GI and oral flashcards

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GI and oral flashcards
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GI and oral pathology
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  1. 1. A 58 year old woman presents with a nodule in her mouth, at the bite line. You see a smooth pink exophytic nodule on the buccal mucosa, along the bite line. What is the likely cause?
    Fibroma.
  2. 2. A 29 year old woman presents with bloody diarrhoea. X ray shows toxic megacolon. There is a thin bowel wall. Sigmoidoscopy shows rectal involvement. What is this?
    Ulcerative colitis
  3. 3. A 31 year old woman presents with weight loss. X ray shows fat wrapping of th ecolon. What is this?
    Crohn's disease
  4. 4. A 47 year old woman presents with persistent nausea and upper abdominal discomfort. Urea breath test is positive. There is extensive neutrophil invasion to the lamina propria, lymphoid aggregates, plsma cells in clusters. Intestinal metaplasia is present. What is the most likely cause and what is the main complication?
    H. pylori chronic gastritis - gastric adenocarcinoma.
  5. 5. A 45 year old man is having an x ray for his impacted third molar tooth. This picks up a dentigerous cyst. Is this malignant or benign, and what is management?
    Benign - complete removal is curative
  6. 6. A 54 year old woman has had a biopsy of her parotid gland. This has come back as an acinic cell carcinoma. Is this malignant or benign, and what is management?
    Malignant
  7. 7. A 54 year old woman has had a biopsy of her parotid gland. This has come back as a Warthin tumour. Is this malignant or benign, and what is management?
    Benign
  8. 8. A 54 year old woman has had a biopsy of her parotid gland. This has come back as a pleomorphic adenoma. Is this malignant or benign, and what is management?
    Benign
  9. 9. A 54 year old woman has had a biopsy of her parotid gland. This has come back as a mucoepidermoid carcionma. Is this malignant or benign, and what is management?
    Malignant
  10. 10. A 79 year old woman presents with fatigue. There is diffuse damage of the oxyntic mucosa in the body and fundus. What is the cause and what is the complication?
    Autoimmune gastritis - B12 deficiency and achlorhydria.
  11. 11. A 32 year old male notices nausea and vomiting. There are well circumscribed polyps in the gastric body and fundus. There are 2 polyps, which are cystically ilated, irregular glands, lined by parietal and chief cells. What class of polyp is this?
    Fundic gland polyp.
  12. 12. A 33 year old male presents with diarrhoea which ablates with fasting. The diarrhea fluid is more concentrated than plsma. What kind of diarrhoea do they have and what is the most common cause?
    Osmotic - lactase deficiency
  13. 13. A 71 year old man presents with a 7 cm non-adherent lump in her parotid. The cut surface is pale gray and has small, mucinous cysts. Histologically, there are cords and cysts lined by squamous and mucous cells. What is this?
    Mucoeppidermoid carcinoma
  14. 14. A 4 year old male presents with rectal bleeding, which on sigmoidoscopy is a rectal hamartoma. Th epolyp is pedunculated, smooth-surfaced, reddish, with cystic spaces on cut sections. Microscopy shows dilated glands with mucin and inflammatory debris. What is this?
    Juvenile polyps
  15. 15. A 14 year old male presents with acute onset abdominal pain. Surgery is performed for presumed acute appendicitis. The surface serosa is dull and granular, there is neutrophilic infiltration of the muscularis propria. What is the diagnosis?
    Acute appendicitis
  16. 16. A 33 year old female presents with a diarrhea that persists during fasting. Specimens show isotonicity. What kind of diarrhoea do they have?
    Secretory
  17. 17. A 29 year old woman presents with bloody diarrhoea. Sigmoidoscopy shows superficial, broad-based ulcers. What is this?
    Ulcerative colitis
  18. 18. A 38 year old female presents with rectal bleeding and mucus discharge. Sigmoidoscopy shows an inflammatory lesion of the anterior rectal wall/. What is this?
    Solitary rectal ulcer syndrome
  19. 19. A 1 day old female fails to pass meconium. They continue to have obstructive constipation. Rectal biopsy shows an absence of ganglions. What is the most likely cause and which gene is associated?
