Path 17A Flashcards

In esophageal atresia, the obstructed segment is replaced by a:
A. Thin non-canalized cord
B. Hypertrophied muscle ring
C. Necrotic fibrous band
D. Dilated mucosal pouch

The main consequence of esophageal atresia is:
A. Functional obstruction
B. Mechanical obstruction
C. Vascular compression
D. Neuromuscular dysphagia

Esophageal atresia most commonly occurs near the:
A. Gastroesophageal junction
B. Cricopharyngeus muscle
C. Tracheal bifurcation
D. Distal stomach

Esophageal atresia is usually associated with a fistula to the:
A. Bronchus or trachea
B. Pleural cavity only
C. Pharyngeal pouch only
D. Aortic arch

The most common form of congenital intestinal atresia is:
A. Jejunal atresia
B. Duodenal atresia
C. Ileal atresia
D. Imperforate anus

Imperforate anus results from failure of the:
A. Vitelline duct to regress
B. Cloacal diaphragm to involute
C. Tracheoesophageal septum to form
D. Urorectal septum to descend

Diaphragmatic hernia results when incomplete formation of the diaphragm allows:
A. Air into the mediastinum
B. Pleura into the abdomen
C. Abdominal viscera into thorax
D. Esophagus into the neck

Omphalocele is best described as:
A. Failure of gut rotation
B. Ventral sac herniation
C. Diaphragmatic rupture
D. Acquired fascial defect

Omphalocele occurs because closure of the abdominal musculature is:
A. Delayed only
B. Excessive
C. Incomplete
D. Inflamed

Omphalocele is commonly associated with:
A. Other birth defects
B. Hirschsprung disease only
C. pyloric atresia only
D. Isolated reflux only

The most frequent site of ectopic gastric mucosa is the:
A. Distal ileum
B. Upper third esophagus
C. Sigmoid colon
D. Gastric antrum

Ectopic gastric mucosa in the upper esophagus is called:
A. Zenker patch
B. A ring
C. Inlet patch
D. B ring

Gastric heterotopia refers to ectopic gastric mucosa in the:
A. Small bowel or colon
B. Distal esophagus only
C. Oral cavity only
D. Appendix only

Gastric heterotopia may present with blood loss from:
A. Variceal rupture
B. Angiodysplasia
C. Hemorrhoids
D. Peptic ulcerations

A true diverticulum is a blind outpouching that:
A. Lacks luminal communication
B. Contains all three layers
C. Contains mucosa only
D. Always becomes inflamed

The most common true diverticulum is:
A. Zenker diverticulum
B. Sigmoid diverticulum
C. Meckel diverticulum
D. Traction diverticulum

Meckel diverticulum most commonly occurs in the:
A. Duodenum
B. Jejunum
C. Sigmoid colon
D. Ileum

The most common site of acquired diverticula is the:
A. Transverse colon
B. Cecum
C. Ileum
D. Sigmoid colon

Congenital hypertrophic pyloric stenosis is more common in:
A. Males
B. Females
C. Turner patients only
D. Premature infants only

Which syndrome increases risk of hypertrophic pyloric stenosis?
A. Marfan syndrome
B. Turner syndrome
C. Down syndrome
D. Noonan syndrome

Which trisomy is linked to hypertrophic pyloric stenosis?
A. Trisomy 13
B. Trisomy 21
C. Trisomy 18
D. Trisomy 16

Which antibiotic exposure in the first 2 weeks increases pyloric stenosis risk?
A. Gentamicin
B. Azithromycin
C. Amoxicillin
D. Metronidazole

Another antibiotic linked to pyloric stenosis risk is:
A. Erythromycin
B. Vancomycin
C. Ceftriaxone
D. Doxycycline

Hirschsprung disease is also called:
A. Congenital pyloric stenosis
B. Functional ileus syndrome
C. Congenital aganglionic megacolon
D. Distal colonic atresia

Hirschsprung disease results from abnormal migration or loss of:
A. Smooth muscle cells
B. Neural crest-derived ganglion cells
C. Enterochromaffin cells
D. Mesothelial cells

Definitive diagnosis of Hirschsprung disease requires absence of:
A. Goblet cells
B. Paneth cells
C. Ganglion cells
D. Chief cells

