1. Which layer is typically thickened in reflux esophagitis? * A. basal layer of the epithelium B. keratin layer of the epithelium C. muscularis mucosae D. spiny layer of the epithelium E. venous muscular tunic 2. On endoscopy of the stomach, if the antrum is obviously inflamed but the fundus seems much less involved, the cause is probably A. alcohol B. aspirin / NSAIDS C. autoimmunity * D. helicobacter E. Zollinger-Ellison 3. Which is LEAST LIKELY to result from cancer of the pancreas? A. back pain B. deep vein thrombosis of the upper extremity C. depression D. insulin resistance * E. pseudomyxoma peritonei 4. True classic Reye's syndrome can be distinguished from the inborn errors which mimic it by finding A. elevated blood ammonia levels B. elevated transaminase levels C. fatty change of the liver D. Mallory's hyaline * E. marked mitochondrial swelling 5. Most patients with hepatoblastoma are A. alcoholics * B. children C. infected with hepatitis B and/or C D. iron-overloaded E. vinyl chloride workers 6. There is presently some reasonable concern that long-term administration of medications to suppress the production of stomach acid can cause A. gastric adenocarcinoma * B. gastric carcinoid C. gastric leiomyosarcoma D. gastric lymphoma E. pancreatic adenocarcinoma 7. "Acrodermatitis enteropathica" usually results from the inability to absorb A. long-chain fatty acids B. medium-chain fatty acids C. selenium D. short-chain fatty acids * E. zinc 8. Boerhaave's disease is rupture of the A. common bile duct B. duodenum * C. esophagus D. gall bladder E. stomach 9. TWO KODACHROMES. What's wrong with the colon? A. adenocarcinoma * B. angiodysplasia C. pseudodiverticulum D. pseudomembranous colitis E. ulcerative colitis 10. ONE KODACHROME. What syndrome? A. Crigler-Najjar B. Fitz-Hugh-Curtis C. Mallory-Weiss D. Osler-Weber-Rendu * E. Peutz-Jegher 11. THREE KODACHROMES. What's the lesion? A. adenocarcinoma * B. carcinoid C. hamartoma D. leiomyoma E. lymphoma 12. ONE KODACHROME. Colon. What's the diagnosis? * A. amebiasis B. collagenous colitis C. Crohn's disease D. pseudomembranous colitis E. ulcerative colitis 13. THREE KODACHROMES. What's wrong with the large intestine? A. adenocarcinoma without multiple polyps B. cytomegalovirus colitis C. familial adenomatous polyposis * D. ulcerative colitis E. no pathology 14. THREE KODACHROMES. What's wrong with the small intestine? A. celiac sprue * B. Crohn's disease C. giardiasis D. typhoid E. Whipple's disease 15. ONE KODACHROME. Small intestine. What's the lesion? A. Crohn's disease B. ileus * C. infarct D. pseudomyxoma peritonei E. no pathology 16. TWO KODACHROMES. Colon. What's the diagnosis? A. adenocarcinoma B. angiodysplasia * C. pseudodiverticulum D. pseudomembranous colitis E. villous adenoma 17. TWO KODACHROMES. Esophageal mass. What's the diagnosis? * A. adenocarcinoma B. adenoid cystic carcinoma C. exuberant granulation tissue D. leiomyosarcoma E. squamous cell carcinoma 18. ONE KODACHROME. Stomach biopsy from the fundus. What's the diagnosis? A. adenocarcinoma * B. atrophic gastritis C. helicobacter gastritis D. hyperplastic change / Menetrier's E. ulcer, benign 19. ONE KODACHROME. Colon. What's the diagnosis? * A. pedunculated tubular adenoma B. pseudomembranous colitis C. pseudodiverticulum D. sessile villous adenoma E. ulcerative colitis with pseudopolyp 20. TWO KODACHROMES. Pancreas. What's wrong? A. acute hemorrhagic pancreatitis B. adenocarcinoma * C. chronic pancreatitis with a pseudocyst D. cystic