleated giant cells within the muscular wall

A dilated lumen folled with mucus

A yellow tumor nodule at the tip of the appendix

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Microscopic study of appendix determined intensive leukocyte infiltration throughout all its layers. What is the most likely type of inflammation?

@Suppurative appendicitis

Apostematous appendicitis

Gangrenous appendicitis.

Superficial appendicitis.

Flegmonous-ulcerative appendicitis

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Microscopic study of appendix determined intensive leukocyte infiltration hyperemia, stases throughout all its layers. What is the most likely type of appendicitis?

@Suppurative appendicitis

Gangrenous appendicitis

Superficial appendicitis

Simple appendicitis

Chronic appendicitis

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A removed appendix delivered to pathology department. Macroscopic investigation revealed its thickening, enlargement, dull and hyperemic serous membrane. A yellowish-green liquid lumen was visible on a cut section within its lumen. What is the most likely type of the appendicitis?

@Suppurative appendicitis.

Catarrhal appendicitis.

Superficial appendicitis.

Gangrenous appendicitis.

Apostematous appendicitis

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Macroscopic investigation of a removed appendix revealed its thickening, enlargement, dull and hyperemic serous membrane with whitish membranaceous incrustation. A whitish-yellow, opaque, viscous liquid detected on a cut section within its lumen. What is the most likely type of the appendicitis?

@Suppurative appendicitis.

Gangrenous appendicitis

Simple appendicitis

Superficial appendicitis

Chronic appendicitis.

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A vermiform appendix, sent to the pathomorphologic department after the operation, is thickened and enlarged in size. Serous membrana is dark and sanguineous. A yellow-green fluid excretes from the lumen, when the vermiform appendix is incised. The wall is diffusely infiltrated with leucocytes. What type of appendicitis do the following changes develop?

Superficial catarrhal

Simple catarrhal

@Phlegmonous

Gangrenous

Abscessing

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At the microscopical exam of the vermiform appendix that was operatively removed were noted the following facts: oedema, diffuse neutrophilic infiltration of the wall with the necrosis and the presence of a mucous membrane defect with the affection of the muscular one. What form of appendicitis has developed?

@Phlegmonous-ulcerative

Phlegmonous

Gangrenous

Superficial

Abscessing

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Microscopic study determined edema, diffusive leukocyte infiltration of appendix wall and also a mucosal lesion with alteration of its muscular layer. What is the most likely diagnose?

@Flegmonous-ulcerative appendicitis

Suppurative appendicitis

Gangrenous appendicitis

Superficial appendicitis

Apostematous appendicitis

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Microscopical examination of a removed appendix revealed an edema, diffuse neutrophilic infiltration of appendix wall along with necrosis and defect of mucous membrane with affection of its muscle plate. What appendicitis form was developed?

Phlegmonous

@Ulcerophlegmonous

Gangrenous

Superficial

Apostematous

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The removed appendix thickened and covered by fibrinopurulent incrustation. A purulent exudates infiltrated all appendix layers; the destruction of mucosa membrane was evident. What is the most likely diagnosis?

@Flegmonous-ulcerative appendicitis

Simple appendicitis

Suppurative appendicitis

Gangrenous appendicitis

Superficial appendicitis

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In the histological specimen an organ is seen. Wall of this organ consists of 4 layers: first is mucous layer forming pits and glands; second is submucous layer of connective tissue; third is muscularis externa containing tree layers of smooth muscles; fourth is serous layer. Which organ can be recognized in the specimen?

@Stomach

Jejunum

Duodenum

Esophagus

Colon

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During histological examination of the stomach it was found out that glands contained very small amount of pariental cells or they were totally absent. Mucose membrane of what part of the stomach was studied?

@Pyloric part

Cardia

-

Body of stomach

Fundus of stomach

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A patient ill with chronic gastritis went for endogastric pH-metry that allowed to reveal decreased acidity of gastric juice. It is indicative of diminished function of the following cells:

Chief exocrinocytes

@Parietal exocrinocytes

Endocrinocytes

Cervical cells

Accessory cells

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Examination of the patient with pernicious anemia revealed antibodies against cell’s proteins of gastric glands cells producing gastric extrinsic factor . What kind of cells in gastric glands was destroyed?