Ganglion cells in Hirschsprung evaluation may be identified using stains for:
A. Creatine kinase
B. Acetylcholinesterase
C. Myeloperoxidase
D. Acid phosphatase

Functional obstruction of the esophagus results from disruption of:
A. Coordinated peristalsis
B. LES blood flow
C. Mucosal regeneration
D. Gastric acid secretion

Nutcracker esophagus is characterized by:
A. Absent lower sphincter tone
B. Distal perforation
C. High-amplitude distal contractions
D. Proximal web formation

Nutcracker esophagus reflects loss of coordination between the:
A. Mucosa and serosa
B. Circular and longitudinal muscle
C. Vagus and phrenic nerves
D. Upper and lower sphincters

Zenker diverticulum results from impaired relaxation and spasm of the:
A. Lower esophageal sphincter
B. Pyloric sphincter
C. Cricopharyngeus muscle
D. Ileocecal valve

Zenker diverticulum usually develops after age:
A. 20
B. 35
C. 40
D. 50

A large Zenker diverticulum commonly causes:
A. Regurgitation and halitosis
B. Hematemesis and melena
C. Jaundice and pruritus
D. Tenesmus and fever

Esophageal stenosis is commonly caused by chronic GERD, irradiation, or:
A. Malrotation
B. Caustic injury
C. Vagotomy
D. Diverticulosis

Patients with benign esophageal strictures generally maintain:
A. Appetite and weight
B. Hearing and vision
C. Posture and tone
D. Temperature and pulse

Malignant esophageal strictures are more often associated with:
A. Hyperphagia
B. Polyuria
C. Weight loss
D. Hematuria

Distal esophageal rings above the GE junction are called:
A. B rings
B. C rings
C. A rings
D. D rings

A rings are covered by:
A. Gastric cardia-type mucosa
B. Squamous mucosa
C. Intestinal metaplasia
D. Respiratory epithelium

Rings at the squamocolumnar junction of the lower esophagus are:
A. A rings
B. Web rings
C. Traction rings
D. B rings

The undersurface of a B ring contains:
A. Colonic-type mucosa
B. Squamous mucosa only
C. Gastric cardia-type mucosa
D. Pancreatic acini

Achalasia is characterized by incomplete relaxation of the:
A. Upper esophageal sphincter
B. Lower esophageal sphincter
C. Pyloric sphincter
D. Ileocecal sphincter

In achalasia, LES tone is typically:
A. Decreased
B. Normal
C. Increased
D. Absent

A classic motility feature of achalasia is:
A. Hyperperistalsis
B. Aperistalsis
C. Reverse peristalsis only
D. Pylorospasm

Which symptom pattern best fits achalasia?
A. Dysphagia solids only
B. Dysphagia liquids only
C. Dysphagia to solids and liquids
D. Odynophagia with diarrhea

Another common achalasia symptom is:
A. Easy belching
B. Difficult belching
C. Hematochezia
D. Chronic cough only

Primary achalasia results from degeneration of distal esophageal:
A. Inhibitory neurons
B. Skeletal myocytes
C. Epithelial stem cells
D. Goblet cells

Primary achalasia causes inability to relax the LES because of:
A. Muscular rupture
B. Inflammatory fibrosis only
C. Ganglion cell degeneration
D. Vagal hyperstimulation

Secondary achalasia may occur in:
A. Crohn disease
B. Chagas disease
C. Celiac disease
D. Ulcerative colitis

In Chagas disease, secondary achalasia is caused by destruction of the:
A. Submucosal plexus only
B. Serosal mesothelium
C. Myenteric plexus
D. Muscularis mucosae

Secondary achalasia in Chagas disease leads to failure of peristalsis and:
A. Esophageal dilatation
B. Gastric volvulus
C. Pyloric closure
D. Colonic ischemia

A patient has achalasia, alacrima, and ACTH-resistant adrenal insufficiency. This syndrome is:
A. Allgrove syndrome
B. MEN 2A
C. Cowden syndrome
D. Peutz-Jeghers syndrome

Triple A syndrome is inherited in an:
A. Autosomal dominant pattern
B. Autosomal recessive pattern
C. X-linked recessive pattern
D. Mitochondrial pattern

