Test Bank For Robbins and Cotran Pathologic Basis of Disease
9th Edition Kumar | 9781455726134 | All Chapters with
Answers and Rationals
A 23-year-old primigravida gives birth at term to a boy infant. Ultrasound examination before delivery
showed poly-hydramnios. A single umbilical artery is seen at the time of birth. The infant vomits all
feedings, and then develops a fever and difficulty with respirations within 2 days. A radiograph shows
both lungs and the heart are of normal size, but there are pulmonary infiltrates and no stomach
bubble. What is the most likely diagnosis?
A Achalasia
B Diaphragmatic hernia
C Esophageal atresia
D Hiatal hernia
E Pyloric stenosis
F Zenker diverticulum - ANSWER: C Esophageal atresia
A 24-year-old man has developed abdominal pain and increasing fatigue over the past 6 months. On
physical examination, he is afebrile and appears pale. On palpation, there is mild pain in the right
lower quadrant of the abdomen. There are no masses, and bowel sounds are active. Laboratory
studies show hemoglobin, 8.9 g/dL; hematocrit, 26.7%; MCV, 74 μm3; platelet count, 255,000/mm3;
and WBC count, 7780/ mm3. His stool is positive for occult blood. Upper gastrointestinal endoscopy
and colonoscopy showed no lesions. One month later, he continues to experience the same
abdominal pain. Which of the following is most likely to cause this patient's illness?
A Acute appendicitis
B Angiodysplasia
C Celiac disease
D Diverticulosis
E Giardia lamblia infection
F Meckel diverticulum - ANSWER: F Meckel diverticulum
A 23-year-old woman, G2, P1, gave birth at term to a boy of normal weight and length following an
uncomplicated pregnancy. The infant initially did well, but at 6 weeks, he began feeding poorly for 1
week, and his mother noticed that much of the milk he ingested was forcefully vomited within 1 hour.
Now, on physical examination, the infant is afebrile, and there are no external anomalies. A
midabdominal mass is palpable. Bowel sounds are active. The medical history indicates that both the
mother and her first child had the same illness during infancy. Which of the following conditions is
most likely to explain these findings?
A Annular pancreas
B Diaphragmatic hernia
C Duodenal atresia
D Pyloric stenosis
E Tracheoesophageal fistula - ANSWER: D Pyloric stenosis
A 24-year-old woman gives birth to term infant after an uncomplicated pregnancy. Apgar scores are 9
and 10 at 1 and 5 minutes after birth. The infant's length and weight are at the 55th percentile. There
is no significant passage of meconium. Three days after birth, the infant vomits all oral feedings. On
physical examination, the infant is afebrile, but the abdomen is distended and tender, and bowel
sounds are reduced. An abdominal ultrasound scan shows marked colonic dilation above a narrow
segment in the distal sigmoid region. A biopsy specimen from the narrowed region shows an absence
of ganglion cells in the muscle wall and submucosa. Which of the following is most likely to produce
these findings?
A Colonic atresia
B Hirschsprung disease
C Intussusception
,D Necrotizing enterocolitis
E Trisomy 21
F Volvulus - ANSWER: B Hirschsprung disease
A 3-year-old child has attained enough mobility, curiosity, and dexterity to explore places in the home
that should not be accessed. The child finds a bottle with a liquid under the kitchen sink, and he drinks
it. Within minutes he has chest pain. His mother takes him to the emergency department, and brings
the bottle. Analysis of the residual contents reveals a pH of 12. Which of the following complications is
most likely to occur following this injury?
A Pharyngeal diverticulum
B Esophageal stenosis
C Gastric lymphoma
D Duodenal ulceration
E Megacolon - ANSWER: B Esophageal stenosis
A 22-year-old woman has had multiple episodes of aspiration of food associated with difficulty
swallowing during the past year. On auscultation of her chest, crackles are heard at the base of the
right lung. A barium swallow shows marked esophageal dilation above the level of the lower
esophageal sphincter. A biopsy specimen from the lower esophagus shows an absence of the
myenteric ganglia. What is the most likely diagnosis?
A Achalasia
B Barrett esophagus
C Plummer-Vinson syndrome
D Sliding hiatal hernia
E Systemic sclerosis - ANSWER: A Achalasia
A 24-year-old woman living in eastern Bolivia has had increasing difficulty with swallowing both
liquids and solids for the past year. She has substernal discomfort from a feeling that foods "get
stuck" going down. On examination her BMI is 18. A barium swallow radiologically shows marked
esophageal dilation. An endoscopic biopsy is obtained and microscopically shows reduced ganglion
cells in myenteric plexus along with lymphocytic infiltration. Which of the following organisms is most
likely infecting this woman?
