Test bank for robbins basic pathology 9th edition by kumar download

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