For each of the tumours listed on the left select the most appropriate association from the list on the right. a. Adenolymphoma. b. Pleomorphic salivary adenoma. c. Squamous carcinoma of oral mucosa. A. Benign easily resectable tumour of parotid gland. B. High incidence of local recurrence. C. Malignant tumour of parotid gland. D. May arise in Sjogren’s disease. E. Prognosis depends on site. The answer is A, B, E. This occurs in middle-aged males, and is often bilateral, it is entirely benign. This is the second commonest parotid tumour. Pleomorphic salivary adenomas are benign, but tend to extend through their capsule so that complete resection is not possible. Intraoral squamous carcinoma has a worsening prognosis the further back in the oropharynx it is situated. Sjogren’s disease (D) is an autoimmune disease of the salivary tissue; a malignant lymphoma may arise within the salivary gland in this condition. Adenoid cystic carcinoma is the commonest malignant salivary gland tumour (C).
If the following events were placed in chronological order which would come fourth? A. Aspiration bronchopneumonia. B. Difficulty in swallowing. C. Heavy alcohol intake. D. Oesophageal bouginage. E. Tracheo-oesophageal fistula. The answer is E. Heavy alcohol intake (C) is associated with the development of oesophageal carcinoma in Western Europe. An early symptom of oesophageal carcinoma is dysphagia (B); surgical treatment may be impossible and palliative oesophageal bouginage undertaken (D). This may be complicated by oesophageal rupture, but occasionally the tumour itself extends locally into the trachea and a fistula may be formed (E) with resultant aspiration bronchopneumonia (A).
For each of the forms of gastritis listed on the left select the most appropriate association from the list of histological features on the right. a. Atrophic gastritis. b. Chronic superficial gastritis. c. Gastric atrophy. A. Granulomatous inflammation of the mucosa. 42 B. Inflammation limited to superficial lamina propria. C. Loss of specialized mucosal cells. D. Mucosa thin with intestinal metaplasia. E. Mucosal hypertrophy. The answer is C, B, D. This is the second stage of chronic gastritis in which specialized mucosal cells such as parietal cells are lost and there is severe inflammatory infiltration in the lamina propria. This is the first stage of chronic gastritis, there is mucosal inflammation, but there is no loss of specialized cells. This is the final stage of chronic gastritis in which the mucosa is thin due to loss of parietal cells, chief cells and replacement by mucous secreting epithelium resembling intestinal mucosa. These features are seen most strikingly in the auto-immune disease pernicious anaemia where antibodies are present against parietal cell and intrinsic factor. Granulomatous (A) and hypertrophic (E) gastritis are rare.
Which ONE of the following is not a predisposing factor in peptic ulcer? a. Achlorhydria. b. Blood group O. c. Cigarette smoking. d. High gastrin secretion. e. Ingestion of aspirin. The answer is A. The presence of gastric acid is necessary for the development of peptic ulcer; in the stomach defective mucosal protection appears to be more important than the quantity of acid; in the duodenum gastric hypersecretion is more important. There is a higher incidence of peptic ulcer in people of blood group O (B). Cigarette smoking (C) and ingestion of certain drugs (E) result in increased risk of peptic (gastric) ulcer. High gastrin secretion (D), i.e., from pancreatic islet cell tumours, results in a fulminating ulcer diathesis (Zollinger-Ellison syndrome).
For each of the features of gastric carcinoma listed on the left select the most appropriate association from the list on the right. a. Linitis plastica. b. Signet ring cells. c. Superficial spreading carcinoma. A. Deep layers of stomach wall infiltrated and thickened. B. Extensive spread in mucosa and submucosa. C. Globule of mucin within tumour cells. D. Nodular mass of tumour protruding into lumen. E. Present in the edge of a gastric ulcer. 43 The answer is A, C, B. In this growth pattern the mucosa appears uninvolved grossly, the stomach wall becoming rigid due to tumour infiltration. Signet ring cells are characteristic of gastric carcinoma but may be seen in other tumours also. In this growth pattern there is no evidence of deep invasion, the tumour spreading widely in the superficial layers. Gastric carcinoma has various growth patterns including nodular outgrowths (D) and large fungating ulcerated masses. Occasionally a carcinoma may arise in the edge of an ulcer (E); more commonly the ulcer is due to tumour necrosis.