@Parietal cells

Mucous cells

Chief cells

DNES-cells

Surface- lining cells

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A biopsy of the antrurn of the stomach of an adult who presents with epigastric pain reveals numerous lymphocytes and plasms cells within the lamina propria, which is of normal thickness. There are also scattered neutrophil within the glandular epithelial cells. A Steiner silver stain from this specimen is positive for a small, curved organism. These histologic changes are moat consistent with infection by which one of the following organisms?

Enteroinvasive Escherichia coli

Enterotoxigenic E. coli

@Helicobacter pylori

Salmonella typhi

Shigella species

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All the following statements regarding Helicobacter pylori gastritis as illustrated in the photomicrograph below are true EXCEPT

it is present in the majority of patients with duodenal ulceration

@the inflammatory infiltrate is characteristically rich in eosinophils

tissue invasion by microorganisms is inconspicuous

organism is absent from arease of intestinal metaplasia

urease is an important virulence factor of H. pilory

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A 49-year-old woman takin ibuprofen for increasing joint pain in her hands presents with increasing pain in her midsternal area. Gastroscopy reveals multiple, scattered, punctuate hemorrhagic areas in her gastric mucosa. Biopsies from one of these hemorrhagic lesions reveal mucosal erosions with edema and hemorrhage. No mucosal ulceration is seen. Which of the following is the most likely diagnosis?

Active chronic gastritis

@Acute gastritis

Autoimmune gastritis

Chronic gastritis

Peptic ulcer disease

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A gastroscopy of a 55-year old patient revealed a diffusive swelling, hyperemia and solitary small hemorrhage of the stomach mucosa. These were accompanied with considerable quantity of a muddy, viscous grey exudate on a gastric surface. What gastritis has developed at the patient?

@ Catarrhal gastritis

Hemorrhagic gastritis

Flegmonous gastritis

Fibrinous gastritis

Corrosive gastritis

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A gastroscopy of a 44-year old patient, with a history of a pain in epigastrium after meal, revealed a hyperemia of the stomach mucosa with the stomach folds reduction. Histological study showed a thinning of the mucosa, a reduction of the glands quantity accompanied with the- growth of a connecting tissue, lymphocytes and plasmocytes infiltration. Specify, what of the listed diagnoses is the most probable?

@Chronic atrophic gastritis.

Acute catarrhal gastritis.

Acute suppurative gastritis.

Chronic superficial gastritis.

Giant hypertrophic gastritis.

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A histological investigation of a gastric biopsy revealed a thinning of a stomach mucosa with reduction of a glands quantity. This was accompanied with a considerable growth of a connecting tissue, dilation of a glands lumen, lymphocytes and plasmocytes infiltration of the mucosa. What is the most likely diagnosis?

@Chronic atrophic gastritis

Chronic superficial gastritis

Chronic atrophic gastritis with an intestinal metaplasia

Phlegmon of stomach

-

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A histological investigation of a gastric biopsy of a 50-year old woman revealed a thinning of a stomach mucosa with reduction of a glands quantity, foci of an intestinal metaplasia; a plethora, an edema and a stromal sclerosis. These were accompanied with a diffuse leucocytes, lymphocytes and plasmocytes infiltration of the mucosa. What is the most likely diagnosis?

@Chronic atrophic gastritis in an active phase •

Chronic atrophic gastritis in a nonactive phase

Chronic superficial gastritis

Acute catarrhal gastritis

Acute fibrinouse gastritis

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A 37-year-old man has had nausea and vomiting for 5 weeks. He experienced an episode of hematemesis yesterday. On physical examination he has no abnormal findings. Upper Gl endoscopy is performed, and there is a 1.5 cm diameter lesion in the gastric antrum which appears to be an area with loss of the epithelial surface. These findings are most typical for which of the following pathologic processes?

Abscess

Serositis

Granuloma

Gangrene

@Ulcer

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A histological investigation of the removed stomach ulcer revealed in its floor the fibrinopurulent exudate, a zone of the fibrinoid necrosis, a granulation tissue with a fibrous tissue underneath. What is the most likely diagnosis?

@Chronic ulcer

Acute ulcer

Acute erosion

Phlegmon of stomach

-

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A post-mortem of a male with a history of anemia accompanied by vomiting by dark gastric contents reveled in a stomach about 1 liter of liquid blood and bloody clots. A gross investigation showed an on small curvature of a stomach an oval solitary ulcer with the elevated firm edgesand a smooth floor. What is the most likely diagnosis?