Longitudinal mucosal tears near the gastroesophageal junction are called:
A. Boerhaave ruptures
B. Zenker diverticula
C. Mallory-Weiss tears
D. Schatzki rings

After forceful vomiting, a patient develops transmural rupture of the distal esophagus. This is:
A. Achalasia
B. Mallory-Weiss syndrome
C. Eosinophilic esophagitis
D. Boerhaave syndrome

The most feared complication of Boerhaave syndrome is:
A. Barrett metaplasia
B. Severe mediastinitis
C. Tracheoesophageal fistula
D. Portal hypertension

In otherwise healthy individuals, infectious esophagitis is usually caused by:
A. Herpes simplex virus
B. Candida albicans
C. Cytomegalovirus
D. Adenovirus

Endoscopic “punched-out” esophageal ulcers most strongly suggest:
A. CMV infection
B. Reflux esophagitis
C. Eosinophilic esophagitis
D. Herpes simplex virus

The glands most prominent in the proximal and distal esophagus are the:
A. Mucosal glands only
B. Brunner glands
C. Submucosal glands
D. Oxyntic glands

Esophageal submucosal glands protect mucosa by secreting:
A. Mucin and bicarbonate
B. Pepsin and acid
C. Bile and phospholipids
D. Histamine and gastrin

LES relaxation contributing to GERD can be mediated by:
A. Sympathetic pathways
B. Vagal pathways
C. Phrenic pathways
D. Somatic reflex arcs

Which can trigger reflux-related LES relaxation?
A. Hypercalcemia
B. Hypothyroidism
C. Gastric distention
D. Hypovolemia

Hiatal hernia is defined by:
A. Distal esophageal ganglion loss
B. Gastric volvulus only
C. Diaphragmatic eventration
D. Stomach protrusion into thorax

Symptoms of hiatal hernia most commonly resemble:
A. Achalasia
B. GERD
C. Boerhaave syndrome
D. Diffuse spasm

Most patients with eosinophilic esophagitis are:
A. Atopic
B. Heavy alcohol users
C. Chronically uremic
D. Immunocompromised

The cardinal histologic feature of eosinophilic esophagitis is:
A. Basal ganglion loss
B. Villous blunting
C. Transmural neutrophils
D. Superficial intraepithelial eosinophils

Failure to improve with high-dose PPI favors:
A. GERD
B. Viral esophagitis
C. Eosinophilic esophagitis
D. Hiatal hernia

Barrett esophagus is a complication of chronic GERD marked by:
A. Intestinal metaplasia
B. Smooth muscle hypertrophy
C. Squamous dysplasia only
D. Transmural ulceration

The major concern in Barrett esophagus is increased risk of:
A. Squamous carcinoma
B. Adenocarcinoma
C. Leiomyosarcoma
D. Small cell carcinoma

Diagnosis of Barrett esophagus requires:
A. Positive fecal occult blood
B. Weight loss and dysphagia
C. Columnar mucosa above GEJ
D. Loss of ganglion cells

The most common benign esophageal tumor is:
A. Papilloma
B. Lipoma
C. Fibroma
D. Leiomyoma

Esophageal leiomyomas usually arise within the:
A. Esophageal wall
B. Mucosal surface
C. Lymphatic channels
D. Subserosal fat

Rising rates of esophageal adenocarcinoma are most linked to:
A. CMV esophagitis/Barrett
B. Obesity-related GERD/Barrett
C. Alcohol-related retching/Barrett
D. Congenital rings/Barrett

Additional risk factors for esophageal adenocarcinoma include:
A. Asthma and eczema
B. Burns and trauma
C. Achalasia and alacrima
D. Tobacco and radiation

Esophageal adenocarcinoma most often arises in the:
A. Upper third
B. Middle third
C. Distal third
D. Cervical esophagus

Esophageal adenocarcinoma often invades the adjacent:
A. Duodenal bulb
B. Gastric cardia
C. Tracheal bifurcation
D. Pancreatic head

Most esophageal squamous cell carcinomas are associated with:
A. Tobacco and alcohol
B. Obesity and GERD
C. Barrett metaplasia
D. Eosinophilic inflammation

About half of esophageal squamous cell carcinomas occur in the:
A. Distal esophagus only
B. Upper third
C. GE junction
D. Middle third

