Path 17a Flashcards

At what level does esophageal atresia most commonly occur?

A) Upper cervical esophagus (C2–C3)

B) Lower thoracic esophagus (T8–T9)

C) Gastroesophageal junction (T10–T11)

D) Tracheal bifurcation (T5–T6)

Which side and pulmonary finding characterize diaphragmatic hernia?

A) Right side; pulmonary hypoplasia

B) Left side; pulmonary hypoplasia

C) Left side; pulmonary hyperplasia

D) Right side; pulmonary hyperplasia

Which genetic disorder is associated with omphalocele?

A) Turner syndrome

B) Klinefelter syndrome

C) Down syndrome

D) Marfan syndrome

Where is ectopic gastric mucosa most commonly found?

A) Middle third of the esophagus

B) Lower third of the esophagus

C) Gastroesophageal junction

D) Upper third of the esophagus

Where does Meckel diverticulum most often occur?

A) Ileum

B) Duodenum

C) Jejunum

D) Esophagus

Meckel diverticulum results from failed involution of which structure connecting the developing gut to the yolk sac?

A) Urachus

B) Vitelline duct

C) Pancreatic duct

D) Bile duct

Loss-of-function of which gene is implicated in Hirschsprung disease?

A) BRCA1

B) BRCA2

C) RET

D) RAD51

What is the first sign of Hirschsprung disease?

A) Bloody diarrhea soon after birth

B) Vomiting with every feeding

C) Failure to pass meconium after birth

D) Abdominal pain during adolescence

What contraction pattern characterizes nutcracker esophagus?

A) Normal-amplitude, coordinated contractions

B) High-amplitude, uncoordinated contractions

C) Low-amplitude, uncoordinated contractions

D) Low-amplitude, coordinated contractions

What causes Zenker diverticula?

A) Reduced wall stress and normal relaxation

B) Reduced wall stress and impaired relaxation

C) Increased wall stress and normal relaxation

D) Increased wall stress and impaired relaxation

Esophageal mucosal webs characterize which syndrome?

A) Mallory-Weiss syndrome

B) Barrett esophagus

C) Chagas disease

D) Plummer-Vinson syndrome

Which findings accompany esophageal webs in Plummer-Vinson syndrome?

A) Iron deficiency anemia, glossitis, cheilosis

B) Iron deficiency anemia, glossitis, gastritis

C) Iron deficiency anemia, cheilosis, jaundice

D) Glossitis, cheilosis, gastric ulcers

Which three findings characterize lower esophageal sphincter function and peristalsis in achalasia?

A) Complete relaxation, increased tone, absent peristalsis

B) Incomplete relaxation, decreased tone, increased peristalsis

C) Incomplete relaxation, increased tone, absent peristalsis

D) Complete relaxation, decreased tone, increased peristalsis

Which infection can cause secondary achalasia?

A) Campylobacter jejuni infection

B) Helicobacter pylori infection

C) Chagas disease

D) Esophageal candidiasis

What are mucosal tears near the gastroesophageal junction called?

A) Esophageal webs

B) Zenker diverticula

C) Barrett metaplasia

D) Mallory-Weiss tears

What typically causes Mallory-Weiss tears?

A) Vomiting associated with acute alcohol toxicity

B) Atopic inflammation from chronic allergies

C) Portal hypertension without vomiting

D) Chronic reflux without vomiting

What appearance characterizes esophageal candidiasis?

A) Yellow-white mucosal webs

B) Red-black mucosal nodules

C) Gray-white pseudomembranes

D) Thin transparent plaques

What is a major mechanism of gastroesophageal reflux disease?

A) Persistently increased esophageal sphincter tone

B) Complete lack of esophageal peristalsis

C) Failure of upper sphincter relaxation

D) Transient lower esophageal sphincter relaxation

Which histologic finding characterizes gastroesophageal reflux disease?

A) Basal zone hyperplasia

B) Goblet-cell metaplasia

C) Gray-white pseudomembranes

D) Jejunal crypt abscesses

Which drug class treats gastroesophageal reflux disease?

A) Macrolide antibiotics

B) Proton pump inhibitors

C) Fluoroquinolone antibiotics

D) Anticonvulsant medications

What underlying condition is associated with eosinophilic esophagitis?