@Chronic gastric ulcer

Chronic atrophic gastritis

Acute gastritis

Acute gastric ulcer

Chronic hypertrophic gastritis

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Morphological exam of a stomach reveals a deep defect of a wall with the affection of a muscular membrana; a proximal margin of the last is excavated but a distal one is plain. Microscopically: an area of necrosis is detected at the bottom of the defect. A granulation tissue and a massive area of a cicatricle tissue (at the place of muscular membrana) are located under it. Make a diagnosis.

Chronic ulcer at the remission stage

Chronic ulcer with the malignancy

Acute ulcer

@Chronic ulcer at the stage of acute condition

Cancer-ulcer

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A gross investigation of a stomach revealed a deep defect of a gastric wall with a lesion of a muscular layer. The proximal edge was undermined and distal one was flat. A histological study of the removed stomach showed in its floor the zone of the fibrinoid necrosis, a granulation tissue and massive fibrosis, which replaced the muscular layer. What is the most likely diagnosis?

@Chronic ulcer in exacerbation

Chronic ulcer in remission

Acute ulcer

Erosion

Cancer-Ulcer

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An operation of a male with a medical history of a hematemesis revealed a stomach ulcer penetrated into the muscular layer. Ulcer edges were dense. A bleeding vessel was detected at the ulcer's bottom. What is the type of an ulcer?

@Chronic ulcer with hemorrhage

Chronic ulcer with penetration

Ecute ulcer with bleeding

Chronic ulcer with perforation

Chronic ulcer with malignisation

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A 44-year old patient, with a history of the chronic duodenum peptic ulcer, died of peritonitis. An autopsy revealed multiple steatonecroses of a retroperitoneal tissue and a pancreas. A gross investigation of a duodenum demonstrated an ulcerative defect, which was 5 mm in diameter and 10 mm deep. The edges presented necrotic masses. Diagnose the complication of a duodenal peptic ulcer?

@Penetration

Hemorrhage

Stenosis

Perforation

-

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During the section of a 29-year-old man, that had duodenal ulcer for a long time, were revealed the signs of peritonitis, numerous steatonecroses of extraabdominal fat and pancreas. In the area of the pancreas’ body, an ulcer-like defect was located (diameter - 5 mm, depth - to 10 mm), the margins of which contained necrotic mass. Diagnose the complications of the duodenal ulcer.

Malignancy

Hemorrhage

Stenosis

Perforation

@Penetration

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During the palliative operation of a 46-year-old woman relatively the cancer of the stomach revealed the presence of the Krukenberg’s metastases in the ovaries. What way of metastasis led to the affection of the ovaries?

@Lymphogenic retrograde

Lymphogenic orthograde

Haematogenic

Implantation

Canalicular

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At the section of a 42-year-old woman, who had an operation relatively the tumour of the stomach, the ovary was hardly enlarged in size, of solid consistence and of white color. Histologically: there were revealed atypical epithelial cells, that were located between the strata and shaft brace of connective tissue. What is the most possible disease?

Serous cystadenoma

@Krukenberg’s carcinoma (metastatic ovarian carcinoma)

Pseudomucinous cystcarcinoma

Malignant tecoma

Malignant granulous-cellular tumour

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An autopsy of a 48-year-old woman with a history of the stomach neoplasm revealed the markedly enlarged, firm, white color ovary. Microscopic investigation showed markedly atypical epithelial cells placed among the layers and fibers of a connecting tissue. What is the most likely diagnosis?

@Krukenberg tumor of ovary.

Serous cystadenocarcinoma

Pseudomucinous cystadenocarcinoma.

Malignant thecoma.

Malignant granulosa cell tumor.

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The liver of a 55-year-old man at autopsy contains multiple tumor masses from 2 to 5 cm in size that are mostly firm and tan and that grossly exhibit umbilication with central necrosis. Which of the following statements would best characterize such an appearance:

There is multicentric origin of a benign neoplasm.

The neoplasm has a high grade.

@The primary neoplasm is in the stomach.

A carcinogen was the underlying cause for the neoplasm.

The neoplasm has an advanced stage.