A Bordetella pertussis
B Candida albicans
C Corynebacterium diphtheriae
D Herpes simplex virus
E Trypanosoma cruzi - ANSWER: E Trypanosoma cruzi
A 53-year-old man consumes a very large meal, washed down with considerable alcohol. The ensuing
discomfort prompts him to take an emetic, but soon afterward he develops lower chest pain. Physical
examination reveals crepitus in subcutaneous tissue over his chest along with tachycardia and
tachypnea. Which of the following abnormalities of the esophagus is most likely present in this man?
A Stricture
B Achalasia
C Ectopia
D Rupture
E Varices - ANSWER: D Rupture
A 30-year-old man has sudden onset of hematemesis after a weekend in which he consumed large
amounts of alcohol. The bleeding stops, but he has another episode under similar circumstances 1
month later. Upper gastroesophageal endoscopy shows longitudinal tears at the gastroesophageal
junction. What is the most likely mechanism to cause his hematemesis?
A Absent myenteric ganglia
B Autoimmune inflammation
C Herpes simplex virus infection
D Portal hypertension
E Vomiting
, F Widened diaphragmatic crura - ANSWER: E Vomiting
A 16-year-old boy who is receiving chemotherapy for acute lymphoblastic leukemia has had pain for 1
week when he swallows food. Physical examination shows no abnormal findings. Upper
gastrointestinal endoscopy shows 0.5- to 0.8-cm mucosal ulcers in the region of the mid to lower
esophagus. The shallow ulcers are round and sharply demarcated, and have an erythematous base.
Which of the following is most likely to produce these findings?
A Aphthous ulcerations
B Reflux esophagitis
C Herpes simplex esophagitis
D Gastroesophageal reflux disease
E Mallory-Weiss syndrome - ANSWER: C Herpes simplex esophagitis
A 44-year-old woman has had increasing difficulty swallowing liquids and solids for the past 6 months.
On physical examination, her fingers have reduced mobility because of taut, nondeforming skin. A
barium swallow shows marked dilation of the esophagus with "beaking" in the distal portion, where
there is marked luminal narrowing. A biopsy specimen from the lower esophagus shows prominent
submucosal fibrosis with little inflammation. Which of the following is most likely to produce these
findings?
A Barrett esophagus
B Hiatal hernia
C Iron deficiency
D Portal hypertension
E Systemic sclerosis - ANSWER: E Systemic sclerosis
A 57-year-old woman has had burning epigastric pain after meals for more than 1 year. Physical
examination shows no abnormal findings. Upper gastrointestinal endoscopy shows an erythematous
patch in the lower esophageal mucosa. A biopsy specimen shows basal zone squamous epithelial
hyperplasia, elongation of lamina propria papillae, and scattered intraepithelial neutrophils with some
eosinophils. Which of the following is the most likely diagnosis?
A Barrett esophagus
B Esophageal varices
C Iron deficiency
D Reflux esophagitis
E Systemic sclerosis - ANSWER: D Reflux esophagitis
A 51-year-old man has sudden onset of massive emesis of bright red blood. On physical examination,
his temperature is 36.9° C, pulse is 103/min, respirations are 23/min, and blood pressure is 85/50 mm
Hg. His spleen tip is palpable. Laboratory studies show a hematocrit of 21%. The serologic test result
for HBsAg is positive. He has had no prior episodes of hematemesis. The hematemesis is most likely to
be a consequence of which of the following?
A Barrett esophagus
B Candida albicans infection
C Esophageal varices
D Reflux esophagitis
E Squamous cell carcinoma
F Zenker diverticulum - ANSWER: C Esophageal varices
A 55-year-old man has had increasing difficulty swallowing during the past 6 months. There are no
significant findings on physical examination. Upper gastrointestinal endoscopy shows areas of
erythematous mucosa 3 cm above the Z-line. A biopsy specimen from the lower esophagus has
changes in the mucosal epithelium illustrated in the figure. Which of the following complications is
most likely to occur as a consequence of this patient's condition?