Squamous cancers in the upper third most often spread to:
A. Cervical lymph nodes
B. Celiac lymph nodes
C. Axillary lymph nodes
D. Inguinal lymph nodes

Middle-third esophageal tumors most often spread to:
A. Gastric/paratracheal/tracheobronchial nodes nodes
B. Mediastinal/paratracheal/tracheobronchial nodes
C. Cervical nodes/paratracheal/tracheobronchial nodes
D. Mesenteric/paratracheal/tracheobronchial nodes

Lower-third esophageal tumors most often spread to:
A. Cervical and celiac nodes
B. Axillary and celiac nodes
C. Gastric and celiac nodes
D. Inguinal and celiac nodes

NSAIDs injure gastric mucosa by inhibiting COX-dependent synthesis of:
A. Gastrin and secretin
B. Leukotrienes C4 and D4
C. Nitric oxide and endothelin
D. Prostaglandins E2 and I2

Gastric prostaglandins E2 and I2 normally:
A. Increase acid secretion
B. Reduce mucosal blood flow
C. Support mucosal defense
D. Inhibit epithelial restitution

Ammonium ions in uremia or H. pylori may cause injury by inhibiting gastric:
A. Chloride channels
B. Potassium pumps
C. Sodium channels
D. Bicarbonate transporters

Proximal duodenal ulcers associated with severe burns or trauma are:
A. Cushing ulcers
B. Curling ulcers
C. Stress erosions
D. Aftoid ulcers

Which esophageal tear typically requires surgical intervention?
A. Boerhaave syndrome
B. Mallory-Weiss tear
C. Eosinophilic esophagitis
D. Hiatal hernia

Gastric, duodenal, and esophageal ulcers occurring with intracranial disease are called:
A. Cushing ulcers
B. Curling ulcers
C. Stress erosions
D. Peptic ulcers

Cushing ulcers are notable for a high incidence of:
A. Obstruction
B. Hematochezia
C. Perforation
D. Intussusception

Stress-related gastric mucosal injury most often results from local:
A. Autoimmunity
B. Ischemia
C. Hyperplasia
D. Metaplasia

A contributor to stress-related gastric injury is:
A. Increased bicarbonate secretion
B. Reduced endothelin release
C. Increased mucosal perfusion
D. Splanchnic vasoconstriction

A Dieulafoy lesion is caused by a:
A. Mucosal venous malformation
B. Large unbranched submucosal artery
C. Distal esophageal tear
D. Hypertrophied muscularis mucosa

The most common site of a Dieulafoy lesion is the:
A. Lesser curvature near GEJ
B. Gastric fundus
C. Distal duodenum
D. Mid-esophagus

Bleeding from a Dieulafoy lesion is often:
A. Malignant
B. Painlessly obstructive
C. Due to varices
D. Self-limited

H. pylori organisms are best described as:
A. Gram-positive cocci
B. Branching filamentous rods
C. Spiral or curved bacilli
D. Encapsulated diplococci

H. pylori is present in almost all patients with:
A. Duodenal ulcers
B. Crohn gastritis
C. Autoimmune gastritis
D. Mallory-Weiss tears

Acute H. pylori infection usually:
A. Causes severe epigastric pain
B. Produces no notable symptoms
C. Causes major GI bleeding
D. Leads to immediate cancer

Compared with acute infection, chronic H. pylori infection more often:
A. Remains entirely silent
B. Produces only perforation
C. Causes adrenal insufficiency
D. Comes to medical attention

H. pylori most often presents as:
A. Body-predominant gastritis
B. Pangastritis with achlorhydria
C. Antral-predominant gastritis
D. Fundic granulomatous gastritis

In typical H. pylori antral gastritis, acid production is:
A. Always absent
B. Normal or increased
C. Severely decreased
D. Irrelevant diagnostically

In H. pylori gastritis, local gastrin may rise, but _____ is uncommon.
A. Hypergastrinemia
B. Dysphagia
C. Achalasia
D. Pernicious anemia

Which H. pylori gene is linked to higher gastric cancer risk?
A. APC
B. RET
C. CagA
D. KRAS

CagA-expressing strains can colonize the gastric body and cause:
A. Distal esophageal webs
B. Acute appendicitis
C. Autoimmune thyroiditis
D. Multifocal atrophic gastritis

