Gastrointestinal Pathology Practice Questions

Q: Hourglass deformity is seen in which of the following conditions?

Peptic ulcer disease. **Explanation:** **1. Why Peptic Ulcer Disease (PUD) is correct:** The "Hourglass stomach" deformity is a classic complication of chronic gastric ulcers, typically located on the **lesser curvature** [1]. It occurs due to chronic inflammation and subsequent **fibrosis (cicatrization)**. As the ulcer heals, the fibrous tissue contracts, pulling the greater curvature toward the lesser curvature. This creates a central constriction that divides the stomach into two distinct pouches, resembling an hourglass. **2. Analysis of Incorrect Options:** * **Carcinoma of the stomach:** Typically presents as a "Leather bottle stomach" (**Linitis Plastica**) in the diffuse type (Signet ring cell carcinoma). This involves a rigid, thickened, and non-distensible stomach wall due to submucosal infiltration, rather than a localized central constriction. * **Duodenal atresia:** Characterized by the **"Double bubble sign"** on X-ray. It is a congenital obstruction of the duodenum resulting in a dilated stomach and a dilated proximal duodenum. * **Congenital Hypertrophic Pyloric Stenosis (CHPS):** Presents with a "String sign" or "Beak sign" on contrast studies and an "Olive-shaped mass" on palpation. It involves hypertrophy of the pyloric sphincter, leading to gastric outlet obstruction, not a mid-stomach constriction. **3. NEET-PG High-Yield Pearls:** * **Leather bottle stomach:** Linitis Plastica (Gastric Cancer). * **Cup and spill/Cascade stomach:** A functional or structural variation where the fundus folds back on the body. * **Watermelon stomach:** Gastric Antral Vascular Ectasia (GAVE). * **Most common site for Peptic Ulcer:** First part of the duodenum (Duodenal Ulcer) and Lesser curvature/Antrum (Gastric Ulcer) [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 773-774.

Q: An elderly male with a history of long-term antibiotic intake presents with profuse watery diarrhea and abdominal cramps. The colonoscopic biopsy findings are shown in the image. What is the most likely diagnosis?

Pseudomembranous Colitis. ***Pseudomembranous Colitis*** - History of **long-term antibiotic use** leading to **C. difficile** overgrowth causing profuse watery diarrhea is pathognomonic for pseudomembranous colitis. - Colonoscopic biopsy shows characteristic **volcano/summit lesions** with **pseudomembranes** composed of fibrin, mucus, and inflammatory debris overlying damaged epithelium. *Crohn's disease* - Characterized by **transmural inflammation** with **skip lesions** and **granulomas**, not pseudomembranes. - Typically presents with **bloody diarrhea**, **weight loss**, and **perianal disease** rather than watery diarrhea following antibiotic use. *Ulcerative colitis* - Shows **continuous mucosal inflammation** limited to mucosa and submucosa with **crypt abscesses**. - Presents with **bloody diarrhea** and **tenesmus**, not the watery diarrhea pattern seen with antibiotic-associated colitis. *Amoebic colitis* - Caused by **Entamoeba histolytica** showing **flask-shaped ulcers** and **trophozoites** in tissue. - Associated with **travel history** to endemic areas and **bloody mucoid stools**, not antibiotic exposure history.

Q: Long arm chromosome 5 deletion is seen in which of the following conditions?