fibrosis E. no pathology 21. TWO KODACHROMES. Pancreas. What's the diagnosis? * A. acute hemorrhagic pancreatitis B. adenocarcinoma C. alcohol lesion, chronic D. cystic fibrosis E. cytomegalovirus 22. TWO KODACHROMES. A man and his liver. What's your best diagnosis? * A. alcoholic hepatitis B. hemochromatosis C. hepatocellular carcinoma D. stable cirrhosis E. viral hepatitis 23. ONE KODACHROME. Which is most likely to have caused this case of cirrhosis? A. alcohol abuse B. hepatitis A * C. hepatitis B D. iron overload E. primary biliary cirrhosis 24. ONE KODACHROME. Gallstones probably composed mostly of * A. bilirubin B. calcium carbonate C. cholesterol D. magnesium carbonate E. uric acid 25. ONE KODACHROME. Liver. What is the most likely diagnosis? A. common duct stone * B. emphysema C. gonorrhea D. macronodular cirrhosis E. syphilis 26. TWO KODACHROMES. Liver. What is the hyaline material? A. amyloid * B. antitrypsin C. bile lakes D. fibrin E. Mallory's hyaline (keratin, ubiquitin) 27. TWO KODACHROMES. Liver. What is the diagnosis? A. alcoholic hepatitis B. hepatocellular carcinoma * C. infarcted D. viral hepatitis E. Wilson's 28. KODACHROMES. Liver. What's the diagnosis? A. amebic abscess B. bacterial abscess * C. hepatocellular carcinoma D. infarct E. metastatic cancer consistent with colonic primary 29. THREE KODACHROMES. Liver biopsies. What is the diagnosis? A. acute viral hepatitis B. alcoholic cirrhosis C. ascending cholangitis * D. chronic active hepatitis E. primary biliary cirrhosis 30. ONE KODACHROME. Liver biopsy. What is the diagnosis? A. acute viral hepatitis B. cholangiocarcinoma C. chronic active hepatitis D. primary biliary cirrhosis * E. no pathology BONUS ITEMS: 31. ONE KODACHROME. Mention any two morphologic features that indicate that this Councilman body, in acute hepatitis, is apoptotic? [hypereosinophilic cytoplasm, dead nucleus, separated from adjacent cells] 32. ONE KODACHROME. What is the significance of this "ground glass" cell seen on liver biopsy? [hepatitis B, must mention "B"] 33. ONE KODACHROME. Liver. What's the diagnosis? [any sickle diagnosis] 34. ONE KODACHROME. Give the eponym for this finding in a hepatic vein? [Budd-Chiari, either is sufficient] 35. The presence of which inflammatory cell is most helpful in the microscopic confirmation of reflux esophagitis? [eosinophil] 36. What infectious disease is the most important cause of longstanding dilation of the esophagus? [Chagas's / T. cruzi] 37. Briefly describe what macroamylasemia (i.e., why the "amylase" is too big) is and why this is so important in patient care. [antibody vs. amylase; false positive for pancreatitis] 38. Where in the body might you see a "Schatzki" ring? [distal esophagus, any "esophagus" or GE junction is okay] 39. Acanthocytes on peripheral smear will let you know that Baby's malabsorption is due to [abetalipoproteinemia] 40. In a few clear sentences, tell about the pathophysiology that causes hepatorenal syndrome. [Nitric oxide OR portal hypertension making it necessary to pump more blood to the gut to keep it from infarcting] NAME: _____________________________ SEAT NUMBER: ___________ UHS PATHOLOGY Gastrointestinal System 2002-2003 Instructions: You know the routine. If you are in the first group, wait until you are dismissed, then leave by the east exit. Leave as a group with no stragglers. The key will be posted as the second group is finishing up. GOOD LUCK! Illustration from William Caxton's 1484 edition of Chaucer's "The Canterbury Tales"