Path 5 Inflammatory

Question 1

False Diverticula

Answer 1

Doesn’t include muscularis propria

Question 2

Infected diverticula appearance

Answer 2

Apple core lesion

Question 3

Inflammatory Bowel Disease

Answer 3

• Chronic, relapsing, unknown etiology

- Risk for adenocarcinoma

Question 4

Crohns disease (4)

Answer 4

• Transmural granulomatous inflammation
• Skip lesions (cobble stone)
• Ulcerations, fissures, fistulas
• Creeping fat

Question 5

Crohns - most common site

Answer 5

Ileocecum

Question 6

Crohns - extraintestinal associations (4)

Answer 6

• Migratory polyarthritis
• Iritis
• Erythema nodosum (skin fat inflamm)
• Primary sclerosing cholangitis

Question 7

Crohns blood finding

Answer 7

-Anti-saccharomyces Ab

Question 8

Crohns appearance -Endoscope, barium enema

Answer 8

• Cobblestoning

- String sign

Question 9

Inflammation - Crohns v Ulcerative colitis

Answer 9

Transmural v Mucosal

Question 10

Ulcerative colitis

Answer 10

• Only colon
• Same extraintestinal as Crohns
• p-ANCA

Question 11

Ulcerative Colitis appearance -Endoscope, barium enema

Answer 11

• Pseudopolyps

- Granular, loss of haustrations

Question 12

Crohns v UC clinical symptoms

Answer 12

-RLQ (no diarrhea) v LLQ (w/bloody diarrhea)

Question 13

Toxic megacolon

Answer 13

Ulcerative colitis only

Question 14

Malabsorption

Answer 14

Crohns only

Question 15

Colonic obstruction

Answer 15

Crohns only

Question 16

Peutz-Jeghers syndrome

Answer 16

• Arborizing hemartomatous polyps
• Hyperpigmented macules on oral mucosa
• Increased risk of other cancers

Question 17

Solitary rectal ulcer syndrome

Answer 17

• Inflammatory polyps (prone to ulceration)

- Bleeding, mucus discharge

Question 18

Juvenile Polyposis syndrome

Answer 18

• Cystically dilated, inflamed hemartomatous polyps

- Children and young adults

Question 19

Hyperplastic polyps (3)

Answer 19

• Never malignant
• Nodular protrusions
• Crypts with proliferating epithelium

Question 20

Adenoma

Answer 20

Epithelial dysplasia

Question 21

Sessile Serrated Adenoma

Answer 21

Features mix between adenoma and hyperplastic polyp

Question 22

Villous adenoma

Answer 22

Broad base, no stalk

Question 23

Familial adenomatous polyposis (mutation, dx, tx)

Answer 23

-Hereditary APC mutation
>100 adenomas by 20s, 100% chance adenocarcinoma by 30
-Prophylactic colectomy

Question 24

Gardners syndrome

Answer 24

FAP syndrome

• Abnormal dentition
• Epidermal cysts
• Desmoid tumors
• Osteomas
• Duodenal & Thyroid cancers

Question 25

Turcot’s syndrome

Answer 25

FAP syndrome

-CNS gliomas

Question 26

APC gene chromosome

Answer 26

5

Question 27

Lynch Syndrome (4)

Answer 27

Hereditary nonpolyposis colorectal cancer

• MSH1 & 2 (mismatch repair gene) mutations
• Microsatellite instability
• Colorectal, endometrial, ovarian cancer

Question 28

Colonic adenocarcinoma morphology (L/R)

Answer 28

• Distal (left) napkin ring lesions

- Proximal (right) raised lesions

Question 29

Colonic adenocarcinoma serum marker

Answer 29

CEA (for Tx and recurrence, NOT screening)

Question 30

Appendix tumor (3)

Answer 30

• Carcinoid, less adenocarcinoma
• Mucocele
• Pseudomyxoma peritonei

Question 31

Carcinoid tumor histology

Answer 31

• Uniform cells

- Island alignment

Question 32

Pseudomembranous colitis (3)

Answer 32

• Antibiotic associated
• C. Difficile toxins A & B (Dx in stools)
• Volcanic mucopurulent eruptions

Question 33

Necrotizing enterocolitis (3)

Answer 33

• Premature babies
• Cytokine induced necrotic inflammation
• Pneumatosis Intestinalis (gas cysts in wall)