A) Portal hypertension with esophageal varices

B) Chagas disease with secondary achalasia

C) Atopic disease, including allergies and asthma

D) Alcohol toxicity with recurrent vomiting

What most commonly causes esophageal varices?

A) Atopic inflammation

B) Portal hypertension

C) Transient sphincter relaxation

D) Esophageal fungal infection

What metaplastic change occurs in Barrett esophagus?

A) Squamous to columnar epithelium

B) Columnar to squamous epithelium

C) Squamous to transitional epithelium

D) Columnar to cuboidal epithelium

Which cells are diagnostic of Barrett esophagus?

A) Squamous cells

B) Goblet cells

C) Neutrophils

D) Eosinophils

Which esophageal cancers are more common in the West and worldwide, respectively?

A) Adenocarcinoma; squamous cell carcinoma

B) Squamous cell carcinoma; adenocarcinoma

C) Adenocarcinoma; adenocarcinoma

D) Squamous cell carcinoma; squamous cell carcinoma

Which condition is a major risk factor for esophageal adenocarcinoma?

A) Plummer-Vinson syndrome

B) Zenker diverticulum

C) Esophageal candidiasis

D) Barrett esophagus

Where does esophageal adenocarcinoma usually develop?

A) Distal third near gastric cardia

B) Proximal third near the pharynx

C) Middle third near tracheal bifurcation

D) Upper third near cervical esophagus

Which exposures are associated with esophageal squamous cell carcinoma?

A) Alcohol and tobacco use

B) Allergies and asthma

C) Portal hypertension and reflux

D) Acute vomiting and candidiasis

Compared with adenocarcinoma, esophageal squamous cell carcinoma has which tendency?

A) Less lymph node metastasis; better prognosis

B) More lymph node metastasis; poorer prognosis

C) More local growth; improved prognosis

D) Less local invasion; poorer prognosis

Which inflammatory cell characterizes acute gastritis?

A) Neutrophils

B) Plasma cells

C) Lymphocytes

D) Eosinophils

How does chronic NSAID use cause gastritis?

A) Enhancing production of vasodilatory products

B) Increasing protective mucus production

C) Stimulating gastric bicarbonate secretion

D) Inhibiting production of vasodilatory products

What are ulcers associated with severe burns called?

A) Zollinger-Ellison ulcers

B) Curling ulcers

C) Cushing ulcers

D) Peptic ulcers

What are ulcers associated with intracranial disease called?

A) Cushing ulcers

B) Peptic ulcers

C) Zollinger-Ellison ulcers

D) Curling ulcers

What most commonly causes chronic gastritis?

A) H. pylori infection

B) Allergic reactions

C) Autoimmune gastritis

D) Chronic NSAID use

Where does H. pylori mainly occur, and where is its preferred gastric biopsy site?

A) Fundus for both

B) Antrum for both

C) Body for both

D) Cardia for both

Which enzyme allows H. pylori to produce protective ammonia?

A) Urease

B) Lipase

C) Catalase

D) Oxidase

Which H. pylori gene is associated with toxicity and increased gastric cancer risk?

A) CDH1

B) KIT

C) CagA

D) APC

Which lymphoma can arise from H. pylori-associated lymphoid aggregates?

A) Hodgkin lymphoma

B) Burkitt lymphoma

C) Follicular lymphoma

D) MALT lymphoma

How does autoimmune gastritis differ from H. pylori gastritis?

A) Antral involvement with hypergastrinemia

B) Antral sparing with hypergastrinemia

C) Fundic sparing with hypogastrinemia

D) Antral sparing with hypogastrinemia

Which cells are lost in autoimmune gastritis?

A) Chief cells

B) Goblet cells

C) Foveolar cells

D) Parietal cells

Which anemia may accompany autoimmune atrophic gastritis?

A) Megaloblastic anemia

B) Aplastic anemia

C) Hemolytic anemia

D) Iron deficiency anemia

Which gastric regions show histologic damage in autoimmune atrophic gastritis?

A) Duodenum and jejunum

B) Antrum and pylorus

C) Antrum and cardia

D) Body and fundus

What can cause eosinophilic gastritis?

