1.    You will see no anatomic pathology at all in the gut in a
case of

A.   amebiasis
B.   cholera (*)
C.   cryptosporidiosis
D.   ischemic colitis
E.   shigellosis

2.   What is the predominant cell in the small-intestinal lesions
of typhoid fever?

A.   eosinophil
B.   lymphocyte
C.   macrophage (*)
D.   neutrophil
E.   plasma cell

3.   Classic "hypersecretory" gastritis involves primarily the

A.   antrum (*)
B.   cardia
C.   entire mucosa
D.   fundus
E.   muscularis throughout the organ

4.   Metaplasia of the stomach mucosa near a primary fundic
cancer usually resembles

A.   antral mucosa 
B.   colon
C.   esophagus
D.   pancreas
E.   small intestine (*)


5.   A tree-like, branching core of smooth muscle distinguishes
a(n)

A.   adenomatous polyp
B.   hyperplastic polyp
C.   juvenile retention polyp
D.   Peutz-Jegher polyp (*)
E.   pseudopolyp


6.   Where's the thrombus in "Budd-Chiari" syndrome?

A.   hemorrhoidal plexus
B.   hepatic vein (*)
C.   inferior mesenteric vein
D.   portal vein
E.   umbilical vein



7.   Infamous for those "flask-shaped ulcers" in the colon?

A.   amoeba  (*)
     B.   Crohn's
C.   shigella
D.   typhoid
E.   ulcerative colitis


8.   Crohn's regional enteritis gets blamed for causing B12
deficiency because it often involves the

A.   colon
B.   duodenum
C.   proximal jejunum
D.   stomach, interfering with intrinsic factor production
E.   terminal ileum (*)


9.   The pentetreotide (octreotide-analogue) nuclear-medicine
scan is a good way to light up

A.   carcinoids (*)
B.   helicobacter
C.   ischemic bowel
D.   premalignant colon polyps
E.   small peptic ulcers

10.  ONE KODACHROME.  Gallbladder.  What's your diagnosis?

A.   adenocarcinoma
B.   cholecystitis with bilirubinate stones
C.   cholecystitis with cholesterol stones (*)
D.   Rokitansky-Aschoff sinuses but the stones were passed
E.   normal gall bladder

11.  TWO KODACHROMES.  Anal lesion.

A.   adenocarcinoma (*)
B.   common hemorrhoid
C.   Crohn's
D.   fissure
E.   ulcerative colitis

12.  ONE KODACHROME.  Liver.  Make the call on the gross.

A.   cirrhosis (*)
B.   congestion
C.   massive necrosis
D.   metastatic cancer
E.   Zahn infarcts



13.  ONE KODACHROME.  Colon.  Your best diagnosis?

A.   adenocarcinoma
B.   Crohn's disease
C.   diverticulosis (*)
D.   hyperplastic polyp
E.   ulcerative colitis 

14.  ONE KODACHROME.  Colon.  Make the most likely call on the
"gross".

A.   hyperplastic polyp
B.   pedunculated adenomatous polyp (*)
C.   pseudomembranous colitis
D.   sessile adenomatous polyp
E.   ulcerative colitis

15.  ONE KODACHROME.  Photomicrograph of stomach.  What's your
diagnosis?

A.   carcinoma (*)
B.   Menetrier's
C.   helicobacter gastritis
D.   peptic ulcer
E.   no pathology


16.  THREE KODACHROMES.  Liver biopsies showing a range for

A.   alcoholic liver disease
B.   cholestatic jaundice
C.   chronic viral hepatitis (*)
D.   hepatocellular carcinoma
E.   primary biliary cirrhosis


17.  ONE KODACHROME.  Pancreas.  What are you going to call it?

A.   acute hemorrhagic pancreatitis
B.   adenocarcinoma
C.   cystic fibrosis
D.   old fat necrosis (*)
E.   no pathology


18.  ONE KODACHROME.  Liver.  What's your diagnosis?

A.   alcoholic hepatitis
B.   congestion (*)
C.   costal grooves
D.   metastatic cancer
E.   primary hepatocellular carcinoma



19.  ONE KODACHROME.  Inner surface of colon.  You suspect

A.   Crohn's disease
B.   diverticulosis
C.   ischemic colitis
D.   pseudomembranous colitis
E.   ulcerative colitis (*)

20.  ONE KODACHROME.  Which do you think is most likely, given
the looks of this liver biopsy?

A.   alcoholic hepatitis
B.   common duct gallstone (*)
C.   hepatitis A
D.   iron overload
E.   tricuspid insufficiency, longstanding and severe

21.  TWO KODACHROMES.  Liver.  What will you call it?

A.   alcoholic hepatitis
B.   antitrypsin deficiency
C.   Dubin-Johnson
D.   mild viral hepatitis (*)
E.   primary biliary cirrhosis