A Achalasia
B Adenocarcinoma
C Diverticular formation
D Lacerations (Mallory-Weiss syndrome)
9th Edition Kumar | 9781455726134 | All Chapters with
Answers and Rationals
A 23-year-old primigravida gives birth at term to a boy infant. Ultrasound examination before delivery
showed poly-hydramnios. A single umbilical artery is seen at the time of birth. The infant vomits all
feedings, and then develops a fever and difficulty with respirations within 2 days. A radiograph shows
both lungs and the heart are of normal size, but there are pulmonary infiltrates and no stomach
bubble. What is the most likely diagnosis?
A Achalasia
B Diaphragmatic hernia
C Esophageal atresia
D Hiatal hernia
E Pyloric stenosis
F Zenker diverticulum - ANSWER: C Esophageal atresia
A 24-year-old man has developed abdominal pain and increasing fatigue over the past 6 months. On
physical examination, he is afebrile and appears pale. On palpation, there is mild pain in the right
lower quadrant of the abdomen. There are no masses, and bowel sounds are active. Laboratory
studies show hemoglobin, 8.9 g/dL; hematocrit, 26.7%; MCV, 74 μm3; platelet count, 255,000/mm3;
and WBC count, 7780/ mm3. His stool is positive for occult blood. Upper gastrointestinal endoscopy
and colonoscopy showed no lesions. One month later, he continues to experience the same
abdominal pain. Which of the following is most likely to cause this patient's illness?
A Acute appendicitis
B Angiodysplasia
C Celiac disease
D Diverticulosis
E Giardia lamblia infection
F Meckel diverticulum - ANSWER: F Meckel diverticulum
A 23-year-old woman, G2, P1, gave birth at term to a boy of normal weight and length following an
uncomplicated pregnancy. The infant initially did well, but at 6 weeks, he began feeding poorly for 1
week, and his mother noticed that much of the milk he ingested was forcefully vomited within 1 hour.
Now, on physical examination, the infant is afebrile, and there are no external anomalies. A
midabdominal mass is palpable. Bowel sounds are active. The medical history indicates that both the
mother and her first child had the same illness during infancy. Which of the following conditions is
most likely to explain these findings?
A Annular pancreas
B Diaphragmatic hernia
C Duodenal atresia
D Pyloric stenosis
E Tracheoesophageal fistula - ANSWER: D Pyloric stenosis
A 24-year-old woman gives birth to term infant after an uncomplicated pregnancy. Apgar scores are 9
and 10 at 1 and 5 minutes after birth. The infant's length and weight are at the 55th percentile. There
is no significant passage of meconium. Three days after birth, the infant vomits all oral feedings. On
physical examination, the infant is afebrile, but the abdomen is distended and tender, and bowel
sounds are reduced. An abdominal ultrasound scan shows marked colonic dilation above a narrow
segment in the distal sigmoid region. A biopsy specimen from the narrowed region shows an absence
of ganglion cells in the muscle wall and submucosa. Which of the following is most likely to produce
these findings?
A Colonic atresia
B Hirschsprung disease
C Intussusception
,D Necrotizing enterocolitis
E Trisomy 21
F Volvulus - ANSWER: B Hirschsprung disease
A 3-year-old child has attained enough mobility, curiosity, and dexterity to explore places in the home
that should not be accessed. The child finds a bottle with a liquid under the kitchen sink, and he drinks
it. Within minutes he has chest pain. His mother takes him to the emergency department, and brings
the bottle. Analysis of the residual contents reveals a pH of 12. Which of the following complications is
most likely to occur following this injury?
A Pharyngeal diverticulum
B Esophageal stenosis
C Gastric lymphoma
D Duodenal ulceration
E Megacolon - ANSWER: B Esophageal stenosis
A 22-year-old woman has had multiple episodes of aspiration of food associated with difficulty
swallowing during the past year. On auscultation of her chest, crackles are heard at the base of the
right lung. A barium swallow shows marked esophageal dilation above the level of the lower
esophageal sphincter. A biopsy specimen from the lower esophagus shows an absence of the
myenteric ganglia. What is the most likely diagnosis?
A Achalasia
B Barrett esophagus
C Plummer-Vinson syndrome
D Sliding hiatal hernia
E Systemic sclerosis - ANSWER: A Achalasia
A 24-year-old woman living in eastern Bolivia has had increasing difficulty with swallowing both
liquids and solids for the past year. She has substernal discomfort from a feeling that foods "get
stuck" going down. On examination her BMI is 18. A barium swallow radiologically shows marked
esophageal dilation. An endoscopic biopsy is obtained and microscopically shows reduced ganglion
cells in myenteric plexus along with lymphocytic infiltration. Which of the following organisms is most
likely infecting this woman?