A) Menetrier disease

B) Portal hypertension

C) Allergic reactions

D) Cigarette smoking

In Western populations, what most commonly causes granulomatous gastritis?

A) Menetrier disease

B) Autoimmune gastritis

C) Crohn disease

D) Zollinger-Ellison syndrome

Which three factors commonly cause peptic ulcer disease?

A) H. pylori, NSAIDs, cigarette smoking

B) NSAIDs, Crohn disease, stress

C) H. pylori, allergies, alcohol

D) EBV, alcohol, cigarette smoking

Where do gastric peptic ulcers most commonly occur?

A) Fundus along lesser curvature

B) Cardia along greater curvature

C) Body along greater curvature

D) Antrum along lesser curvature

What accompanies H. pylori infection of the gastric body and fundus?

A) Increased acid secretion without atrophy

B) Increased acid secretion and atrophy

C) Decreased acid secretion without atrophy

D) Decreased acid secretion and atrophy

According to these notes, which gastritis has greater adenocarcinoma risk than H. pylori gastritis?

A) Granulomatous gastritis

B) Acute NSAID gastritis

C) Autoimmune atrophic gastritis

D) Eosinophilic gastritis

Which cytokine is excessively secreted in Menetrier disease?

A) IL-6

B) TGF-alpha

C) TNF-alpha

D) IL-8

Which two features characterize Menetrier disease?

A) Foveolar atrophy and hyperproteinemia

B) Parietal atrophy and hyperproteinemia

C) Foveolar hyperplasia and hypoproteinemia

D) Parietal hyperplasia and hypoproteinemia

Which gastric cells become markedly enlarged in Zollinger-Ellison syndrome?

A) Foveolar cells

B) Chief cells

C) Parietal cells

D) Goblet cells

Zollinger-Ellison gastrinomas are associated with which MEN type?

A) MEN1

B) MEN2A

C) MEN4

D) MEN2B

Which gene is linked to fundic gland polyps and intestinal-type gastric adenocarcinoma?

A) RET

B) KIT

C) APC

D) CDH1

Which combination lists all four gastric adenocarcinoma metastatic sites in these notes?

A) Virchow, inguinal, ovarian, left axillary nodes

B) Cervical, periumbilical, ovarian, right axillary nodes

C) Virchow, periumbilical, ovarian, left axillary nodes

D) Virchow, periumbilical, ovarian, right axillary nodes

According to these notes, how do gastric cancer rates relate to H. pylori infection rates?

A) Approximately equal

B) Inversely proportional

C) Not associated

D) Directly proportional

Which gene is mutated in familial diffuse gastric cancer?

A) CDH1

B) RET

C) KIT

D) APC

Which virus causes lymphoproliferation and can contribute to GI lymphomas?

A) Human papillomavirus

B) Herpes simplex virus

C) Epstein-Barr virus

D) Cytomegalovirus

Which findings collectively characterize carcinoid syndrome?

A) Cough, facial flushing, diarrhea, left-sided heart failure

B) Bronchospasm, facial flushing, diarrhea, right-sided heart failure

C) Bronchospasm, facial flushing, constipation, left-sided heart failure

D) Bronchospasm, facial pallor, constipation, left-sided heart failure

Which gastrointestinal region harbors the most aggressive neuroendocrine tumors?

A) Foregut

B) Midgut

C) Stomach

D) Hindgut

From which cells do gastrointestinal stromal tumors originate?

A) Gastric chief cells

B) Intestinal goblet cells

C) Gastric parietal cells

D) Interstitial cells of Cajal

Approximately 75% of gastrointestinal stromal tumors have gain-of-function mutations in which gene?

A) APC

B) CDH1

C) RET

D) KIT

What type of diverticulum is Meckel diverticulum?

A) False diverticulum

B) True diverticulum

C) Pulsion diverticulum

D) Traction diverticulum

Which gastric cancer type has signet-ring cells?

A) Gastrointestinal stromal tumor

B) Diffuse gastric adenocarcinoma

C) Intestinal-type gastric adenocarcinoma

D) Gastric MALT lymphoma

What type of diverticulum is Zenker diverticulum?

A) False diverticulum

B) True diverticulum

C) Fundic gland polyp

D) Intestinal-type adenocarcinoma