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neoplastic liver Ds , Gallbladder , pancrease .
Q1. A 35-year-old man complains of difficulty swallowing and a tendency to regurgitate his food. Endoscopy does not reveal any esophageal or gastric abnormalities. Manometric studies of the esophagus show a complete absence of peristalsis, failure of the lower esophageal sphincter to relax upon swallowing, and increased intraesophageal pressure. Which of the following is the most likely diagnosis?
(A) Achalasia
(B) Barrett esophagus
(C) Esophageal stricture
(D) Mallory-Weiss syndrome
(E) Schatzki ring
(A) Achalasia
(B) Barrett esophagus
(C) Esophageal stricture
(D) Mallory-Weiss syndrome
(E) Schatzki ring
Q2. A 70-year-old woman presents with difficulty swallowing and a 9-kg (20-lb) weight loss over the past several months. Endoscopy reveals irregular narrowing of the lower third of the esophagus. A biopsy shows markedly atypical cuboidal
cells lining irregular gland-like structures. Which of the following is the most likely diagnosis?
(A) Adenocarcinoma
(B) Esophageal stricture
(C) Leiomyosarcoma
(D) Scleroderma
(E) Squamous cell carcinoma
cells lining irregular gland-like structures. Which of the following is the most likely diagnosis?
(A) Adenocarcinoma
(B) Esophageal stricture
(C) Leiomyosarcoma
(D) Scleroderma
(E) Squamous cell carcinoma
Q3. A 50-year-old obese man (BMI = 32 kg/m2) comes to the physician complaining of indigestion after meals, bloating, and heartburn. Vital signs are normal. A CT scan of the abdomen reveals a hiatal hernia of the esophagus. Endoscopic biopsy shows thickening of the basal layer of the squamous epithelium, upward extension of the papillae of the lamina propria, and an increased number of neutrophils and lymphocytes. Which of the following is the most likely diagnosis?
(A) Esophageal varices
(B) Mallory-Weiss syndrome
(C) Reflux esophagitis
(D) Schatzki mucosal ring
(E) Squamous cell carcinoma
(A) Esophageal varices
(B) Mallory-Weiss syndrome
(C) Reflux esophagitis
(D) Schatzki mucosal ring
(E) Squamous cell carcinoma
Q5.A 45-year-old woman presents with a 6-month history of fatigue and swelling in her neck. Physical examination shows a goiter. A CBC discloses megaloblastic anemia and a normal reticulocyte count. Additionally, there is an elevated serum level of TSH and antithyroid antibodies. Needle aspiration of the left lobe of the thyroid reveals benign follicular cells and numerous lymphocytes. Anemia in this patient is most likely caused by antibodies directed to which of the following
targets?
(A) Chief cells
(B) Intrinsic factor
(C) Paneth cells
(D) TSH receptor
(E) Vitamin D
targets?
(A) Chief cells
(B) Intrinsic factor
(C) Paneth cells
(D) TSH receptor
(E) Vitamin D
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