Which cytokine pattern is linked to pangastritis and gastric cancer?
A. ↑TNF/IL-1β, ↓IL-10
B. ↓TNF/IL-1β, ↑IL-10
C. ↑IL-10, ↓gastrin
D. ↑IFN-γ, ↓acid only

Intraepithelial neutrophils and subepithelial plasma cells suggest:
A. Autoimmune gastritis
B. H. pylori gastritis
C. Viral esophagitis
D. Lymphocytic colitis

Lymphoid aggregates with germinal centers in H. pylori gastritis represent induced:
A. Peyer patches
B. Lamina propria fibrosis
C. Paneth cell metaplasia
D. MALT

H. pylori-associated MALT may transform into:
A. Adenocarcinoma
B. Leiomyoma
C. Lymphoma
D. Carcinoid tumor

Autoimmune gastritis typically spares the:
A. Fundus
B. Antrum
C. Body
D. Oxyntic mucosa

Autoimmune gastritis is commonly associated with:
A. Hypergastrinemia
B. Hyperchlorhydria
C. Hypopepsinuria
D. Hypoglycemia

Autoimmune gastritis often features antibodies to parietal cells and:
A. Pepsin
B. Gastrin
C. Intrinsic factor
D. Mucin

Loss of parietal cells causes impaired secretion of:
A. Bile and pepsin
B. Gastrin and mucus
C. Pepsinogen and bile
D. Acid and intrinsic factor

Reduced serum pepsinogen I in autoimmune gastritis reflects loss of:
A. Chief cells
B. G cells
C. Goblet cells
D. Paneth cells

The principal agents of injury in autoimmune gastritis are:
A. Neutrophils
B. CD4+ T cells
C. Eosinophils
D. Plasma cells

Autoimmune gastritis mainly damages the oxyntic mucosa of the:
A. Antrum and pylorus
B. Cardia and antrum
C. GE junction only
D. Body and fundus

Vitamin B12 deficiency from autoimmune gastritis can cause:
A. Nephrolithiasis
B. Pancreatitis
C. Peripheral neuropathy
D. Hemarthrosis

Lymphocytic gastritis preferentially affects:
A. Women
B. Men
C. Neonates
D. Elderly smokers

Lymphocytic gastritis is strongly associated with:
A. Chagas disease
B. Alcohol use
C. H. pylori only
D. Celiac disease

Histologically, lymphocytic gastritis shows increased:
A. Plasma cells
B. Intraepithelial T lymphocytes
C. Eosinophils
D. Neutrophilic abscesses

Lymphocytic gastritis often involves the:
A. Antrum only
B. Fundus only
C. Entire stomach
D. Distal duodenum only

Another name for lymphocytic gastritis is:
A. Giant hypertrophic gastritis
B. Reactive gastropathy
C. Atrophic pangastritis
D. Varioliform gastritis

The most common specific cause of granulomatous gastritis is:
A. Crohn disease
B. Sarcoidosis
C. Tuberculosis
D. Ulcerative colitis

After Crohn disease, granulomatous gastritis is next associated with:
A. GERD and Barrett
B. Hyperthyroidism and celiac
C. Sarcoidosis and infections
D. NSAIDs and smoking

Peptic ulcer disease refers to chronic mucosal ulceration of the:
A. Esophagus or duodenum
B. Stomach or duodenum
C. Jejunum or duodenum
D. Colon or rectum

Nearly all peptic ulcers are associated with H. pylori, NSAIDs, or:
A. Cigarette smoking
B. Lactose intolerance
C. Achalasia
D. Gallstones

H. pylori is present in about what fraction of chronic gastritis cases?
A. 25%
B. 50%
C. 75%
D. 90%

Autoimmune gastritis may also show:
A. Villous atrophy
B. Endocrine cell hyperplasia
C. Mural thrombosis
D. Transmural fissures

The most common form of peptic ulcer disease occurs in the:
A. Gastric antrum or duodenum
B. Fundus or cardia
C. Jejunum or ileum
D. Esophagus or colon

The most common peptic ulcers are most strongly linked to chronic:
A. Autoimmune gastritis
B. H. pylori gastritis
C. Viral gastritis
D. Granulomatous gastritis