    Hirschsprung disease - RET
  20. 20. A 51 year old woman presents with chronic, nonbloody, watery diarrhea. There is no weight loss. Radiology and endoscopy are normal. Microscopy shows normal collagen, and an increase in intraepithelial lymphcytes. What is the likely cause and what else might you look for?
    Lymphocytic microscopic colitis - Autoimmunde diseases and coeliac
  21. 21. A 51 year old woman presents with chronic, nonbloody, watery diarrhea. There is no weight loss. Radiology and endoscopy are normal. Microscopy shows a dense subepithelial collagen layer, with mixed inflammatory infiltrate. What is the likely cause?
    Collagenous microscopic colitis - s t
  22. 22. A 61 year old woman presents with a mobile parotid mass. Qhen excised, this is a rounded, well-demarcated mass, which is encapsulated. On histology they are heterogeneous, with sheets of myoepithelial cells. Is this malignant or benign, and what is management?
    Pleiomorphic adenoma. These are benign but rarely transform. - Recur if excised.
  23. 23. A 65 year old woman presents with rectal bleeding when straining at stool. PR and sigmoidoscopy shows dilated submucosal vessels below the anorectal line. What is the most likely cause?
    External haemorrhoids.
  24. 24. A 26 year old man presents with pain in his posterior mandible. On excision, this is a cyst lined by parakeratonized stratified epithelium. What is this?
    Odontogenic keratocyst - a malignant cyst
  25. 25. A 69 year old woman presents with 'mouth cancer'. She does not drink or smoke, but has tested positive for HPV-16. On examiantion you note that the lesion is at the base of her tongue. On examination you find an irregular, roughened thickening. Which gene might you expect to be mutated?
    p16
  26. 26. A 69 year old woman presents with 'mouth cancer' located on the the floor of her mouth. She has been a lifelong alcoholic and smoker. On examination you find a raise, firm pearly plaque. Which gene might you expect to be mutated?
    p53
  27. 27. A 64 year old female presents with heartburn. On endoscopy the lamina propria shows moderate oedema. The surface epithelium is intact. Histology shows scattered neutrophils are present and in direct contact with epithelial cells. What is the most likely cause of this?
    Acute gastritis
  28. 28. A 54 year old woman is concerned about stomach cancer. On endoscopy 3 polyps are seen, which are ovoid and covered by a smooth surface. On microscopy, they are irregular, cystically dilated with elongated foveolar glands. The lamina propria is oedematous. What class of polyp is this?
    Inflammatory or hyperplastic polyp.
  29. 29. A 67 year old male presents with unexplained weight loss, a sudden onset of abdominal pain and weight loss. On colonoscopy there is an annular lesion of the distal colon which produces a 'napkin ring' lesion. What are you concerned about?
    Adenocarcinoma and obstruction
  30. 30. A 67 year old male presents with unexplained weight loss. On colonoscopy he has a polypoid, exophytic mass in the proximal colon, which extends along one wall of the caecum. What is your diagnosis?
    Adenocarcinoma
  31. 31. A 48 year old male presents with abdominal pain. McBurney's sign is positive. On appendicectomy, the resected appendix is noted to contain a tumour which involves the distal tip of the appendix, producing a solid bulbous swelling of about 2 cm. What is the most common tumour of the appendix?
    Carcinoid
  32. 32. A 71 year oldd female presents with pain on swallowing. She has recently been treated for breast cancer. OG shows ulceration and histology shows accumulation of neutrophils. What are the two most likely causes of this?
    Radiotherapy or chemotherapy
  33. 33. A 32 year old man presents with haematemesis. OG endoscopy shows transmural oesophageal tears. What may be causing this?
    Boerhaave syndrome
  34. 34. A 34 year old man presents with haematemesis. A further history reveals that the patient had prolonged vomiting after drinking alcohol, before the period of haematemesis. OG endoscopy shows longitudinal lacerations which cross the gastro-oesophageal junction. What is the most likely cause of this?
    Mallory Weiss tears.
  35. 35. A 39 year old man presents with odynophagia. ndoscopy shows shallow ulcerations and histology shows nuclear and cytoplasmic inclusions within capillary endothelium and stromal cells. What is the most likely cause of this?
    Cytomegalovirus
  36. 36. A 28 year old woman presents with diarrhea and constipation. Microscopic colitis, celiac, giardiasis, lactose intolerance, infection and malignancy and malabsorption have been ruled out. What is the likely diagnosis?
