A 63-year-old man comes to the physician because of a 2-month history of progressive fatigue. He also has shortness of breath and palpitations, which worsen on physical exertion and improve with rest. He has had intermittent constipation, low-grade fever, and generalized myalgia for the past 3 months. He has had a 10.4-kg (23-lb) weight loss over the past 4 months despite no change in appetite. His temperature is 37°C (98.6°F), pulse is 108/min, respirations are 16/min, and blood pressure is 130/78 mm Hg. Examination shows pale conjunctivae. His hemoglobin concentration is 9.1 g/dL, mean corpuscular volume is 70 μm3, and serum ferritin is 12 ng/mL. Test of the stool for occult blood is positive. Colonoscopy shows a 1.7-cm wide exophytic ulcer with irregular, bleeding edges in the ascending colon. Which of the following biopsy findings would have been the greatest predisposing factor for developing this patient's current condition?
AA pedunculated inflammatory polyp
BA villous adenomatous polyp
CA serrated hyperplastic polyp
DA submucosal lipomatous polyp
EA tubular adenomatous polyp
A 62-year-old man presents to his primary care physician because of abdominal pain that started after he went camping several months ago and drank from a mountain stream. This past year, he also went on a trip around the world, eating local foods at each stop. Furthermore, he has had a history of cholelithiasis and had his gallbladder removed 3 years ago. Otherwise, his medical history is significant for well-controlled hypertension and diabetes. Based on clinical suspicion, an endoscopy and biopsy was performed showing a mix of mononuclear cells and a motile, urease-positive, oxidase-positive, spiral shaped organism. The changes seen on biopsy in this patient most likely predispose him to which of the following pathologies?
AGallbladder adenocarcinoma
BEsophageal adenocarcinoma
CColon adenocarcinoma
DMALT lymphoma
EPancreatic adenocarcinoma
A 41-year-old male who takes NSAIDs regularly for his chronic back pain develops severe abdominal pain worse with eating. Upper endoscopy is performed and the medical student asks the supervising physician how the histological differentiation between a gastric ulcer and erosion is made. Which of the following layers of the gastric mucosa MUST be breached for a lesion to be considered an ulcer?
AEpithelium, lamina propria
BEpithelium
CEpithelium, lamina propria, muscularis mucosa
DEpithelium, lamina propria, muscularis mucosa, submucosa, and adventitia
EEpithelium, lamina propria, muscularis mucosa, and submucosa
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