A Bordetella pertussis
B Candida albicans
C Corynebacterium diphtheriae
D Herpes simplex virus
E Trypanosoma cruzi - ANSWER: E Trypanosoma cruzi
A 53-year-old man consumes a very large meal, washed down with considerable alcohol. The ensuing
discomfort prompts him to take an emetic, but soon afterward he develops lower chest pain. Physical
examination reveals crepitus in subcutaneous tissue over his chest along with tachycardia and
tachypnea. Which of the following abnormalities of the esophagus is most likely present in this man?
A Stricture
B Achalasia
C Ectopia
D Rupture
E Varices - ANSWER: D Rupture
A 30-year-old man has sudden onset of hematemesis after a weekend in which he consumed large
amounts of alcohol. The bleeding stops, but he has another episode under similar circumstances 1
month later. Upper gastroesophageal endoscopy shows longitudinal tears at the gastroesophageal
junction. What is the most likely mechanism to cause his hematemesis?
A Absent myenteric ganglia
B Autoimmune inflammation
C Herpes simplex virus infection
D Portal hypertension
E Vomiting
, F Widened diaphragmatic crura - ANSWER: E Vomiting
A 16-year-old boy who is receiving chemotherapy for acute lymphoblastic leukemia has had pain for 1
week when he swallows food. Physical examination shows no abnormal findings. Upper
gastrointestinal endoscopy shows 0.5- to 0.8-cm mucosal ulcers in the region of the mid to lower
esophagus. The shallow ulcers are round and sharply demarcated, and have an erythematous base.
Which of the following is most likely to produce these findings?
A Aphthous ulcerations
B Reflux esophagitis
C Herpes simplex esophagitis
D Gastroesophageal reflux disease
E Mallory-Weiss syndrome - ANSWER: C Herpes simplex esophagitis
A 44-year-old woman has had increasing difficulty swallowing liquids and solids for the past 6 months.
On physical examination, her fingers have reduced mobility because of taut, nondeforming skin. A
barium swallow shows marked dilation of the esophagus with "beaking" in the distal portion, where
there is marked luminal narrowing. A biopsy specimen from the lower esophagus shows prominent
submucosal fibrosis with little inflammation. Which of the following is most likely to produce these
findings?
A Barrett esophagus
B Hiatal hernia
C Iron deficiency
D Portal hypertension
E Systemic sclerosis - ANSWER: E Systemic sclerosis
A 57-year-old woman has had burning epigastric pain after meals for more than 1 year. Physical
examination shows no abnormal findings. Upper gastrointestinal endoscopy shows an erythematous
patch in the lower esophageal mucosa. A biopsy specimen shows basal zone squamous epithelial
hyperplasia, elongation of lamina propria papillae, and scattered intraepithelial neutrophils with some
eosinophils. Which of the following is the most likely diagnosis?
A Barrett esophagus
B Esophageal varices
C Iron deficiency
D Reflux esophagitis
E Systemic sclerosis - ANSWER: D Reflux esophagitis
A 51-year-old man has sudden onset of massive emesis of bright red blood. On physical examination,
his temperature is 36.9° C, pulse is 103/min, respirations are 23/min, and blood pressure is 85/50 mm
Hg. His spleen tip is palpable. Laboratory studies show a hematocrit of 21%. The serologic test result
for HBsAg is positive. He has had no prior episodes of hematemesis. The hematemesis is most likely to
be a consequence of which of the following?
A Barrett esophagus
B Candida albicans infection
C Esophageal varices
D Reflux esophagitis
E Squamous cell carcinoma
F Zenker diverticulum - ANSWER: C Esophageal varices
A 55-year-old man has had increasing difficulty swallowing during the past 6 months. There are no
significant findings on physical examination. Upper gastrointestinal endoscopy shows areas of
erythematous mucosa 3 cm above the Z-line. A biopsy specimen from the lower esophagus has
changes in the mucosal epithelium illustrated in the figure. Which of the following complications is
most likely to occur as a consequence of this patient's condition?
A Achalasia
B Adenocarcinoma
C Diverticular formation
D Lacerations (Mallory-Weiss syndrome)