    Irritable bowel syndrome
  37. 37. A 68 year old male presents with a red patch in his mouth. It is red, velvety and slightly depressed, and cannot be attributed to any other cause. He has been a lifelong cigar smoker. Histology shows mild dysplasia, and adjacent lymphocyte and macrophage infiltrate. What is this and what is the possible complication?
    Erythroplakia - Squamous cell carcinoma transformation
  38. 38. A 56 year old male presents with chronic GERD. Histology shows intestinal metaplasia within the eosophageal squamout mucosa. What is the most likely cause of this and what is the main complication?
    Barrett oesophagus - Oesophageal adenocarcinoma
  39. 39. A 67 year old man presents with a white patch in his mouth which cannot be scraped off. There is no obvious cause. He has been a lifelong pipe smoker. Histology shows hyperkeratosis. What is this and what is the possible complication?
    Leukoplakia - Squamous cell carcinoma transformation
  40. 40. A 69 year old male presents with gastritis. Histology shows discohesive cells which show infiltration. They have large mucin vacuoles and a signet ring cell morphology. There is also a desmoplastic reaction. What is the most likely cause?
    Diffuse type gatric adenocarcinoma
  41. 41. A 7 year old child presents with an ulcerated lesion in her mouth. It is purple and has grown rapidly. Histology shows dense proliferation of immature vessels like granulation tissue. What is this?
    Pyogenic granuloma.
  42. 42. A 67 year old Japanese male presents with gastritis. Histology shows atypical cells growing along broad cohesive fronts to form an ulceration. There are apical mucin vacuoles, and abundant mucin in the gland lumen. What is the most likely cause?
    Intestinal type gastric adenocarcinoma
  43. 43. A 53 year old woman has a painless, slow growing, mobile, discrete mass in her parotid gland. Histology shows a mixture of ductal and myoepithelial cells. Is this malignant or benign, and what is management?
    Pleiomorphic adenoma. These are benign but rarely transform. - Recur if excised.
  44. 44. A 21 year old woman from Gambia presents with bloating. She comments that in the first 3 years of her life she had repeated diarrhea. Histologic features show crypt hyperplasia and villus atrophy. IgATTG is negative. What is the most likely cause?
    Tropical enteropathy
  45. 45. A 17 year old woman presents with painful recurrent ulcers. Examination shows they are multiple, shallow, hyperemic ulcerations with a thin exudate and rimmed by erythema. What 3 conditions might this make you suspicious of?
    Celiac disease, IBF, Behcet disease
  46. 46. A 29 year old woman presents with bloody diarrhoea. Examination shows perianal fistulas and steatorrhoea. What is this?
    Crohn's disease
  47. 47. A critically ill 37 year old male is being investigated. Endoscopy shows shallow gastric erosions which are rounded. The base is stained brown-black. There are multiple ulcers, which are sharply demarcated, with normal adjacent mucosa. What is the most likely cause of this?
    Stress ulcer
  48. 48. A 38 year old with glioblastoma multiforme is being investigated for nausea and vomiting. Endoscopy shows shallow gastric erosions which are rounded. The base is stained brown-black. There are multiple ulcers, which are sharply demarcated, with normal adjacent mucosa. What is the most likely cause of this?
    Cushing ulcers
  49. 49. A 49 year old female with severe burns is being investigated for coffee-ground haematemesis. Endoscopy shows shallow erosions in the proximal duodenum which are rounded. The base is stained brown-black. There are multiple ulcers, which are sharply demarcated, with normal adjacent mucosa. What is the most likely cause of this?
    Curling ulcers
  50. 50. A 39 year old man presents with odynophagia. Endoscopy shows punched out ulcers. Histopatholgoy shows nuclear viral inclusions wtihin a rim of degenerating epithelial cells at the ulcer edge. What is the most likely cause of this?
    Herpesvirus
  51. 51. A 42 year old female presents with heartburn and dysphagia. Occasionally, she is concerned by severe chest pain. Endoscopy shows hyperemia. Histology shows some eosinophil migration into the squamous mucosa, and a few neutrophils. Additionally there is protrusion of the stomach into the thorax. What is the most likely cause of this?