H. pylori-related peptic ulcer disease is associated with:
A. Decreased acid, increased bicarbonate
B. Increased acid, increased bicarbonate
C. Increased acid, decreased duodenal bicarbonate
D. Decreased acid, decreased bicarbonate

In patients older than 60, increased duodenal peptic ulcer disease is especially associated with:
A. Corticosteroid use
B. NSAID use
C. Celiac disease
D. Crohn disease

Duodenal peptic ulcer risk is particularly increased when low-dose aspirin is combined with:
A. Antibiotics
B. PPIs
C. Other NSAIDs
D. Anticoagulants only

Peptic ulcer disease is also associated with cigarette use and cardiovascular disease because they decrease:
A. Mucosal blood flow and healing
B. Gastrin and acid secretion
C. Duodenal motility and appetite
D. Intrinsic factor and pepsin

Most duodenal peptic ulcers occur:
A. In the distal duodenum
B. Near the ligament of Treitz
C. In the proximal duodenum
D. In the jejunum

Duodenal peptic ulcers are usually located within a few centimeters of the:
A. GE junction
B. Pyloric valve
C. Ampulla of Vater
D. Ileocecal valve

The duodenal wall most commonly involved by peptic ulcer is the:
A. Posterior wall
B. Lateral wall
C. Inferior wall
D. Anterior wall

Gastric peptic ulcers are most commonly found along the:
A. Greater curvature
B. Cardia
C. Lesser curvature
D. Fundus

Gastric peptic ulcers are typically located near the interface of the:
A. Body and antrum
B. Cardia and fundus
C. Fundus and body
D. Pylorus and duodenum

Pain from peptic ulcer disease is typically:
A. Better 1–3 hours after meals
B. Worse 1–3 hours after meals
C. Unchanged by meals
D. Only present with fasting

Peptic ulcer pain is classically:
A. Better at night
B. Worse at night
C. Only morning-predominant
D. Absent during sleep

Nighttime peptic ulcer pain is often relieved by:
A. Exercise only
B. Alkali or food
C. Vomiting only
D. Water restriction

The type of gastritis with the greatest risk of gastric adenocarcinoma is:
A. H. pylori gastritis
B. Lymphocytic gastritis
C. Reactive gastropathy
D. Autoimmune gastritis

In autoimmune gastritis, increased cancer risk may relate to:
A. Hyperchlorhydria
B. Rapid gastric emptying
C. Achlorhydria with bacterial overgrowth
D. Excess pepsin secretion

Bacterial overgrowth in autoimmune gastritis may increase formation of carcinogenic:
A. Ketone bodies
B. Nitrosamines
C. Bile salts
D. Leukotrienes

Hypertrophic gastropathies are characterized by giant cerebriform enlargement of rugal folds due to:
A. Inflammation and ulceration
B. Smooth muscle hypertrophy
C. Epithelial hyperplasia without inflammation
D. Fibrosis and calcification

Hypertrophic gastropathies are linked to excessive release of:
A. Histamine
B. Growth factors
C. Pepsin
D. Somatostatin

Menetrier disease is associated with excessive secretion of:
A. TGF-α
B. TNF-α
C. EGF receptor blockade
D. IL-10

Menetrier disease is characterized by diffuse hyperplasia of the:
A. Chief cells
B. Parietal cells
C. Foveolar epithelium
D. Enterochromaffin cells

Menetrier disease most prominently affects the:
A. Antrum and fundus
B. Body and fundus
C. Pylorus and fundus
D. GE junction only

A major clinical consequence of Menetrier disease is:
A. Protein-losing enteropathy
B. Massive GI perforation
C. Esophageal varices
D. Pancreatic insufficiency

Fundic gland polyps occur sporadically and in patients with:
A. Lynch syndrome
B. MEN1
C. Familial Adenomatous Polyposis
D. Peutz-Jeghers syndrome

The rising prevalence of fundic gland polyps is linked to increased use of:
A. H2 blockers
B. PPIs
C. NSAIDs
D. Bile acid binders

PPIs increase fundic gland polyps in part by causing increased:
A. Secretin secretion
B. Motilin release
C. Gastrin secretion
D. Somatostatin tone