22.  ONE KODACHROME.  From an autopsy.  The liver shows

A.   fatty change (*)
B.   metastatic cancer
C.   macronodular cirrhosis
D.   micronodular cirrhosis
E.   primary hepatocellular carcinoma


23.  ONE KODACHROME.  Stomach biopsy showing

A.   autoimmune gastritis
B.   cancer (*)
C.   helicobacter
D.   leiomyoma
E.   retention polyp


24.  ONE KODACHROME.  I hope you know your salivary gland tumors!

A.   acinic cell neoplasm
B.   adenoid cystic carcinoma
C.   mixed tumor 
D.   mucoepidermoid lesion
E.   Warthin's tumor (*)



25.  ONE KODACHROME.  Liver lesion?

A.   alcoholic hepatitis
B.   chronic hepatitis
C.   cirrhosis but no cancer
D.   hepatocellular carcinoma
E.   widespread necrosis (*)

26.  ONE KODACHROME.  Pancreas.  What do you want to call it?

A.   acute hemorrhagic pancreatitis (*)
B.   adenocarcinoma
C.   chronic pancreatitis
D.   cystic fibrosis
E.   no pathology

27.  TWO KODACHROMES.  What's wrong with his liver?

A.   alcoholic cirrhosis (*)
B.   Budd-Chiari
C.   iron overload
D.   massive necrosis
E.   viral hepatitis

28.  TWO KODACHROMES.  Liver biopsy pathology.

A.   alcoholic hepatitis
B.   cirrhosis
C.   common duct stone
D.   hepatocellular carcinoma (*)
E.   viral hepatitis

29.  ONE KODACHROME.  Liver biopsy from a child.  Make your best
call.

A.   antitrypsin deficiency
B.   galactosemia
C.   hepatoblastoma (*)
D.   herpes hepatitis
E.   leukemia

30.  THREE KODACHROMES.  Pancreas.  What do you want to call it?

A.   acute hemorrhagic pancreatitis
B.   chronic pancreatitis (*)
C.   cystadenoma
D.   cystic fibrosis
E.   no pathology here



BONUS ITEMS

31.  TWO KODACHROMES. Tell me honestly how a pathologist would
know this is adenocarcinoma 
of the pancreas rather than just old scarring.  


          [incomplete glands, huge nuclei, either is sufficient;
other stuff was not present]
          [the presence of glands obviously has nothing to do
with the distinction]

32.  ONE KODACHROME.  What is the classical name for this
physical finding on the surface of the 
abdomen?

          Caput medusae; I need one word or the other


33.  ONE KODACHROME.  What is the usual name for this picturesque
chronic pancreatic lesion?

               Pseudocyst; "cyst" is not acceptable



34.  ONE KODACHROME.  What significance do old-time pathologists
give to this "ground glass" 
hepatocyte? 


               [hepatitis B; I accepted hepatitis because I am
soft]

35.  ONE KODACHROME.  What name do we give to this picturesque
gall-bladder finding?

          Strawberry or cholesterolosis; NOT cholesterol stones



36.  ONE KODACHROME.  Diagnose this pancreatic lesion.

               hemochromatosis


37.  ONE KODACHROME.  Stomach.  This is a trichrome stain, and
this is not cancer.  Diagnosis?

               Menetrier's / hypertrophic gastritis / ZE



38.  ONE KODACHROME.  Formalin-fixed colon.  Give your diagnosis
and justify it briefly.

               Infarct; if you know blood is black that is enough


39.  ONE KODACHROME.  Diagnose this pancreatic lesion, please.

[CMV]




40.  What's the fairly common disease which produces a lace-like
pattern of white lines on the inner 
lining of the oral mucosa?

[lichen planus]



41.  What's the term we give to the continuous, painful urge to
defecate?

[tenesmus]




42.  What is pseudomyxoma peritonei?

[disseminated mucin-producing tumor causing fibrosis]



43.  What's the eponym for the birth defect in which the
autonomic plexi are lacking in a portion of 
the rectosigmoid?

[Hirschsprung's]



44.  If you saw lipofuscin in Kupffer cells on a liver biopsy,
what conclusion would you draw?

[recent hepatocyte necrosis]



45.  At surgery, you see a single orange nodule the size of a
golfball embedded in the liver, with 
some shallow grooving on its surface. It's probably what?

[focal nodular hyperplasia]


                                             NAME:
__________________________
                                                       30 points


                                             Who's sitting near
you?





UHS PATHOLOGY
Gastrointestinal Section
2001-2002


Instructions:  You know the drill.  

If you are in the first group, do NOT leave before you're told to
do so. You will exit all together.


GOOD LUCK!



 




The Town Drunkard Asleep Again

From the first edition of Mark Twain's Life on 
the Mississippi.