    Reflux oesophagitis
  52. 52. A 42 year old female presents with heartburn and dysphagia. Occasionally, she is concerned by severe chest pain. Endoscopy shows hyperemia. Histology shows some eosinophil migration into the squamous mucosa, and a few neutrophils. What is the most likely cause of this?
    Reflux oesophagitis due to a gastric hernia (most likely a hiatus hernia)
  53. 53. A 61 year old male presents with weight loss. Endoscopy shows a solitary, well-circumscribed, fleshy submucosal mass. Histologically there are spindle cells and epithelioid cells. CT shows some small nodules in the liver. What is the most likely cause, and what genetic mutation might you expect?
    Gastrointestinal stromal tumour - c-KIT
  54. 54. A 58 year old male has a history of chronic gastritis. Endoscopy shows a polyp in the antrum. It contains intestinal type columnar epithelium. There is low grade dysplasia, with enlargement of the nucleus, epithelial crowding and pseudostratification. What class of polyp is this and what are you concerned about?
    Gastric adenoma - Malignant transformation
  55. 55. A 72 year old male presents with dysphagia which is not improved by PPIs. Endoscopy is unremarkable. Histology shows epithelial infiltration with eosinophils, which is not particularly centred around the gastro-oesophageal junction. What is the most likely cause of this and what is your managements?
    Eosinophilic oesophagitis - dietary restrictions
  56. 56. A 29 year old woman presents with bloody diarrhoea. CT shows thick bowel wall, and there is a fistula and stricture. What is this?
    Crohn's disease
  57. 57. A 29 year old woman presents with bloody diarrhoea. Colonoscopy shows transmural inflammation along the colon, with skip lesions and ulcerations. What is this?
    Crohn's disease
  58. 58. A 57 year old woman presents with intermittent cramping, and lower abdominal discomfort. Colonoscopy shows small diverticula, which are under 1cm in diabeter, mainly in the sigmoid colon. They are surrounded by epiploic appencides. What is this, and what is the most severe complication?
    Diverticulosis - Perforation
  59. 59. A 56 year old male undergoes a colonoscopy for occult faecal blood screening. Colonoscopy shows shows a polyp in the left colon, which is smooth and nodular, on the crest of a mucosal fold. Histology shows mature goblet and absorptive cells. There is crowing and a serrated surface. What is this?
    Hyperplastic polyp
  60. 60. A 71 year old female presents with rapid breathing, a fever and a low blood pressure. She has a history of atherosclerosis. Colonoscopy shows patchy inflammation and haemorrhage in the sigmoid colon. Microscopy shows sloughing of the surface epithelium and there is pseudomembrane formation. What is the most likely cause?
    Sepsis secondary to ischaemic bowel disease, possibly due to c. difficile.
  61. 61. A 29 year old woman presents with bloody diarrhoea. Colonoscopy shows continuous colonic involvement, beginning in the rectum. There are ulcers and pseudopolyps. What is this?
    Ulcerative colitis
  62. 62. An 18 year old female presents with unexplained weight loss. Colonoscopy shows at least 100 polyps. On MRI she also has a medulloblastoma. What is the diagnosis?
    Turcot syndrome
  63. 63. A 17 year old male presents with weight loss. Colonoscopy shows at least 100 polyps. Additionally he has osteomas of his mandible and skull, epiderma cysts and a thyroid tumour. What is the diagnosis?
    Gardner syndrome
  64. 64. A 19 year old female presents with weight loss. Colonoscopy shows at least 100 polyps. What is the diagnosis and what is your complication?
    Familial adenomatous polyposis - Colorectal adenocarcinoma
  65. 65. A 31 year old woman presents with weight loss. Colonoscopy shows an apthous ulcer in the terminal ileum. What are you concerned about?
    Crohn's disease
  66. 66. A 67 year old female is undergoing colonoscopy for a positive faecal occult blood finding. Colonoscopy shows a sessile polyp with a texture resembling velvet. Histology shows nuclear hyperchromasia, elongation and stratification. What is this?
    Adenoma
  67. 67. A 25 year old male presents with weight loss. Colonoscopy shows a right colon cancer. What might you be suspicious of?