Increased gastrin promotes growth of:
A. Oxyntic glands
B. Paneth cells
C. Goblet cells
D. Brunner glands

Dysplasia and carcinoma may occur in:
A. Sporadic fundic gland polyps only
B. FAP-associated fundic gland polyps
C. All hyperplastic polyps equally
D. Menetrier disease only

Sporadic fundic gland polyps carry:
A. High cancer risk
B. Moderate lymphoma risk
C. No cancer risk
D. Only sarcoma risk

In gastric adenomas, adenocarcinoma risk is most related to:
A. Patient age alone
B. Lesion size
C. Presence of H. pylori only
D. Degree of acid secretion

Gastric adenomas are usually:
A. Multiple and fundic
B. Solitary and under 2 cm
C. Diffuse and infiltrative
D. Pedunculated and duodenal

Gastric adenomas are most commonly located in the:
A. Fundus
B. Body
C. Cardia
D. Antrum

Gastric adenomas are best classified as:
A. Hamartomatous lesions
B. Reactive lesions
C. Premalignant neoplastic lesions
D. Purely inflammatory lesions

Compared with intestinal adenomas, gastric adenomas have a:
A. Lower invasive cancer risk
B. Similar invasive cancer risk
C. Much higher invasive cancer risk
D. Negligible malignant potential

The most common malignancy of the stomach is:
A. Lymphoma
B. GIST
C. Neuroendocrine tumor
D. Adenocarcinoma

Gastric adenocarcinoma accounts for more than:
A. 50% of gastric cancers
B. 70% of gastric cancers
C. 90% of gastric cancers
D. 99% of gastric cancers

The intestinal type of gastric adenocarcinoma typically forms:
A. Diffuse infiltrative thickening
B. Bulky masses
C. Pure ulcers only
D. Signet-ring sheets only

The diffuse type of gastric adenocarcinoma characteristically:
A. Forms exophytic polyps
B. Produces only mucosal plaques
C. Infiltrates and thickens the wall
D. Spares the muscularis

The diffuse type of gastric adenocarcinoma is composed of:
A. Reed-Sternberg cells
B. Signet ring cells
C. Plasma cells
D. Squamous pearls

Spread of gastric adenocarcinoma to the pouch of Douglas is called:
A. Krukenberg tumor
B. Blumer shelf
C. Irish node
D. Virchow node

Blumer shelf may be detected on:
A. Thyroid exam
B. Pelvic ultrasound only
C. Rectal exam
D. Chest percussion

The overall reduction in gastric cancer is most closely related to decreased prevalence of:
A. Crohn disease
B. NSAID use
C. H. pylori
D. Barrett esophagus

Another contributor to declining gastric cancer rates may be reduced intake of dietary:
A. Oxalates
B. N-nitroso compounds
C. Gluten peptides
D. Short-chain fatty acids

Familial gastric cancer is strongly associated with germline loss-of-function mutation in:
A. APC
B. KRAS
C. CDH1
D. TP53

CDH1 encodes:
A. β-catenin
B. E-cadherin
C. N-cadherin
D. p16

Loss of function of E-cadherin is a key step in development of:
A. Intestinal gastric cancer
B. Diffuse gastric cancer
C. MALT lymphoma
D. Duodenal adenoma

Sporadic intestinal-type gastric cancers are strongly associated with increased signaling through the:
A. Notch pathway
B. Hedgehog pathway
C. MAPK pathway
D. Wnt pathway

Increased Wnt signaling in sporadic intestinal-type gastric cancer can result from gain-of-function mutation in:
A. β-catenin
B. E-cadherin
C. SMAD4
D. PTEN

Increased Wnt signaling can also result from loss-of-function mutation in:
A. RET
B. APC
C. KIT
D. RB1

Patients with FAP who carry germline mutations in which gene have increased risk of intestinal-type gastric cancer?
A. APC
B. KRAS
C. TP53
D. CDH1

Most gastric adenocarcinomas involve the gastric:
A. Fundus
B. Cardia
C. Antrum
D. pylorus

Compared with the greater curvature, gastric adenocarcinoma more often involves the:
A. lesser curvature
B. greater curvature
C. posterior wall
D. fundic dome

Diffuse gastric cancer is composed of discohesive signet ring cells because of loss of:
A. APC
B. E-cadherin
C. KIT
D. chromogranin A

