Pathology EMQ template.

Name: Muthuswamy Sarvesvaran

Theme: Upper GI disease

 

OPTION LIST

 

A	Active chronic gastritis	I	Lymphoma of MALT
B	Acute erosive gastritis	J	Oesophageal carcinoma
C	Barretts oesophagus	K	Oesophageal stricture
D	Duodenal ulcer	L	Oesophageal varices
E	Duodenitis	M	Pyloric stenosis
F	Gastric cancer	N	Zollinger-Ellison syndrome
G	Gastric ulcer	O
H	GORD	P

 

 

For each scenario below, choose the most appropriate answer from the list above. Each option may be used once, more than once or not at all.

 

1. A 57-year-old man presents with a 6-month history of weight loss and dyspepsia. Endoscopy and biopsies were taken. Endoscopy shows thickened mucosal folds, whereas biopsies show infiltrates of atypical lymphocytes with clusters of intraepithelial lymphocytes.

 

 

2. A 32-year-old man presents with a history of epigastric burning pain. He notes that this is worse at night. Additionally, he suffers from a severe burning pain in the chest when drinking hot liquids and has difficulty swallowing solids. Endoscopy reveals stricturing in the lower oesophagus and circumferential erosions.

 

 

3. A 55-year-old man presents with severe retrosternal burning. Upper gastrointestinal endoscopy reveals changes consistent with gastro-oesophageal reflux and biopsy confirms metaplastic changes of the epithelium.

 

 

4. A 40-year-old man presents with epigastric discomfort when eating. Endoscopy is performed and shows diffuse erythema in the antrum without ulceration. Biopsies from the antrum reveal an infiltrate of lymphocytes, plasma cells and neutrophils in the gastric mucosa. However the lymphocytes are not atypical. Staining reveals H.Pylori organisms lining the mucosal surface.

 

 

5. A 50 year old man presents to A&E with an episode of fresh hematemesis in the past hour. The only significant finding on examination is epigastric tenderness. OGD reveals a lesion in the first part of the duodenum. He is H.Pylori positive.

 

 

 

ANSWERS

1. I

2. H

3. C

4. A

5. D