    HNPCC (Lynch syndrome)
  68. 68. A 38 year old female presents with diarrhea, weight loss and abdominal pain. Bloods show anaemia. What three causes of anaemia might she have?
    Pyridoxine, folate or vit B12 deficiency
  69. 69. A 67 year old woman presents with diarrhoea and sweating which comes in spasms, associated with colicky abdominal pain. Biops shows intramural polypoid lesions, which are yellow in appearance. The lesion is associated with a kinking of the bowel. On histology, there are islands, and sheets of uniform cells with scant, pink granular cytoplasm and a round stippled nucleus. What is the most likely cause and what is the most important prognostic factor?
    Zollinger-Ellison syndrome - Location. Midgut carcinoid tumours are the most aggressive.
  70. 70. A 42 year old female presents with anaemia and bloating. Anti-TTG, Bipsy from the second portion of the duodenum shows high CD8+ T lymphotyces. Tere is intraepithelial, lymphocytosis, crypt hyperplasia and villous atrophy. There are increased numbers of plasma cells, mast cells and eosinophils. What is causing her symptoms and what should she avoid?
    Celiac disease - Wheat, rye, barley
  71. 71. A 47 year old woman presents in shock with sudden onset haematemesis. Angiography confirms the cause. What is the most likely cause of this?
    Oesophageal varices.
  72. 72. A 63 year old woman presents with an enlarged parotid gland. She also has a fever. An x ray the previous month confirmed sialolithiasis. What is the cause of her symptoms, and which two organisms might you suspect?
    bacterial sialadenitis secondary to a duct stone - Staph aureus, strep viridans
  73. 73. A 61 year old woman presents with difficulty swallowing. An OG endoscopy confirms incomplete LES relaxation, increased LES tone, oesophageal aperistalsis. What disease may cause this?
    Chagas disease
  74. 74. A 27 year old woman has been on the contraceptive pill for 8 years. She presents with severe abdominal pain. A colonoscopy shows a segmental, patchy area of haemorrhage and ulceration at the splenic flexure. There is blood-tinged mucus in the lumen. Microscopy shows atrophhy and sloughing of surface epithelium. What is the most likely cause?
    Ischaemic bowel disease caused by hypercoagulability.
  75. 75. A 19 year old man presents with parotid swelling. A biopsy shows interstitial inflammation with a mononuclear inflammatory infiltrate. What complications might you look for?
    Sialadenitis secondary to mumps - Pancreatitis, orchitis
  76. 76. A 19 year old female presents with abdominal pain. McBurney's sign is positive. What is the likely diagnosis?
    Acute appendicitis
  77. 77. A 19 year old man presents with a recurrent 'cold sore'. What is the likely causative agent?
    HSV-1
  78. 78. A 26 year old woman presents with mouth soreness. She shows you a superficial, curdlike, grey inflammatory membrane, which can be scraped off to show an eythematous base. What is the likely causative agent?
    Candida albicans
  79. 79. A 81 year old woman enters your clinic and tells you she has 'mouth cancer'. What is this likely to be?
    Squamous cell carcinoma
  80. 80. A 32 year old woman presents with a dry mouth and dry eyes. She is not taking any drugs. What condition might you suspect?
    Sjogren syndrome
  81. 81. A 2 day old baby presents with failure to thrive and frothy secretions. What should you consider?
    Oesophageal atresia.
  82. 82. A 31 year old woman presents with dysphagia and esophagitis. What developmental condition may cause this?
    Ectopic gastric mucosa - an 'inlet patch'
  83. 83. A 32 year old man presents with occult blood loss. What developmental condition may cause this?
    Ectopic gastric mucosa - gastric heterotopia
  84. 84. A 69 year old woman has been taking antibiotics for a UTI. Recently she has noticed pain when swallowing. What is the most likely cause of this?
    Pill induced esophagitis
  85. 85. . What are the 3 most common causes of iatrogenic eosophageal injury?
    Chemotherapy, radiation therapy, graft-versus-host disease.
  86. 86. A 46 year old woman presents with oesophageal candidiasis. What would you consider?
    AIDS
  87. 87. . What are the 4 areas of the stomach?
    Cardia, fundus, body, antrum
  88. 88. . Which cells secrete mucin and where are they located?
