Q6. Regarding the location of gastric ulcers which is true
a) Type I ulcers are the most common
b) type II ulcers are located with in 2 cm of pylorus
c) Type III ulcers are associated with duodenal ulcers
d) Type IV ulcers have the least morbidity
Q7. Which of the following is not a mechanism of
a) Over expression of k-sam
b) Over expression of c-erbB2
c) Inactivation of c-met
d) Inactivation of p53
Q3. Which does not predispose to Carcinoma stomach?
a) Low fat and protein diet
b) Salted meat and fish
c) Low Nitrate consumption
d) HIgh Complex carbohydrate consumption
Q4.Which of the following is not true about gastric lymphomas?
a) Stomach is the most common organ in the gi system which is involved in Lymphoma
b)Peak incidence of lymphomas is seen in 6th-7th decade
c)Endoscopy usually reveals gastritis like picture or gastric ulcer.
d)MALT lymphoma is the commonest variety.
Q5. Which is false for GIST of stomach
a) It is the same as leiomyoma and leomyosarcoma as described previously.
b) origin is from mucosa from the interstitial cells of Cajal
c) Associated with C-Kit Mutation
d) Imatinab is a new effective drug for adjuvant therapy.
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Answers
6. a
Type 1 gastric ulcers are most common, accounting for about 60% to 70% of the total. They are located on the lesser curvature at or proximal to the incisura, near the junction of the oxyntic and antral mucosa.
Type 2 gastric ulcers (~15%) occur in the same location as the type 1 lesion but are associated with either active or chronic duodenal ulcer disease.
Type 3 gastric ulcers (20%) are typically located within 2 cm of the pylorus (pyloric channel ulcer).
Type IV gastric ulcer is located in the proximal stomach or in the gastric cardia
2. c
The over expression of met, sam and erbB2 associated with inactivation of p53 and p16 are associated with carcinoma stomach.
Sabiston 17th page 1304
3. c
Factors associated with increased risk of developing stomach cancer are
Nutritional Environmental Social Medical
Low Fat and Protein Poor food preparation Low Social class Prior gastric surgery
Salted meat and fish No refrigeration H.Pylori
HIgh NItrate Consumption Poor drinking water Gastric atrophy
High Complex Carbohydrates Smoking Adenomatous polyp and male gender
Sabiston 17th page 1303
4. d
Diffuse B cell lymphoma is the commonest variety (55%) followed by MALT
The stomach is the most common site for lymphomas in the gastrointestinal system. However, primary gastric lymphoma is still relatively uncommon, accounting for less than 15% of gastric malignancies and 2% of lymphomas.
Endoscopy rarely reveals a mass lesion and stomach is the most commonly involved organ
5.b
Gastric sarcomas arise from mesenchymal components of the gastric wall and constitute about 3% of all gastric malignancies
, GISTs were previously classified as leiomyomas or leiomyosarcomas. Histologically, they appear to arise from the muscularis propria and most likely originate from the cells of Cajal.
Kit is a transmembrane tyrosine kinase receptor,The Kit protein is detected by immunohistochemistry and can reliably distinguish GISTs from true smooth muscle neoplasms.
Imatinib mesylate (formerly ST1517, now Glivic/Gleevec) is a competitive inhibitor of certain tyrosine kinases, including the kinases associated with the transmembrane receptor Kit and platelet-derived growth factor receptors. Initial studies showed encouraging results, with 54% of patients exhibiting at least a partial response