Polyposis coli. **Explanation:** **Correct Answer: C. Polyposis coli** Familial Adenomatous Polyposis (FAP), or Polyposis coli, is an autosomal dominant condition characterized by the development of hundreds to thousands of adenomatous colonic polyps [1]. The underlying genetic defect is a mutation or deletion in the **APC (Adenomatous Polyposis Coli) gene**, which is located on the **long arm of chromosome 5 (5q21)**. The APC gene is a tumor suppressor gene that regulates the Wnt signaling pathway; its loss leads to the accumulation of β-catenin, promoting cellular proliferation and the "adenoma-carcinoma sequence." **Analysis of Incorrect Options:** * **A & B. Crohn's disease and Ulcerative Colitis:** These are Inflammatory Bowel Diseases (IBD). While they have a genetic predisposition (e.g., *NOD2/CARD15* mutations on chromosome 16 for Crohn’s), they are not primarily associated with 5q deletions. * **D. Pheochromocytoma:** This neuroendocrine tumor is associated with mutations in genes like *RET* (Chr 10), *VHL* (Chr 3), *NF1* (Chr 17), and *SDHB/D* (Chr 1/11). It is not linked to chromosome 5q. **High-Yield Clinical Pearls for NEET-PG:** * **Gardner Syndrome:** FAP + Osteomas (mandible) + Soft tissue tumors (desmoid tumors) + Dental abnormalities. * **Turcot Syndrome:** FAP + Central Nervous System tumors (Medulloblastoma). * **Rule of 100s:** In FAP, >100 polyps are required for diagnosis, and the risk of progression to colorectal carcinoma is nearly **100%** by age 40 if a prophylactic colectomy is not performed [1]. * **Screening:** Annual sigmoidoscopy starting at age 10-12 for at-risk family members. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 821-822.

Question 1

Adenocarcinoma in the esophagus most commonly occurs in association with which of the following conditions?

Accepted Answer

Barrett's esophagus

Answer

Midline esophagus

Answer

Upper esophagus

Answer

Zenker's diverticulum

Question 2

Anal cancer is associated with which of the following viruses?

Accepted Answer

Human papilloma virus

Answer

Epstein-Barr virus (EBV)

Answer

Human T-lymphotropic virus 1 (HTLV-1)

Answer

Polyoma virus

Question 3

A patient presents with symmetrical, persistent, and painless swelling of the lacrimal and salivary glands. The patient reports no or minimal xerostomia and shows a positive response to steroid therapy. What is the most likely diagnosis?

Accepted Answer

Mikulicz disease

Answer

Primary Sjögren syndrome

Answer

Secondary Sjögren syndrome

Answer

All of the above

Question 4

Hourglass deformity is seen in which of the following conditions?

Accepted Answer

Peptic ulcer disease

Answer

Carcinoma of the stomach

Answer

Duodenal atresia

Answer

Congenital hypertrophic pyloric stenosis

Question 5

Which of the following is NOT true regarding Barrett's esophagus?

Accepted Answer

Increased incidence of squamous cell carcinoma

Answer

It represents metaplasia

Answer

It involves columnar epithelium

Answer

It typically involves the lower esophagus

Question 6

A patient has an increased number of columnar cells in the lower esophagus. Which of the following histological changes is present?

Accepted Answer

Metaplasia

Answer

Dysplasia

Answer

Anaplasia

Answer

Normal histology

Question 7

An elderly male with a history of long-term antibiotic intake presents with profuse watery diarrhea and abdominal cramps. The colonoscopic biopsy findings are shown in the image. What is the most likely diagnosis?

Accepted Answer

Pseudomembranous Colitis

Answer

Crohn's disease

Answer

Ulcerative colitis

Answer

Amoebic colitis

Question 8

Which condition involves the entire thickness of the bowel wall with skin lesions?

Accepted Answer

Crohn's disease

Answer

Ulcerative colitis

Answer

Irritable bowel syndrome

Answer

Both Crohn's disease and ulcerative colitis

Question 9

What is the most common extra-intestinal malignancy associated with Hereditary Non-Polyposis Colorectal Cancer (HNPCC)?

Accepted Answer

Gastric carcinoma

Answer

Pancreatic carcinoma

Answer

Small bowel carcinoma

Answer

Transitional cell carcinoma

Question 10

Long arm chromosome 5 deletion is seen in which of the following conditions?

Accepted Answer

Polyposis coli

Answer

Crohn's disease

Answer

Ulcerative colitis

Answer

Pheochromocytoma

Gastrointestinal Pathology — MCQs

Gastrointestinal Pathology — MCQs

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