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The subclavicular lymphatic nodules are enlarged in the 45-year-old patient. A metastasis of a signet-ring cell cancer was revealed at the biopsy material from the nodule. Choose the most possible localization of a primary tumour.

Pulmonary cancer

Esophageal cancer

Thyroid cancer

@Cancer of the stomach

Uterine neck cancer

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A 48-year old female presents to her physician enlarged supraclavicular lymph nodes. Microscopic investigation of a biopsy from a lymph node revealed the metastasis of the signet-ring cancer. Choose the most probable localization of a primary tumor.

@Cancer of stomach.

Cancer of oesophagus.

Cancer of thyroid.

Cancer of lung.

Cancer of cervix uteri.

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A 53-year-old man presents with increasing gastric pain and is found to have a 3-cm mass located in the anterior wall of his stomach. This mass is resected and histologic examination reveals a tumor composed of cells having elongated, spindle-shaped nuclei. The tumor does not connect to the overlying gastric epithelium and is instead found only in the wall of the stomach. The tumor cells stain positively with CD117, but negatively with both desmin and S-100. Special studies find that these tumor cells have abnormalities of the KIT gene. Which of the following is the most likely diagnosis?

Ectopic islet cell adenoma (VIPoma)

@Gastrointerstinal stromal tumor (GIST)

Submucosal leiomyoma (“fibroid tumor”)

Lymphoma of mucosa-associated lymphoid tissue (MALToma)

Nonchromaffin paraganglioma (chemodectoma)

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Pre-hepatic (hemolytic) jaundice takes place in all the following cases besides the only one of them:

@Viral hepatitis

Sepsis

Malaria

Hemolytic disease of newborns

Relapsing fever

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A 42-year-old previously healthy woman notes that over the past week her eyes have developed a jaundiced appearance. She has had mild nausea and vomiting over the past week. On physical examination she has scleral icterus. She has no other major physical examination findings except for mild right upper quadrant tenderness. Which of the following underlying conditions is most likely to contribute to development of her icterus?

Hypercholesterolemia

Thrombocytopenia

Metastatic carcinoma

@Hepatitis

Diabetes mellitus

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A 4-year-old boy presents with mild fatigue and malaise. Several other children in the day-care center he attends 5 days a week have devel­oped similar illnesses. Physical examination finds mild liver tenderness, but no lymphadenopathy is noted. Laboratory examination finds mildly elevated serum levels of liver enzymes and bilirubin. The boy recovers from his mild illness without incident. Which of the following organisms is the most likely cause of this child's illness?

Cytomegalovirus (CMV)

Epstein-Barr virus (EBV)

Group A b-hemolytic streptococcus

@Hepatitis A virus

Hepatitis B virus

#

The patent with the viral hepatitis A entered the infectious hospital. Which antibodies will synthesize first?

@IgM.

IgG.

IgA.

IgD.

IgE.

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An autopsy of a male, with a history of a drug abuse, revealed vacuolar dystrophy of hepatocytes, a Councilman's bodies, periportal inflammation consisted mainly of chronic inflammatory cells, lymphocytes, plasma cells and histiocytes. What is the most likely etiology of the disease?

@Viral

Bacterial

Toxic

Parasite

Fungus

#

At the histological exam of a dead man, who was given numerous drug injections, were revealed the hydropic dystrophy of hepatocytes, dim-glasslike hepatocytes, acidophilic Kaunsilmann corpuscles, and lymphocytic-macrophagocytic conglomerations in portal tracts. What is the most possible etiology of the disease?

Bacterial

@Viral

Toxic

Parasitic

Fungus

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In biopsy of the liver of a 40-year-old man, who received injections of narcotics the pathologist has found out acidophilic Councilmen’s bodies, lymphocytes and macrophages surrounding portal tracts, "ground-glass” hepatocytes (an etiology of disease is virus B). Call this disease

@Virus hepatitis B

Tuberculosis

Virus chirrosis

Parasitogenic hepatitis

Steatosis

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A patient presented with vomiting, loss of appetite and jaundice. A histological investigation of his liver biopsy revealed vacuolar and ballooning dystrophies of hepatocytes and necrosis of some cells. The Councilman's bodies were also determined. Besides, a destruction of the liver's beam architecture within lobes and inflammation consisted mainly of chronic inflammatory cells, lymphocytes, plasma cells and histiocytes were registered. What form of virus hepatitis is most likely?