    Foveolar cells - cardia
  89. 89. . Which cells secrete gastrin and where are they located?
    G cells - antrum
  90. 90. . Which cells secrete luminal acid and where are they located?
    Parietal cells - Gastric fundus and body
  91. 91. . Which cells secrete pepsin and where are they located?
    Chief cells - Body and fundus
  92. 92. . What are the three types of acute peptic ulceration?
    Stress ulcers, curling ulcers and cushing ulcers.
  93. 93. . What are the two main causes of peptic ulcer disease?
    NSAID use, h. pylori.
  94. 94. . What is the name for an extranodal B cell lymphoma located in the stomach tissue?
    MALToma
  95. 95. . What are the 4 main mechanical causes of intestinal obstruction?
    Herniation, adhesion, volvulus, intussusception
  96. 96. . Which part of the GI tract is most commonly responsible for intestinal obstruction?
    Small intestine
  97. 97. . What are the 2 complications of visceral herniation?
    Incarceration and strangulation.
  98. 98. . What are the 3 most common chronic malabsorptive disorder in the UK?
    Pancreatic insufficiency, celiac disease, Crohn's disease.
  99. 99. A 58 year old man has just had a bone marrow transplant for his CLL. He presents with malabsorption and diarrhoea. What should you consider?
    Intestinal graft-versus-host disease
  100. 100. A 30 year old female presents with diarrhea which is associated with steatorrhea and is relieved by fasting. What kind of diarrhoea do they have?
    Malabsorptive
  101. 101. A 34 year old male presents with diarrhea which has purulent, bloody stools that continue during fasting. What kind of diarrhoea do they have?
    Exudative diarrhea
  102. 102. A 38 year old female presents with diarrhea, weight loss and abdominal pain. She comments that she is has had recurrent epistaxes of recent. What cause of bleeding might she have?
    Vitamin K deficiency
  103. 103. A 1 day old male presents with meconium ileus. What should you consider?
    Cystic fibrosis
  104. 104. A 13 month old female presents with failure to thrive and weight loss. She has dermatitis herpetiformis. What should you consider?
    Celiac disease
  105. 105. A 32 year old woman presents positive for IgA-TTG. What should you consider and what malignancy is associated?
    Celiac disease - Enteropathy associated T cell lymphoma
  106. 106. A 2 day old baby presents with explosive diarrhea with watery, frothy stools and adbnormal distension. What should you consider?
    Congenital lactase deficiency
  107. 107. A 28 year old man of chinese ethnicity presents with diarrhea which abets with fasting, but which is otherwise profuse. There is no blood associated. What should you consider?
    lactase deficiency
  108. 108. A 35 year old woman has had Crohn's disease for 9 years. She has a pancolitis, with repeated recurrence. What are you concerned about?
    Dysplasia
  109. 109. A 30 year old female has Crohn's with associated primary sclerosing cholangitis. What should you screen for?
    Dysplasia
  110. 110. . What is a sessile polyp?
    Without stalks
  111. 111. A person presents multiple GI hamartomatous polyps and is diagnosed with Peutz'Jeghers syndrome. What are you concerned about?
    Malignancy
  112. 112. . What are the 3 types of adenoma?
    Tubular, tubulovillous, villous
  113. 113. A 56 year old male presents with a GI adenoma. What is the most important predictor of malignancy?
    Size
  114. 114. A 57 year old woman is told that she has a GI adenocarcinoma. What are the two most important prognostic factors?
    Depth of invasion and presence of absence of lymph node metastases.
  115. 115. A 59 year old man is diagnosed with Dukes A carcinoma. What does this mean and what is his 5 year survival?
    The cancer is in the lumen, having invaded into but not through the bowel wall - 90% 5 year survival
  116. 116. A 59 year old man is diagnosed with Dukes B carcinoma. What does this mean and what is his 5 year survival?
    Invasion through muscularis, but not involving lymph nodes - 70 % 5 year survival
  117. 117. A 59 year old man is diagnosed with Dukes C carcinoma. What does this mean and what is his 5 year survival?
    Involvement of lymph nodes - 20% 5 year survival
  118. 118. A 59 year old man is diagnosed with Dukes D carcinoma. What does this mean and what is his 5 year survival?
    Widespread metastases - less than 5% 5 year survival

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