For each of the pathological features noted on the left select the most appropriate disease from the list on the right. a. Colonic mucosal pseudopolyps. b. Pericolic abscess formation in the left iliac fossa. c. Small intestinal mucosa with cobblestone appearance. A. Appendicitis. B. Crohn’s disease. C. Diverticulitis. D. Diverticulosis. E. Ulcerative colitis. The answer is E, C, B. Pseudopolyps consist of surviving hyperplastic mucosa and granulation tissue. Diverticulosis (D) is the presence of diverticulums which are not inflamed; in diverticulitis the diverticulums become inflamed and may rupture to produce pericolic abscesses. The symptoms are similar to those in appendicitis (A) but affect the left side. The appearance of linear fissuring and ulceration of the oedematous mucosa of Crohn’s disease gives the typical cobblestone appearance.
For each of the organisms on the left select the most appropriate association from the list on the right. a. Campylobacter. b. Clostridium difficile. c. Vibrio cholerae. A. Antibiotic associated diarrhoea. B. Enlargement of Peyer’s patches. C. Infective diarrhoea. D. Stimulation of adenyl cyclase activity. E. Stool examination often diagnostic. 44 The answer is C, A, D. Recently many cases of infective diarrhoea have been shown to be due to organisms of the Campylobacter group. Antibiotic associated diarrhoea (pseudomembranous colitis) is due to infection by Clostridium difficile and the effects of its toxin on the mucosa. The vibrio toxin stimulates adenyl cyclase activity which alters fluid and electrolyte balance between mucosal cells and gut lumen. Enlargement of Peyer’s patches is a feature of typhoid (B). Stool examination is essential for the diagnostic of amoebic dysentery (E).
Which ONE of the following is an example of a primary malabsorption syndrome. A. A-beta-lipoproteinaemia. B. Blind-loop syndrome. C. Coeliac disease. D. Crohn’s disease. E. Pancreatic insufficiency. The answer is C. Coeliac disease (gluten sensitive enteropathy) is a primary malabsorption syndrome, as are tropical sprue and Whipple’s disease. The others are all causes of secondary malabsorption in that they interfere with absorption for various reasons, i.e., bacterial colonization in the blind-loop syndrome (B), severe mucosal damage in Crohn’s disease (D). Pancreatic insufficiency (E) causes inadequate digestion. A-beta-lipoproteinaemia is a biochemical defect which interferes with absorption (A).
Which ONE of the following conditions predisposes to colonic carcinoma. A. Bacillary dysentery. B. Crohn’s disease. C. Diverticular disease. D. Ischaemic colitis. E. Ulcerative colitis. The answer is E. There is an increased risk of colonic carcinoma in patients with longstanding, extensive ulcerative colitis. Crohn’s disease (B) is associated with increased risk of small intestinal malignancy but this is very rare, and may have a characteristic growth pattern.
For each of the types of colonic polyp listed on the left select the most appropriate association from those on the right. a. Tubular adenoma. b. Tubulo-villous adenoma. c. Villous adenoma. 45 A. Always shows invasion of the stalk. B. Hamartomatous lesion. C. High risk of undergoing malignant transformation. D. Intermediate histological features. E. Usually less than 10 mm diameter. The answer is E, D, C. Tubular adenomas are usually small rounded nodules on a stalk. Tubulo-villous adenomas show a mixed histological pattern and are intermediate in size between tubular and villous adenomas. Villous adenomas are usually sessile, larger than 10 mm in diameter and have a large surface area; these are most likely to become malignant. Invasion of the stalk of a polyp is an important criterion of malignancy (A) but is not invariably present. If the stalk has twisted glandular tissue may be trapped in the stalk giving rise to pseudoinvasion. The juvenile polyp is a hamartomatous lesion of the mucosa (B).