Intestinal-type gastric cancer typically develops from precursor lesions such as:
A. adenomas and flat dysplasia
B. chronic ulcers and flat dysplasia
C. fundic polyps and flat dysplasia
D. carcinoid nodules and flat dysplasia

Because most gastric cancers are discovered late, the overall 5-year survival is:
A. excellent
B. moderate
C. variable
D. low, under 30%

Extranodal lymphomas most commonly arise in the GI tract, especially the:
A. jejunum
B. stomach
C. esophagus
D. colon

The most common primary gastric lymphoma is:
A. diffuse large B-cell
B. mantle cell lymphoma
C. marginal zone B-cell
D. Burkitt lymphoma

In the stomach, MALT is most often induced by:
A. chronic gastritis
B. autoimmune hepatitis
C. portal hypertension
D. acute pancreatitis

The most common inducer of gastric MALT is:
A. EBV
B. NSAID use
C. CMV
D. H. pylori

Gastric MALTomas can transform into tumors identical to:
A. Hodgkin lymphoma
B. diffuse large B-cell lymphoma
C. follicular lymphoma
D. plasmacytoma

If NF-kB is constitutively active due to MALToma translocations, H. pylori treatment:
A. is curative
B. is partly effective
C. is not effective
D. is first-line anyway

Gastric MALTomas typically express CD19 and:
A. CD20
B. CD3
C. CD5
D. CD10

Gastric carcinoid tumors may be associated with autoimmune chronic:
A. superficial gastritis
B. erosive gastritis
C. atrophic gastritis
D. viral gastritis

A syndrome associated with gastric neuroendocrine tumors is:
A. Peutz-Jeghers syndrome
B. Zollinger-Ellison syndrome
C. Carney triad
D. Cowden syndrome

Neuroendocrine tumors within the stomach and duodenum ______ metastasize and are generally cured by resection.

a. rarely

b. often

Neuroendocrine tumors that arise in the ____ and ____ are often multiple and tend to be aggressive.

a. jejunum, ileum

b. stomach, ileum

c. duodenum, ileum

Rectal neuroendocrine tumors tend to produce:
A. catecholamines
B. bile salts
C. polypeptide hormones
D. mucin only

Symptomatic rectal neuroendocrine tumors may present with:
A. abdominal pain and weight loss
B. jaundice and ascites
C. dysphagia and regurgitation
D. hemoptysis and cough

The most common mesenchymal tumor in the abdomen is:
A. leiomyoma
B. liposarcoma
C. schwannoma
D. GI stromal tumor

GISTs arise from the:
A. enteric ganglion cells
B. smooth muscle cells
C. interstitial cells of Cajal
D. submucosal fibroblasts

The cell of origin for GIST is found in the GI:
A. mucosa
B. muscularis propria
C. serosa
D. lamina propria

Gastric GIST, paraganglioma, and pulmonary chondroma:
A. Johnson Triad
B. Carney Triad
C. Zollinger-Ellison Triad

Carney triad is seen most often in:
A. elderly men
B. adolescent boys
C. middle-aged women
D. young women

Most GISTs are due to gain-of-function mutations in:
A. APC or RB
B. KIT or PDGFRA
C. KRAS or NRAS
D. RET or ALK

The most useful diagnostic marker for GIST is:
A. desmin
B. S100
C. KIT
D. CD20

Acquired pyloric stenosis in adults most often results from:
A. antral gastritis or nearby ulcers
B. congenital muscle hypertrophy
C. aganglionosis
D. volvulus formation

In Hirschsprung disease, which segment is always involved?
A. cecum
B. sigmoid colon
C. ileum
D. rectum

The main symptom of esophageal mucosal webs is:
A. progressive odynophagia
B. non-progressive dysphagia
C. hematemesis
D. chest pain only

Which feature best distinguishes diffuse gastric cancer from intestinal type?
A. precursor adenomas
B. bulky gland-forming masses
C. discohesive signet ring cells
D. high-risk geography

Which statement is correct regarding gastric malignancy?
A. most are found early
B. stomach is uncommon for extranodal lymphoma
C. MALT is congenital in stomach
D. gastric adenocarcinoma often presents advanced